Permit II p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
:'_ COMMUNITY DEVELOPMENT Permit #: ELR2011 -00205
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 09/14/2011
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 160
Project: Verizon Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Low voltage for access control (3 access points)
Contractor: SIEMENS INDUSTRY INC Owner: PACIFIC REALTY ASSOCIATES
15201 NW GREENBRIER PKWY ATTN N PIVEN
SUITE A4 15350 SW SEQUOIA PKWY #300
BEAVERTON, OR 97006 PORTLAND, OR 97224
Solt o PHONE. 503-624-6300
PHONE: 503 -2�
FAX 503 -25 O D
ao9- tfet FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/14/2011 $75 00
12% State Surcharge - Electrical 09/14/2011 $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: N 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: Y Total $84 00
Other Desc Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accor., ce with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. AT - 1 TION Or- .on law =.uires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 - 001 -*010 through OAR 1- -01 -009' You may obtain a copy of the rules or direct questions to OUNC by calhpa 503 232 1987 or 1 800 32 2344
Issue • By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Sep -14 -2011 11:00am From - Siemens Building Technologies, Inc. 4255074350 T -527 P 003/004 F -427
Electrical Permit Application FOR OFFICE. USE ONLY
{ ` Received cj� MP / permit No.: ,� t //_ r
11111 - C ity of T t tl IA nnteln /
n T R 9 7223 q I Pl It
l Other Permit:
Phone :503.718,2 : Fax: 503 - 598.1960 DatrJnv-
Inspection Line: 501-639.4175 DareReady/By: Sum: f� See Page 2for
TiG7tELD Internet: www.tigsi - or -gov Notified/Method - t p� Supptementalinformation
:y ' vs - F i< , fsfSV' °F �`{ J7' � '" '' ." ':5V005,11,17,'", 14 uxb ,,, v- i c"Y.� • cI� K ; fri) ": be 6 - t 5 T ,: f f , ie'n' 9 . 1r " ^"i. ,
*�1r. r 1 4 " , h t ri@NftP. �� �1L'bF.--,:i. • 5,„ .i,y , nh� i s2$ Y ' 1 ' &A 's lfr.+S�r\ ..+ ._,: ;' , t `r . ... l ., a, .19:i'
`� spl; r.`'+�.,rrkk^ry'>r,t >L...,..r �' 6, -Y. t ,
F'Ianr cheek all than apply (submit 2 sets of plans w(items checked below):
❑ New construction ( Addition/alteration/replacement 0 ;ervace or feeder 400 amps or mote ❑ Building averlluee atones.
❑ Demolition (3 Other: _ whue the available fault current 1:1 Marinas and boatyards.
r v. � *_ +"R °- r aueds 10,0(10 amps 150 volts or ID Floating building. .
�u n , a 5 r . f 4 ID% we. •• , , r s: + n.r � � a c P
Ja ° • it t b, i, +l i'� 9 i N, h. r . ;�+ rq -. t �•o 'x ��1 ' ::,:z"; 4 00o Commcrciol -use a cultural
'�i , �n a :r : s� - a a �.,•��, �° W. V. . �:` � �'.: � s �� .- - 1c.s ro ground, or exceeds l ❑ 1�
❑ I- and 2- family dwelling I q Commereial/industrial ❑ Accessory building amps far all other installations. buildings.
Master builder 0 0rite
El Insrallatlon of 75 kVA or
❑ Mulli family „ C] tmereency system. larger separately derived system -
w. gyp;/, "+•min' ,ri::�1 r�" �.' 1 - �� -, f �u_�'•� � lost] of ❑ .,,y.. ..E...,1�., ..1.3'•,
4,'''''..:1',e,',..';'11,- i" i Ps l r :ly`l d�'ll �, t n�i,e?.��sa�'�', =�Qzr.'1'�,a< i ❑add ;tionofncwmotor
), Rn 1J.iS ' d>''r n . ,
1 uVHl' or morn, oceopaooy-
Job no.: 440P -98899 Job : ite address; 15575 SW Sequoia Parkway El 5„ or mare residential units, 0 Recreational vehiole parks.
-- • ° - -- - 0 t [nab facilities- ID Supply v0l�tse for more than
City/State/ZIP; Tigard, OR 97124 _- C hazardous locations. 600 volts nominal,
Suite/bldg. /apt ❑ ` L rvree or feeder 600 amps or more no -: Ste 160 Project name: Verizon F g °' a t yw ; traiir,O M
Cross street/directions to job si:e: Dr�
er.prtun �iT�� Total -
_ New residential single or mule - family dwelling unit.
111 t hides attached garage -
Lot u0.: 1,000 sq. fl or less _ 168,94 4
Subdivision: _ _ Ea Achill 500 sq. ft. or portion 33.92 1
Tax 1?t r t e map /parccl -: �{, w ¢ LI miSed energy, residential 75.00 2
cE t rid r imityosr�{7irgn !, r -F ,'1j'4 kiW �af$nk,,!,. ( with aboveesq.ft.) 2
ta
Limited energy. mulls- Jhmily 75,00
Installing 3 access controlled points to existing doors _ residanual (with ab
Semites or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
a 5 r stain r "�Y` c 201 amps t0 400 amps 13356 2
„HM(, r' .f 1° i �� 4 4' y { e O'; 7L1V(1111T,` 7 a .'y ri,a ' q ' p
l i� r '`rl�seiM1T'yr -,d ' s • �•�' not amps to 600 amps 200.34
]dame: Pacific Realty 4ssoeii tes - - , .. 601 snips to 1.000 amps 301 04 2
Address: 15350 SW Sequoia 'arkway Ovrr 1.000 amps or volts 552,26 2
- . - 7 eruporary services or feeders installation, alteration, and/or
City /State/ZIP: Tigard, OR 9 7224 relocation
5 200 amps or las 59.36 1
Phone: (503)624 - Fax: (503)624-775 201 amps to 400 amps 125.08 2
Owner installation: This insinuation is being made on property that I own which is not 2 0 1 amps to 599 amps 168.54 2
intended for sale, lease, rent, ■ ,r exchange, according to ORS 447, 449, 670, and 701. ]]ranch circuits - new, alteration, or extension, per panel
Owner signature: Dalt': A lee for branch circuits with
., , .F „-,1 a 1 , •�` t ,, F } '> $'+,;'� OA " ' ii � M a '1'A,CfyPER ', ; ',,:T above service or feeder fee, 7,42 2
q , 5 f j ►, r �!:S, - ^l; ; r� c rachbranchcircuit
Business name: Siemens Ind] istry, Inc. ii - Fee for bninth circuits without
,ervice or feeder fee, first 56 -I8 2
Contact name: Charles Hugl es -
uranch circuit
- • l h add'1 branch circuit 7.42 2 -
Address: 15201 Greenbrier 'arkway A4 M +4cellancous (service or feeder not lnduded)
f .,ch manutbcturcd or modular 67 84 I 2
City /State/ZIP; Beaverton, C R 97006 dwelling, service and/or feeder
Fax: (503) -19(11 1:i-connect only 67 84 2
Phone: (503) 207 1900 _ ( ) 207 - - I'u,,np or irrigation circle 67.8 2
E-mail; Charles.hughes@sie nens.eom _ , , _ Sc'n o o utline lighting 67.84 2�
, -N 1 N ' n , - ii ;id„ ',I- 0 ,�� 'o" a;.) , l , . ,r 11'. s circuits or limited-energy PJO
2
n ..1 r. ,i4.x.•36tP x +E i�a ; -.- .1 : .�• ' uq � ti fl hl�ll ra•ct , K () / 7
p ,nel, alteration, or extension. Pace 2
Business name: Siemens Inc ustry, Inc. Lath additional ins, ectlon over allowable in an of the above
