Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'` 7 f COMMUNITY DEVELOPMENT Permit #: ELR2011 -00181
Date Issued: 08/02/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 110
Project: Integrated Services Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Low voltage for audio /stereo & data systems.
Contractor: AZIMUTH COMMUNICATIONS INC Owner: PACIFIC REALTY ASSOCIATES
P.O. BOX 508 ATTN: N PIVEN
WILSONVILLE, OR 97070 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 639 -0110 PHONE: 503 - 624 -6300
FAX: 503 - 639 -0115
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/02/2011 $150.00
12% State Surcharge - Electrical 08/02/2011 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: Y 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 $168.00
Other Desc: Requiredltems 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 cordance with - • •roved 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. AT ENTION: Oregon law - quire to follow the rules adopted by the Oregon Utility Notification n er. Those rules are set forth in OAR
952 -001 010 through OAR 952 - 001 -0•. You a o•tain a copy of the rules or direct questions to OUNC by calling 503.3 19 7 or 1.800.332.2
i'
Issue 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.
Electrical Permit Application .. FOR OFFICE USE ONLY ive City of Tigard Date/Bya a 0. 0 (. Permit No.: 6 aay eey /w
1111
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: 6
TI GA i2 D Inspection Line: 503.639.4175 Date Ready /By: Juris. fa See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
•
. ' TYPE OF WORK . PLAN REVIEW
❑ New construction N Addition/alteration/replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and, boatyards.
. CATEGORY O F' CONSTRUCTION . exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Z Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: i) 5 5-t:J /I (� 100HP or,more. occupancy.
�� �U� �� PJ' ❑ ❑ Recreational vehicle arks.
Six or mo re residential units. P
City/State /ZIP: Va. Rfl A n v' 2 q -7 22 V- ❑ Health -care facilities.
❑ Hazardous locations. ❑ 600v rage al. more than
1 / l
Suite /bldg. /apt. no.: // 6 Project name: ❑ Service or feeder 600 amps or more.
FEE , SCHEDULE
Cross street/directions to job site: Description 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 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
U D ►/ � C E /D01-TA 1/ v Limited energy, multi - family residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80:30 2
❑ PROPERTY OWNER. . ❑ TE ' 201 amps to 400 amps 106.85 2
Name: I S I 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to-599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑" APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: Z1114(A7-1_4_ LOA I n U id /(4 i0 1iJS B. Fee for branch circuits
Contact name: g L--0 without service or feeder fee, 46.85 2
first branch circui t
Address: P D ?())/ . , Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: t LS niLl 3 i u C.:: D i 9\70-76 Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: (r� 7 q3 _ Lggq+ 1 Fax: : (5o 6Sci - D 0 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
, CONTRACTOR . Sign or outline lighting 53.40 2
•
Signal circuit(s) or limited- c r. ) ' Business name:
A2_,, e n q e CO 01 en U N t ( / 7diA LS energy panel, alteration, or /561' OZ
Address: p, e 3 - 510 $' extension. Describe: Page 2 2
City/State /ZIP: u( ts . 6 Ai v ;,,,e...__ 92t) ^74) Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (j ) ( _ i A Fax: (5 ") 6 � —o// s Investigation per hour (1 hr min) 62.50
CCB Lic.: 36-q LL l f Electrical Lic.: l 452 Lk Suprv. Lic.23i2,LC¢3- Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: ` � f° Subtotal: — /5� •
Print name: % ,-' , u�L 0_6 I Date: g l ( ) // I ' Plan review (25% of permit fee): ---'
State surcharge (12% of permit fee): ig -e2v
Authorized signature: TOTAL PERMIT FEE: Ap $' . z�
Print name: Date: This permit application expires if a permit is not obtained within Mr
days after it has been accepted as complete.
• Number of inspections allowed per permit
1:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 46t5T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL.. WORKONLY:, "
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
(- COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
_ (SEE OAR 918- 309 -0000)
Check ype of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
Fl Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical.
n Nurse Calls-
❑ Outdoor Landscape Lighting*
n Protective Signaling
0 Other
Total:number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1. Building \Permits\ELC- PermitApp.doc 03/23/06