Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' 2 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00209
TIGAR.LD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Date Issued: 09/29/2011
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 160
Project: Verizon Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: Data telecommunications system
Contractor: CHRISTENSON ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
111 SW COLUMBIA ST, STE 480 ATTN N PIVEN
PORTLAND, OR 97201 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 419 -3300 PHONE:
FAX 503 - 419 -3695
FEES
Description Date Amount
Specifics:. Restricted Energy Permit 09/29/2011 $75.00
12% State Surcharge - Electrical 09/29/2011 $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: Alt i / Vf. -Permittee Signature: t/ -19 _ :. :.
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 -28 - 2011 WED 01:18 PM f ty 1 c , INC FAX NC, 95034193695 P. 01/03
Electrical Permit AnpliciagakiC FOR :)I VICE USE ONLY
Received
of Tigard CC Ps arum
ip
r [3125 SW I •I allDlvd „ Tigard, 9722P3 2011 Dete /ISv: '/ /15/// a.2o /i -clO '
6 Plan ltevtow
■ Phone. 503.639,4171 Pax: 5 '' Datrl6y' other Permit:
T
br IGARD
„I G A it I) Inspection Line 503.639.417 Date Ready/By: he td See Page 2 for
Internet: www tigard- or,gov B UILDING DIVISION Notified/Mothod' Supplemental informgtintr
'. , ,P VOR1t' . 'I ” , Sai1 w ,'.
' i REyIJ ,;,, . ,!,4,, , -
0 New construction Y4 Addition /alteration/replacement Please check all that apply (submit nets of plans w /Items checked below),
a ❑ Service or feeder 400 amps or more ❑ Building over three stories,
❑ Demolition • Other: where the available fault current ❑ Marinas and boatyards.
.f . .. LATE QRY 'OT CONSTRUCTION, ,, .. , exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
less to ground, or exceeds 14.000 ❑ Comrherclal -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations buildings,
❑ Multi - family Master builder ❑ Other; ❑ Fire pump ❑ Ioaiallation of75 KVA or
Q Emergency system. 14rger soparatoly derived system
,IOB SITE, NFORMATION• AND, LOCATIO ❑ Addition of new momr load ed of 171"A", r: , °1- z', °I -3 ",
1001 or more.
Job no. Job Site address:
_ ��� 55 Y v 1 . Jt ❑ Six or more resrden occupancy,
tlal unite. ❑ Recreational vehicle parks.
City /State IP: <" ( di/AM • � „ � • ❑ Health-care facilities, U supply voltage for more than
❑ ITnznrdons locations 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 'CSI L c af rtS5 El Se vice or feeder 600 amps or mom
ts FEE SCHEDULE
Cross strcctldirections to job Site y C � �/�� _ 51� �� llearl'Iption i Oty. - 1 " Pee. 1 Total I •
*..-J h T� '''r' �+ New residential single- or multi - family dwelling unit.
_ Includet. attached garage.
Subdivision: LLot no.: 1,000 sq. tt. or less _ 168 „54 4
Ea. add'I 500 sq, R. or portion 33,92 1
Tax map /parcel no -: ^ Limited ener gy, residential
' D ESCRIPTION OF WORi. (with shove sq f1.) 75,00 2
y V �� Limited energy, family 75 00 2
. 0 111 r ►, residential (with ith above aq_1,1
' Services or feeders installation, alteration, and / or re
200 amps or less 100,70 2
E PROPERTY O'WNER'' ' ' : Q TENANT 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
— Temporary 4crviee6 or feeders installation, alteration, and /or —
City/State/ZIP: relocation
Phone: ( ) I Fax; ( ) 200 amps or less 59 36 _ I�
201 amp 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
Branch circuits new. alteration, or extension] er panel
Owner signature : - -- Date: A Fee for branch circuits with
0 AP, PLICANT , , , ' • 0, CONTACT PERSON above service or feeder fcc 7.42 2
each branch circuit
Business name: A ` ; /� ' B. Fee for branch circuits without
• • � L;. it service or f fee. f ii st 56.18 2
Contact name: branch circuit
• Bach add'I branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each nianufacnired or modular G7 84 2
Y _ ty _ dwelling, service und/nt feeder -
Fax: ( ) Reconnect only 67 84 2
Phone; ( ) ^^^'��
- -- Pump or irrigation circle 67.84 2
E-mail: — Sign or outline lighting _ 67,84 2
M CONTRA TOR t Si gnal circuit(s) or limited- energy _.
Business name: 1 , r - panel, alteration, or extension. Page _2 1 S 2
�It.011 1
_ _ " t t .. Each additional inspection over allows hic in any of the above
Address: :11.... Mg. t Additional inspection (1 hr min) 66,25/ hr - ■ Investigation (1 hr min) G6.251 hr
City /State /ZIP; (�li�.,t /AR, ` "t /� 1 1 _ Industrial plant Cl hr min) 7k, I R/ hr -WT—
Phone: ( � I 9 � � i � ip ) `l L , Inspections for wh t ch no fee lb �� g0 00/ hr —�-
specifically listed (16 mat)
CCB Lie,: �� Electrical Lie.: i A ' � are. Lic,: ELECTRICAL ?LIMIT IT FEES .
Subtotal
Suprv. Electrician signature, required.^ efig
1�x �//� __ Pla_n review (25% of permit fee):
t
• Print name' - ,f 0 Mrl k Slate surcharge (12 % of permit fee):
TOTAL PERMIT FEE.
Authorized signature:
_ Thin hermit application expiniS if 71 tlet'titit IS not ohtaincd ith n
`” days after it has been accepted as complete.
Print name: Date: w Numlbal of inspections allowed per pennrl.
I-11imichne nnil,u- i.r -i' rIni.App dot Min I/111 '1 In -Inn MI I/ i)p1/Wl I!
SEP -28 -2011 WED 01:19 PM CHRISTENSON ELECTRIC, INC FAX NO 95034193695 P. 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental. lamination
LIMITED ENERGY PERMIT PEES:
RESIDENT, ''4fI', WQRK' ONLY: • '
Fee for all residential systems combined $67.84
Check Type of Work Involved:
E Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Ileating, Ventilation and Air Conditioning System*
7 Vacuum Systems*
n Other:
COMMERCIAL'WORK ONLY _
Fee for each commercial $67.84
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
▪ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
.
!4 Data Telecommunication Installation
n e Alarm Installation
n IIVAC
❑ Instrumentation
n intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lightutl;*
❑ Protective Signaling
n Other
Total number of commercial systrms:
*No Iicenses arc required. Licenses are required
for all other installations
S\ Iluilditii� \v.41miiatc SUIUINc)
P. 03/03
AUTOMATIC COVER SHEET
DATE. SEP -28 -2011 WED 01:19 PM
TO:
FAX #: 95035981960
FROM CHR I STENSON ELECTRIC, I NC
FAX #; 95034193695
03 PAGES WERE SENT
(INCLUDING THIS COVER PAGE)