Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 1 COMMUNITY DEVELOPMENT
Permit #: ELR2011 00118
• Date Issued: 05/25/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.243• Parcel: 1S136CD00401
Jurisdiction: TIGARD
Site address: 8020 SW PFAFFLE ST, STE# 100
Project: H & S Holdings Subdivision: CITY BIBLE CHURCH Lot:
Project Description: Data telecommunications system. 7/5/11, reprint permit to add suites 100 & 200.
Contractor: WEST COAST BUSINESS COMMUNICATIONS INC Owner: PFAFFLE OFFICE, LLC
11134 NE HALSEY ST PCCC LLC
PORTLAND, OR 97220 915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: 502 - 465 -9222 PHONE:
FAX: 503 - 257 -0028
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/25/2011 $75.00
12% State Surcharge - Electrical 05/25/2011 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 - 0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELR2011 00118
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
Parcel: 1 S136CD00401
Jurisdiction: TIGARD
Site address: 8020 SW PFAFFLE ST
Project: H & S Holdings Subdivision: CITY BIBLE CHURCH Lot:
Project Description: Data telecommunications system.
Contractor: WEST COAST BUSINESS COMMUNICATIONS INC Owner: PFAFFLE OFFICE, LLC
11134 NE HALSEY ST PCCC LLC
PORTLAND, OR 97220 915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: 502 - 465 -9222 PHONE:
FAX: 503 - 257 -0028
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/25/2011 $75.00
12% State Surcharge - Electrical 05/25/2011 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of th les or direct to OUNC by calling 50 32.1987 or 1.800.332.2344.
r
Issued By. ��e / Permittee Signature: f • r� 0
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Electrical Permit Application FOR 'OFFICE ONLY '
ill City of Tigard �� Received
Plan R _ Permit No / --CYO I I o '
Other Permit: 13125 SW Hall Blvd., Tigard, OR 97223 Y ���1
g �� ' D an Review ,. r
' -. 0 Phone: 503.718.2439 Fax: 503.59 . GS .! YYY � �� Date/By: . � A. �(�/ Idif
Y
T I "C. :h,R(D Inspection Line: 503.639.4175 C
1.4C J ' Ready/By:
H See Page 2 for
Internet. www.tigard Py � . C
t )" Notifi Date Ready ed/Method Supplemental Information
N•. .,. .�'e� , n2 w 5 -'aY sd 7.1 �vN fi'se 4? ' l � a te ,'" k `.� Ta'.M1'in �. .
�ac TYPEOFWOR(),01� ��� a,I'Lt1NRE�IEW�s .. - - € : Ts
❑ New construction K Adclition/alteration/Oit Please check all that apply (submit 2 sets of plans w /items checked below):
El Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other : ''' where the available fault current ❑ Marinas and boatyards.
x 1 s "' f''= .{?"' -.- ,�; exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
� " s #OATtGORY OF4SRIM CTION . x
��. �r�" �R _�`-�" '�" "�'� °�-^ w� °""��'"` ° "�` °�'�'�" "` �"* '- less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. Installation of 75 KVA or
�� "� ❑ Emergency system. larger separately derived system.
j �`1 g OB S ANDLOCAisiirk p. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: BoA 5 7FA t' r /- r L� IOOHP or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
Clt } /State/ZIP: ❑ Health -care facilities. El Supply voltage for more than
�l U A 2 0) o fa , - 5 Id t C ❑ Hazardous locations. 600 volts nominal.
V J
Suite/bldg. /apt. no.: Project name: , ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Descripti I Qty. I Fee. I Total I *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
:, . � . n -. 75.00 2
i - - 'v �; ;K DI , S " °OF W 3 ,, .e � (with above sq. ft.)
Limited energy, multi - family 75.00 2
Voice_ / 9A TA CA 0 LI) 3 ( residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
:r.: y _. x:s. sV sra: .si" -te ' • ,. ns= s s - " i x'
r� ®PROPERTYTy ° OVYNERs 4 �� ° ® T '� 201 amps to 400 amps 133.56 2 % 401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. k e D APPLICANT t V C is'ilf �T PERSON I ' each branch a or f t eder fee, 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Ci /State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
_ Sign or outline lighting 67.84 2
Co .3, ��� Signal circuit(s) or limited - energy
Business name: W e 5+ Co ,43,s- ' N e >3 ` /J ' Ile, 0/ N, 1 . Each addition al panel, alteration,
diti o n, l i extension. I Page 2 7 2
nal inspection over allowable in any of the above
Address: 1 1 \ 34 E '- 0,(_.0_,y, S 57 . Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: � 2--LA ,J
/ 0 4 �'1 - 1'Z Z a Industrial plant (1 hr min) 78.18! lu
Phone: (5- ) y ( _ — 17_1_7_ Fax: ( 3 3) 25-1 - p Z5i, Inspections for which no fee is 90.00 / hr
specifically listed ('/ hr min)
CCB Lie.: Electrical Lic.: Suprv. Lic.: p . ' "" "" ELECTRICAL PERMy)✓ES' ', - t ='
IT '"
.k � . Subtotal: -2r1 o v
Suprv. Electrician signature, required: '
Plan review (25% of permit fee):
Print name: a e: State surcharge (12% of permit fee): 420 �
,S,51 ✓� A) �ECJ� / � Date: .5 tf
TOTAL PERMIT FEE: g /
Authorized signature: 2.l.4 -P�t This permit application expires if a permit is not obtained within 180
`.i e r ,✓ S / � *
days after it has been accepted as complete.
Print name:
d/ J ( , f Date: S// � Number of inspections allowed per permit.
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RatI? {ENTIAL W R WW
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
C®1VIME'RC ONL A 4-
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
IN Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
(l Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations