Permit ill . CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00149
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/17/2007
PARCEL: 2S102CB -02300
SITE ADDRESS: 13240 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 008 JURISDICTION: TIG
PROJECT: PACIFIC MEDICAL
Project Description: Relocate fire alarm cables to accomodate removal of walls.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS:
Owner: .Contractor:
PACIFIC PROPERTIES F COMMUNICATIONS LLC
BY MARTIN JOHNSON 5565 SE BYRON DR
13200 SW PACIFIC HWY MILWAUKIE, OR 97267
TIGARD, OR 97223
Phone: Contact #: PRI 503- 234 -8080
FAX 503- 234 -6060
FEES Reg #:
Description Date Amount
[ELPRMT] ELR Permit 5/17/2007 $75.00
[TAX] 8% State Surcha 5/17/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility N. • - • . - ter. Tho - ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules . r direct question o • i - 503.246.6699 or 1.800.332.2344.
/ / •
Issu 6y: /� /� P ermittee Signature: 4 4 4 . `/ -
OWNER INSTALLATION ONLY I
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'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
ElectricalPermit Application FOR OFFICE USE ONLY
Received
IN City of Tigard Date/ Permit No.: (, ��0D7 n � jigrEEM
° 13125 SW HaII Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
TI G n K D Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 4' . Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction 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 OF 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 ® 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 ", "l -3 ",
Job no.: Job site address: 13240 SW Pacific Highway IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 - Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: PA. A 4 g 1 Gm... 4'' now' ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: /C Description
Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 • 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
Re - Locate Alarm Cables to Accommodate Removal of Wall for TI 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 I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 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: ( ) I 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 I ® CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: F Communications LLC B. Fee for branch circuits
without service or feeder fee,
Contact name: Anthony D. Forni first branch circuit 46.85 2
Address: 5565 SE Byron Drive Each addi branch circuit 6.65 2 •
- Miscellaneous (service or feeder not included)
City/State /ZIP: Milwaukie, OR 97267 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 234 -8080 I Fax: : (503) 234 -6060 Reconnect only 66.85 2
E -mail: anthony @f - communications.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: F Communications LLC energy panel, alteration, or
Address: 5565 SE Byron Drive extension. Describe: I Page 2 75.00 2
Relocate Alarm Cable
City/State /ZIP: Milwaukie, OR 97267 Each additional inspection over allowable in any of the above
Per inspection • 62.50
Phone: (503) 234 -8080 • I Fax: (503) 234-6060
Investigation per hour (1 hr min) 62.50
CCB Lic.: 165089 t 1 t /Oglectrical Lic.: 3- 617CLE Suprv. Lic.: 3845LEA Industrial plant per hour 73.75
l • / �r is % ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 4 , f Subtotal: $75.00
Print name: Anthony D. Forni .Date: 05 -17 -07 Plan review (25% of permit fee): N/A
State surcharge (8% of permit fee): $6.00
Authorized signature: TOTAL PERMIT FEE: $81.00
This permit application expires if a permit is not obtained within 180
Print name: Anthony D. Forni Date: 05 - - days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440 -461 ST(I1 /OS /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00149
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/17/2007
Phone: (503) 639 -4171 A •
Inspection Requests (24 Hrs.): (503) 639 -4175 ` __..
INSPECTION WORKSHEET FOR DATE: 6/5/2007 TIME: 7:01AM PAGE: 16
SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL
DESCRIPTION: Relocate fire alarm cables to accomodate removal of walls. • OWNER: PACIFIC PROPERTIES, PHONE #:
CONTRACTOR: F COMMUNICATIONS LLC PHONE #: 503 -234 -8080
Inspection Request Scheduled For: Date: 6/5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 049618 -01 503 -234 -8080 ' Y
Corrections /Comments /Instructions:
2 - Ks Pisi
Cam•` �'` � �
PASS ❑ PARTIAL APPROVAL ❑ CANCEL 34 NO ACCESS
CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G" t$61 -- Date: C- 5' Ti Phone #: (503) 718- 2,143
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELR2007 -00149
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/17/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/30/2007 TIME: 7:00AM PAGE: 23
SITE ADDRESS: 13240 SW PACIFIC HWY • CLASS OF WORK:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL
DESCRIPTION: Relocate fire alarm cables to accomodate removal of walls.
OWNER: PACIFIC PROPERTIES, PHONE #:
CONTRACTOR: F COMMUNICATIONS LLC PHONE #: 503 - 2348080
Inspection Request Scheduled For: Date: 5/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 049248-01 503- 234 -8080 Y
ROUT
Corrections /Comments /Instructions: 11 J 13fl
) `77I
v c/ A6s
•
1
•
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G .-1 No 6 1 Date: 51 SO IM Phone #: (503) 718 13111/0