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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2012 -00106 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/29/2012 WYM® Parcel: 2S112DC00701 Jurisdiction: Tigard Site address: 15955 SW 72ND AVE Project: Guitarish Music/Advantage Point Subdivision: FANNO CREEK ACRE TRACTS Lot: 39 Project Description: Low voltage for data. 2/13/12, reprinted to correct address and project name. Contractor: PACIFIC NETWORKS INC Owner: PACIFIC REALTY ASSOCIATES 16869 SW 65TH AVE, STE 373 ATTN: N PIVEN LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 753 -0836 PHONE: 503 - 624 -6300 FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 05/29/2012 $75.00 12% State Surcharge - Electrical 05/29/2012 $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. ATTE : Oreg law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 through OAR 95 9 You may obtain a copy of the rules or direct questions to OUNC by calling .1987 or 1.800.3324344. Issued 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. ,, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2012 -00106 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/29/2012 Parcel: 2S112DC00701 Jurisdiction: Tigard Site address: 15957 SW 72ND AVE Project: Guitarfish Music Subdivision: FANNO CREEK ACRE TRACTS Lot: 39 Project Description: Low voltage for data. Contractor: PACIFIC NETWORKS INC Owner: PACIFIC REALTY ASSOCIATES 16869 SW 65TH AVE, STE 373 ATTN: N PIVEN LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 753 -0836 PHONE: 503 - 624 -6300 FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 05/29/2012 $75.00 12% State Surcharge - Electrical 05/29/2012 $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 ace. =- - • 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. ATT.. 'TION • Oregon' law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0410 through OAR 952 -01. -It 91 You may obtain a copy of the rules or direct questions to OUNC by callin. 0- • : 1987 or 1.800.33 44 / 4 ' �� Issued : • . '� i — ► -� �f //� I Permittee Sign. Air 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. S'T • Electrical Permit ApplicatioR . FOR OFFICE USE ONLY CI Of TI aC(I Received ^ —�' Permit No.. Ex. /,,,, 4 a-06 tY g Date /By: e. O{ 71 u 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ,. - Phone: 503.718.2439 Fax: 503.598.19MAY 2 5 2012 Date /By: Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for Internet: www.tigard or.gov CITY OF ry n Notified/Method: Supplemental Information RY 67G; i' AR TYPE OF P AR ,03 s.)i •-a tt`3 PLAN REVIEW ['New construction [T Addition /alteration /replacement Please check all that apply (submit i 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 El 1- and 2- family dwelling commercial /industrial CI Accessory building amps for all other installations. buildings. CI Multi-family Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. • JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A". "E", "I -2", "I -3 Job no.: Job site address: S'Lj S SW 7 2 �✓e too o or more residential R occupancy. ❑Six ormore residemial units. El Recreational vehicle parks. City/State/ZIP: Cit y u CI Health-care facilities. ❑ Supply voltage for more than Ti - D 2 J [ 2.2 I I CI Hazardous locations. 600 volts nominal. G / .-. Suite /bldg. /apt. no.: Project name: u i T � 1 i S it • ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: _ Description I Qty. I Fee. I Total I New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 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 `\ 61/1 - 6 Co I,N m t ` ,, CX� f • residential (with above sq. ft.) (� Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 . LrPROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 C _ '1 11 401 amps to 600 amps 200.34 2 Name: Pa fr,- �_ e. (4, 111 Ace.... 601 amps to 1,000 amps 301.04 I 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and /or City /State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168s4 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with (g APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2 P ' V each branch circuit Business name: R. Fee for branch ch circuits without �� 1 L wvC S (N Fee service or feeder fee, first 56.18 2 Contact name: 1�) u O NS .1,1()N-1 branch circuit `� Each add'l branch circuit 7.42 2 Address: %%V 01 SW 651-14 IN (Jt 4 t 3 -- i 3 Miscellaneous (service or feeder not included) 1 Each manufactured or modular City /State /ZIP: �ca.-02- ©1 w - e ` .O - 0 2 • 61.7 (•� S dwelling, service and /or feeder 67.84 ( r502) co 4S — 4 00 JU � �' Fax: (.5) 3s C 0 ,. Reconnect only 67.84 2 Phone: Pump or irrigation circle 67.84 2 E Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy l pp Business name: A- atom. G Lid T ,21 e�L. Co panel, alteration, or extension. / Page 2 7S 2 Each additional inspection over allowable in any of the above Address: Additional inspection (I hr min) 66.25/ hr City/State/ZIP: Investigation (I hr min) 66.25/ hr Industrial plant (I hr min) 78.18/ hr Phone: ( ) Fax: ( ?'t 0 1 . 9 b /, Inspections for which no fee is specifically listed ('/ hr min) 90.00/ hr CCB Lic.: 6 V Electrical Lic.:CLLS;) Suprv. Lic.: 5 ELECTRICAL PERMIT FEES � Suprv. Electrician signature, required: ,) Subtotal: 7J ' N 1 C ` a S(/W t/ Plan review (25% of permit fee): Print name: t „ r, ce. A J ^ . 7 Date: L� d_S — / ,, State surcharge (12% of permit fee): q. I � lCi S vvtw / TOTAL PERMIT FEE: gC/gC) Authorized signature I\s / This permit application expires if a permit is not obtained within 180 Print name: " N' 1 Vt O 0 W3 , `J Date:_ S— 25 - I ? days after it has been accepted as complete. * Number of inspections allowed per permit. I: \nuilding \Permits \EI-C- PermitApp.doc 07/01/10 440- 4615T(I I /05!COM /W En • Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMI'TEJD ENERGY PERMIT FEES: ;RESIDENTIAL WORK ONLY; . 1 Fee for all residential systems combined $75.00 Check Type of Work Involved: n A • udio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* I I Vacuum Systems* n O ther: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems Data Telecommunication Installation n Fire Alarm Installation n HVAC n I • nstrumentation n I • ntercom and Paging Systems n Landscape Irrigation Control* n Medical n Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n O ther Total number of commercial systems: I *No licenses are required. Licenses are required for all other installations I: \I3uilding \Permits \ELC- PennitApp.doc 07/0 l /I0