Permit N i n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
: . COMMUNITY DEVELOPMENT PERMIT #: ELR2006 - 00281
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/17/2006
PARCEL: 2S 102CC -00500
SITE ADDRESS: 13500 SW PACIFIC HWY 86 ZONING: C -G
SUBDIVISION: TIGARD MARKETPLACE LOT: JURISDICTION: TIG
Project Description: Low voltage for data
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC CORP /ELLIOTT ASSOCIATES HASTINGS COMMUNICATIONS INC
200 SW PINE ST, SUITE 200 14994 SW EMERALD CT
PORTLAND, OR 97204 BEAVERTON, OR 97007
Phone: 503- 224 -6791 Contact #: PRI 503 -524 -5678
FEES Reg #: ELE 34- 602CLE
LIC 131979
Description Date Amount
[ELPRMT] ELR Permit 11/17/200E $75.00
[TAX] 8% State Surcha 111171200E $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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules irec q tions t UNC at 503.246.6699 or 1.800.332.2344.
Iss ed By: VPIi(,V-- Permittee Signature: i
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'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.
Electrical Permit Application rolz (brier: Iisi ONLY
Received /_ /) a��_ 6-0;.51
City of Tigard Date/s Permit No.: L GA
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
a Phone: 503.639.4171 Fax: 503.598.1960 Date/1 . Other Permit:
f 1 C. n ,t (7 Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
(EI':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 ", "1 -3 ",
Job no.: I Job site address: 13 500 S 1,4) 0.G I FI G � W � ❑ Six or Six or or more. occupancy. occupancy. n•
more residential units. ❑Recreational vehide parks.
City/State/ZIP: -1- 1 6. A D R ❑ Health-are a d o u cations. ❑ 60 Supply ltage f l r more than
❑ Hazardous locatioay.
Suite/bldg. /apt. no.: I Project name: 6 0 W • Iv • LEs s ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: - r1' G. ARb MA RKET PLA CE. Description I 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 75.00 2
Lou/ V O L-TA G E., 1lA t GE. i 13Ar'!4 residential (with above sq. ft.)
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
//�� A _ - - 401 amps to 600 amps 160.60 2
Name:
PtJ►.G 1 7 L Lo RtP E.1 11 t Prsso Gl LLy'e.-5 601 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 I
Owner installation: This installation is being made on property that 1 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
.APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: rr ArST i Al ebS Ct AMUiv I CAT! CMS r/V C. B. Fee for branch circuits
w k16.5 f without service or feeder fee,
Contact name:
PA I GK t-+PtS T I first branch circuit 46.85 2
1 G>)cit.' Sw E � cr Each add'l branch circuit 6.65 2
Address: I t
'l 1 Miscellaneous (service or feeder not included)
City /State/ZIP: p Each manufactured or modular
$ f lJ� RT�N R 97007 90.90 2
�3 7 g9 S Ss2. I �,3 S Zys678 Reclne,service and/orfeeder
Phone: ( ) a Fax: : () 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 -
Business name: S q - E - - energy panel, alteration, or
Address: extension. 4 1 Page 2 2
City /State/ZIP: Each additional inspection over allowable in any of the above
Phone: ( 5D3) 7 S9 S8 SL I Fax: ( ) Per inspection 62.50
/11/°g Investigation per hour (I hr min) 62.50
oo CCB Lic.: 131 q 79 Electrical Lic.: 3q -GAL CL4 Suprv. Lic.1 305 Ind ustrial plant per hour 73.75
ELECTRICAL PERMIT FEES
1, Suprv. Electrician signature, required: RSubtotal: - 75. co
Pr name: Ph TA i GK -r AJ 65 Date: ii , 0 Plan review (25% of permit fee):
/j 6
State surcharge (8% of permit fee): . 0
Authorized signature: 87 , 00
gn ,' TOTAL PERMIT FEE:
Print name: PArR / c k /1743 -rid as I D �/ /7 , O 6 This permit application expires If a permit Is not obtained within 180
/ days after it has been accepted as complete.
• Number of inspections allowed per permit
I:\ Bui lding\Pennits\ELC- PermitApp.doc 05/23/06 44046 15T(11/05/COMAVFB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system •
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC . , .
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control* •
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
•
*No licenses are required. Licenses are required
for all other installations
I:\ Building\Pamits\ELC- PamitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006 -00261
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/17/2006
Phone: (503) 639 -4171 V��
Inspection Requests (24 Hrs.): (503) 639 -4175 F :..
INSPECTION WORKSHEET FOR DATE: 11/21/2006 TIME: 7:00AM PAGE: 28
SITE ADDRESS: 13600 SW PACIFIC HWY 86 CLASS OF WORK:
SUBDIVISION: TIGARD MARKETPLACE LOT #: TYPE OF USE:
PROJECT NAME: GO WIRELESS
DESCRIPTION: Low voltage for data
OWNER: PACIFIC CORP /ELLIOTT ASSOCIATES, PHONE #: 503 - 2246791
CONTRACTOR: HASTINGS COMMUNICATIONS INC PHONE #: 503- 5246678
Inspection Request Scheduled For: Date: 11/21/2006 Pour Time:
Code # Inspection Description Contact # Message
136 Low voltage — 040086 -01 503 - 319.1792 N
MCI
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N 68 LE' Date: 1 11 1 —k( 1 3 O Phone #: (503) 718 - Z b