Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• = COMMUNITY DEVELOPMENT Permit #: ELR2012 -00089
T1GA'AD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2012
Parcel: 2S 113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE 200
Project: Perto Construction Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Data telecommunications system.
Contractor: TECHNOCOM INC Owner: PACIFIC REALTY ASSOCIATES LP
7929 SW BURNS WAY SUITE F ATTN: N PIVEN
WILSONVILLE, OR 97070 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 682 -4195 PHONE: 503 - 624 -6300
FAX: 503 - 682 -2781
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/09/2012 $75.00
12% State Surcharge - Electrical 05/09/2012 $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 OA 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: PermitteeSignature: (//11 /77 L / C � 77° " "
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 603.639.4175 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 Peirmit Appiica � I m i ,o, CEIVED
IN C of Tigard bZ p er mit>uo. 13125 SW Hall Wt. Tigard. OR 97I Y - 8 2012 �� 0 �-Z ����9
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
r, i; r 1as)teotion Lure: 503.639,4175
I - Other Os /O? 0 10,
T i
Internet www hgard- or.gov CITY OF TIGA D � M / S 10 See Page t I Inf
1 11 1 i I I 1 '� Srtprplt aeon
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❑ New construction ® Addition /alteration/replacement Please chdck all Chet apply (submit j seta of plans w /items checked below)
I3 Demolition I CI Other
13Servic4 or feeder 400 amps or more Q Building over three stories.
view t available flub omroot
� � u � O Marinas and bvalyanLr.
R :1;",': ' ' r;,_ \ ;,;. exceed 10.000 amps at 150 volts or CI Floating buildings.
❑ 1 - and 2- family dwelling ®Ctmtmcrcial /industrial less to round. or exceeds 14.000 ❑Commercial -use a caltwa,
i ❑ Accessory building amps RU all outer installations. buildings.
❑ Multi -fondly ❑ Master builder
❑ Other' El Fire PulnP• ❑ Installation of 75 KVA or
T ;� ❑ E tie ncy ystem. larger sepamtely denied system.
a Additidrt Of new tooter 1 0. 1 4 of Q »A ° "<w, °1.2 - • » I -3 ^,
Job no.: 124040 I Job site address. 16101 SW 72" AVE 1ooltrL. scum, occupancy.
0 Six or there residential units. ID Recreational vehicle parks.
City/State/ZIP: PORTLAND, OR 97224 CI Health -tire facilities. 0 Supply voltage for more than
Suite/bldg. /apt nb.: 200 Projcct name: PERLO CONSTRUCTION - 0 S ervic e o feeder 600 amps or mom. 600 "°tom nom,naL
ddi —
Cross stree
ens to job site:
netertynce l twJ■
New residential single- or multi- family dwelling unit.
- Includes bttaehed garage.
Subdivision: i I Lot no.: 1.000 se. 4. or less 1 168.54 4
Tax map /parcel no.: - Fa. add'1 sq. ft. or portion I 33.92 i
_ residential
` -„„ r :
Limited e �� r .R: 75.00 2
5 witha
VOICE/DATA dABLi.NC Limited clergy,
reaidcnjal (with above sq. R) 75.00 2
Services dr feeders inetallatlon and/or relocation
200 amps 5r less
100.70 2
133.56 2
Name. 401 amps d0 600 amps 200.34 2
Address: I 60l amps M 1,000 amps 301.04 2
____: Over 1,00( amps or volts 552.26 2
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City /State/ZIP: j � Temporary services or feeders installation, alteration, and/or
reloaded
Phone: ( ) I I Pax: ( ) 200 amps dr less . 59.36 1
Owner inst911At50b: This installation is hieing made on proper - fi b 4 ty that 1 own which is not 201 00 nem 175 ng 2
intended for sale, pease, rent, or exchange, according to OR 447, 449, 670, and 701. 401 a mps tb 599 amps 168.54 2
Branch c icaite - new, alteration, or extension, per pond
Owner signature: I
Date: A. Fee for branch circuits with 1
-- - -- - above service or feeder fee,
each brabcb circuit 7.42 2
Business name: T>~ CHNOCOM INC B. Fee for braaeh circuits wirhow
Contact name: LESLIE PARSONS
service dr formica rec. first
_ branch drptit 56.18 2
Address: 7929 SWIBURNS WAY, SUITE F � � branch aeon 7.42 2
Miscellaneous (ecrvlce or feeder not Included)
City/State/ZIP: WILSONVILLE, OR 97070 Each manufactured or modals
dwelling, seEvice and/or feeder 67.84 2
Phone: (503) 454 -7352 I Fax: : (503) 602_278I _Reconnect nob ��' 2
E -mail: I.parsons�a.goteebnocom.eom Pump or ir4ation circle 67.84 2
.:. -. __ r or
::..:.. .. . _ - - _ 67.84 .. _ - .....^,.... outline tin
, µ . .. , , sweal i' se+rw H) or liu,itao-cnc gy
Business name: TEiCHNOCOM INC panel, alteration, or extension. 1 Page 2 75.00 2
_Each additional inspection over allowable in any of the above
Addreca: 7929 SW BURNS WAY SUITE F
_ Additional ibmprrtion (1 br min) 66.25/ hr
City /State/ZIP: WILSONVILLE,OR 97070 Investigation (1 hr min) 66.25/ hr
Industrial pl&rtt (1 hr min) 78.18/ hr
one: (503) 682 (503) 682-2781
CCB Lic.: 73872 Inspections for which no fee it
----��-� " �
lect L 34.26 L S uprv.icL1cL Lic.: 2861LEA ✓ / ficsll listed S6 hr rain
' • ,.- . ..- ..... - - -. -- .:... _.
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Suprv. Electrician signature, required; Subtuw 73.00
I Plan review (25%ofpermit fm);
Print name: scort BERKEY Date: 05/08!12 State tamharge (12% of permit fee): 9.00 _
Authorized signature:: I TOTAL PERMIT FEE: 84.00
l _ This Well Cappllcation expires if a permit is not obtained within 180
Print name: SCO 1 u BERKEY / Date: 05/08/12 i a it o accepted as complete.
' • Numltero�jiaspectiorts allowed per permit
r: maildluckrermarrELC •Permtgpp.doe 07/01/10 • 440.4615T(1 1/01)COM/WPa
i
Electrical Permit Application -. City of Tigard
Page 2 - Su ,pletnental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined........ $75.00
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Check Type cif Work Involved:
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❑ Audio [and Stereo Systems*
❑ Burglat Alarm
❑ Garag Door Opener*
1
❑ Heating, Ventilation and Air Conditioning System"
❑ Vacuudi Systems*
❑ Other :1
I
Fce for each coanmenial $75.00
system J
(SEE OAR 9 18 - 309 - 0000)
(heck Type of Work Involved
❑ Audio acid Stereo Systems
❑ Boiler (Ltrols
❑ Chock Systems
® Data TeLcommunication Installation
O Fire Alarm Installation
❑ HVACI 1
i
❑ Instrum
❑ Intercor and Paging Systems
❑ T andsc4e Irrigation Control*
❑ Medical
❑ Nurse Calls
i
❑ OutdoorjLandscape Lighting*
❑ Proteeu Signaling
❑ Other _j_
Total number of commercial syste : 1
No licenses are required. Licenses are required
for all other installations
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