Address: 15201 Greenbrier Parkway A-4 Additional inspection (1 hr min) 6625/ hr
investigation (1 hr min) 6625/ hr
City /State/23P: Beaverton, S 1R 97006 _ _ bndustrinl plant (1 hr min) 7818/ hr
'
Phone: (503) 207 - 1900 Fax: (503) 207 - 1901 Inspections for which no fee is 90,00 / hr
_ s, cctfrcall listed l,4hrmin)
GCB Lie.: 133041 Elects �c. :37' 9 ." &t. S prv Lie_ 795 - LEA ' , rt,:�r { : ' "� v ff ° , °�t 1i11J( i � w ri '; 'J 1
^ Subtotal: '7 .OQ
Suprv, Electrician signature, require.. ,, Plan review (25% of permit the): � '
Print name: Douglas Green _ Date: 9/14/2011 State surcharge (12% of permit fee): ,C'
�rr`� TOTAL PERMIT FE: 84,00
Authorized signature; `, -- This permit appllcarton expires if a permit is not obtained within 180
-
days after it has been accepted as complete
Print name: CharlesHughe Late: 9/14!2011 ' Number of inspections allowed per permit.
L1 43uilding 'Pamils\ELC- PermiIApp.doc 0 w9u no15T(I I ,avCOM,WE6
Sep -14 -2011 11:06am From - Siemens Building Technologies, Inc. 4255074350 T -527 P 004/004 F -427
Electrical Permit A. aplication - City of Tigard
Page 2 - Supplemental :reformation
LIMITED ENERGY PERMIT FEES:
Fee for all residential syst ems combined........ $75.00
Check Type of Work Iiiv1 tived:
❑ Audio and Stereo S rstcros*
O Burglar Alarm
❑ Garage Door Oper er*
❑ Heating, Ventilatio and Air Conditioning System*
❑ Vacuum Systems*
n Other:
�� 90,1101 p� �.�� —d " I [v..C�'��� ' �' '. ,�,'� .";" c4' - ='�'a
Fee for each commercial $75.00
system
(SEE OAR 915- 309 -O0i 0)
Check Type of Work Inr; olved:
❑ Audio and Stereo S ystems
❑ Boiler Controls
❑ Clock Systems
n Data Tdccornmun cation Installation
❑ Fire Alarm Installa ion
❑ HVAC
❑ Instrumentation
❑ Intercom and Pagt zg Systems
❑ Landscape litigant n Control*
I Medical
fl Nurse Calls
❑ Outdoor Landscal ,e Lighting*
Q Protective Signalit g
E Other Access Cor System
Total number of coma: iercial systems: 1
*No Licenses are recluil ed. )i iccnaes are required
for, all other installatit: ns
1.18uudin:WermitelELC•Tami,App doc 07.)3/10
Sep -14 -2011 11:06am From - Siemens Building Technologies, Inc 4255074350 T -527 P 001/004 F -427
SIEMENS: Building Technologies Division
Fax
To: City of Tigard FROM Shelley Lemieux
ATTN: Cashie ' Phone: 425 - 313 -4973
Fax: 503 -591► -1960 "i . - .5 Fax: 866 -793 -8264
Phone: 503 - 7111 - 2439 E - Mai. Shelley.Lemieuxa@.Siemens.Com
Date: 9/14/111 Pages Including 4
Cover
RE: Electrical Permit application Inv #.
Message: Applicatioi i & payment Authorization form attached. For questions regarding the application please
contact Charles Hug ies 503 - 207 -1839. Please fax a copy of the receipt to the number listed above.
Siemens Build ng Technologies, Inc.
22010 SE 51 Street
Issaquah. WA 98029
Telephone (425) 507 -4300
Fax (425) 507 -4350
www.sbt.siemens.com
Siemens Building Technologies, Inc.