Permit •
Ae CITY OF TIGARD ELECTRICAL -
ENER
RESTRICTED ENERGY
-- 1y;� DEVELOPMENT SERVICES PERMIT #: ELR2003 -00053
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/03
SITE ADDRESS: 14945 SW SEQUOIA PKWY 150 PARCEL: 2S112AD -01000
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: LOGO VOLT. Gel +-I Mc- I - STIrr -- - '
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: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233 - 6911
• Reg #: ELE 26- 1063CRE
LIC 38868
MET 00004556
• FEES SUP IUOTI$I Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/18/03 $75.00 Elea! Final
[TAX] 8% State Tax 2/18/03 $6.00
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 throuc
Issued by _ _/ e . _ _ 1 , _/ Permittee Signature L
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
t
Electrical Per ) Skl t'flleion FOR OFFICE USE ONLY
Electrical Da -/ -i0. $5 Permit No.>f a -a a 4
City of Tigard FEg 18 20 Planning Approval Sign
Date/By: Permit No.:
13125 SW Hall Blvd. ARQ Plan Review Other
Tigard, Oregon 97223 at 1 CF j l l vis J o.t Date/By: Permit No.:
Phone: 503 - 639 -4171 Fax: ®9g99 Post-Review Land Use
/A nu d �ioial' 1 t' Date/By: Case No.:
Internet: www.ci.tigard.or.us _t-� � .I I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 ' Name/Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
,❑'1`lew construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ I & 2- Family dwelling „'Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /`-/T y3 5w S � r (71,a At ' FEE* SCHEDULE
Suite #: , S 8 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: P.i.v 7),74, li Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential-single or multi-family per 1
.1 dwelling unit. Includes attached garage.
Service included:
1000 sq. ft or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 , 2
Services or feeders - installation,
71- 57 alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
"PROPERTY OWNER I ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: / 1-7 Reconnect only 66.85 2
Address: / -- i -514i S'e t wp / k P,, ,, t,' ,643c0 Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: , 7 T 4 " 7 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to ❑ APPLICANT ❑ CONTACT PERSON Branch h amps 133.75 2
c
Br circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: i��r�► r' Description:
ion extension Page 2 2
Description:
Address: 9 :i 7 7''` A 1/6
City /State /Zip: / 1 A6 n.i �f Z/ Each additional inspection over the allowable in any of the above:
Per inspection per hour (min. I hour) 62.50
Phone: o3 -2i1 Fax 9747 Investigation fee:
CCB Lic. #:3g�� Lic. #: i9 /�N Lr2� Ocher
- Electrical Permit Fees*
Supervising electrician Subtotal $ '76`, d
signature required: Plan Review (25% of Permit Fee) $
Print Name: I Lic. #: State Surcharge (8% of Permit Fee) $ , • e p
TOTAL PERMIT FEE $ / .
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 18_ 180 days after it has been accepted as complete.
• `1 *Fee methodology set by Tri -County Building Industry Service Board.
���n AV a/ 7
(Please print name)
i:'Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information ,e..
LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00 -
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm
❑ Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
0 Boiler Controls
• n Clock Systems
Data Telecommunication Installation
•
Fire Alarm Installation
HVAC
Instrumentation
El Intercom and Paging Systems
Landscape Irrigation Control
0 Medical
0 Nurse Calls
El Outdoor Landscape Lighting
•
Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations -
•
iMsts\Permit Forms\ElcPermitAppPg2.doc 01/03