Permit C ITY O.F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.74 ° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00049
r i G A R D 13125 SW Hall Blvd.; Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/18/2009
PARCEL: 2 S 112AD -01000
SITE ADDRESS: 7�9_4 SEQUOIA PKWY 110 ZONING: I -P'.
SUBDIVISION: PACIFIC CORPORATECENTER LOT: JURISDICTION: TIG
PROJECT: STERLING CORPORATION
Project Description: Installation of low voltage for voice /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 REALTY ASSOCIATES AZIMUTH COMMUNICATIONS INC
15350 SW SEQUOIA PKWY #300 -WMI P.O. BOX 508
PORTLAND, OR 97224 WILSONVILLE, OR 97070
Phone: Contact #: PRI 503 639 - 0110
FAX 503- 639 -0115
FEES Reg #: ELE 36 -94CLE
LIC 145828
Description Date Amount SUP 2312LEA
[ELPRMT] ELR Permit 2/18/2009 $75.00
[TAX] 12% State Surch 2/18/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
•
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 No ' a ion Ce -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules direct questions • U ' C • 503.246.6699 or 1.800.332.2344. cii
Iss d By: g."/ ;r 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'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.
Eil Permit Applic. I FOR OFFICE USE ONLY
q a
City of Tigard ' ` r � 0 •+ Date/By: 0
l b9 Permit No.: �� G(�
I
• 13125 SW Hall Blvd., Tigard, • • • 2 Q
p Plan Review
Other Permit:
Phone: 503.639.4171 Fax: 5.W 1 1 9 0 Date/By:
TI G A R D w Inspection Line: 503.639.41 Received Date Ready/By: ruri ' 0 See Page 2 for
Internet: ww.tigard- or.gov •„ jr Notified/Method: Supplemental Information
$'' 4 4, • rLO
r{{ • r 'i e o ` : PLAN REVIEW
❑ New construction li A ditI • t o i r IS I ���� • a O c e ment ' 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 IommercialIindustrial ❑ 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.
A
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "1 -3 ",
100HP or more. occupancy.
Job no.: Job site address: iI+ 9 6'10 J uOt fir `U K y ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: - Ji� , C' .. " T / ❑ H Health
zardous locations. ❑ 600p1olt voltage for more than
Suite/bldg. /apt. no.: ((, Project name: Sieje iji 0,5 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: A e Q0S ! T;120AA i..-(p Mix, Dercir Desuipdon 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 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/(016-Pr Limited energy, multi - family
'fpt 75.00 2 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
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: ( ) 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, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: A % t M � ^ i4 C U pit C"TLOI 5 Signal circuit(s) er or t i o limited-
n, i, or
1 energy panel, alteration, or
Address: 9 SW T Arl -flu S I"(E K )„0 (2 � extension. Desc be: Page 2 TS 2
( VOICE /17k1 - Pc
City/State /ZIP: 1-v ALAI cog— 9 /-a 6 2 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5O'3) (p;9.0 ((0 7/r / Fax: (5 ‘ 39-0/ I Investigation per hour (I hr min) 62.50
CCB Lic.: �Li.� t
Industrial loot per hour 73.75
ILK C6 �i Elecfical ic.: ��a Suprv. Lic.: Z Industrial p ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ^ ( ' f" ' �� Subtotal: �� r,l
� ` 1 Plan review (25% of permit fee):
Print name: 51-04 Q� ,j Date: SA /�� State surcharge (12% of permit fee): te ---0
Authorized signature: "`f " r I[ TOTAL PERMIT FEE: 844"
Print name: Date:
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:\Building\Permits\ELC- PermitApp.doc 05/23/06 440.4615T(I I /05 /COMAVEB
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- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
p Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
p 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 \Pmnits\ELC- PermitApp.doc 03/23/06