Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
�_s�l'� DEVELOPMENT H BMENT Tigard, ) 639 -4171 DATE ISSUED: 9% 8/03 3 -00281
SITE ADDRESS: 15055 SW SEQUOIA PKWY 140 PARCEL: 2S112DA -00800
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: (2) lowe voltage systems. Data Telecommunication and security system.
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: SECURITY. X
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
PACIFIC REALTY ASSOCIATES CABLEFORCE COMMUNICATIONS
15350 SW SEQUOIA PKWY #300 -WMI 2737 NE NELA ST
PORTLAND, OR 97224 PORTLAND, OR 97210
Phone: Phone: 503 778 - 7474
Reg #: LIC 151912
ELE 26 -1161 CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/18/03 $150.00 Low Voltage Inspection
Elect'I Final
[TAX] 8% State Tax 9/18/03 $12.00
Total $162.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 throuc
Issued by Permittee Signature Xi/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
N
E'lect 'rical Permit Application • FOR OFFICE USE ONLY
} Receivedq � Electrical
Date/By: /� 03 B 13 Permit No.: 0 0 ���� 3 O r
Cit of Ti and RECEIV D Planning •ppoval sign
Y g Date/By: Permit No.:
13125 SW Hall Blvd. p y Plan Review Other
Tigard, Oregon 97223 SEP 1 8 200 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
�4 nal/h :ri � ;f} l�d ' ll i Date/By: Case No.:
fU
Internet: www.ci.tigard.or.us CITY OF . .. Contact hois ® See Page 2 for
24 -hour Inspection Request: 503 -639 1'LSD " r • Name/Method:
6) Supplemental Information.
°tt , ,_ , ...
TY$� (JF- W ORIZ - 2'-''''.& - - . . , PLAN REVIE'oFr Please cheek. all'�that � aPP1Y) , 1--
0 New construction p Demolition ❑ Service over 225 amps- ❑ Health -care facility
❑ Addition/alteration/replacement ❑ Other: commercial ❑ uzaron
ID over 320 amps- rating of ❑ Building ng over 10 10,000 square feet,
- w. , / ' , :iCATEGORy` COlv auXttOF ,-.,- i ;' I & 2 family dwellings four or more residential units in
❑ 1 & 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:
' .. v Submit _ sets of plans with any of the above.
JOB STTE'T1�iRORMATION.and I Ue�TTQN , Y ' The above are not applicable to temporary construction service.
l_5() Job site address: � SS L. ) S P U0 r A . " 17 , ;,-z:, FEE SCAh 1DU1;E 4 ' - '
...�
Suite #: No Bldg. /Apt. #: Number of inspections per Permit allowed
Project Name: (.,_` o h vjE2s . Description Qty Fee (ea.) Total i
Cross street/Directions to job site: New residential - single or multi- family per
dwelling unit. Includes attached garage.
C 1" ea! ✓ Service included:
1000 sq. R or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 NCO 2 /Sa"
Tax map /parcel #: Each manufactured home or modular dwelling
'`DESCRIPTIOI'1 OF +-WORK • t ' :- -' ' -,' service and/or feeder 90.90 2
Services or feeders - installation,
t! 6 L.) V 0 1_744- & C4. LIZ 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 ON -V-NER - - ` r; 601 amps to 1000 amps 240.60 2
❑ TF.1.1'ANT
.. Over 1000 amps or volts 454.65 2
-
Name: 1 0 A( 7/2 u s. 7, Reconnect only 66.85 2
Address: Sze c. Co I A P/C I./ Y Temporary services or feeders - installation,
alteration, or relocation:
City/State/Zip:
0902 7LA'/c 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
- APPIs) c0,T" `, `< , ❑ CONTACT PERSON • • Branch circuits - new, alteration, or
Name: (--,,, c extension per panel:
Address: A . Fee for branch circuits with purchase of
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: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
' C RA,CTOR 4�'-' _':' Each pump or irrigation circle 53.40 2
OTi'1' " Each sign or outline lighting 53.40 2
Job No: C j, / e l e C u.ra t r(flan $ Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: Description:
Address: 24 3 a .v Ls, ^4-LA S;.
City/State/Zip: Po Each additional inspection over the allowable in any of the above:
P 2 7LANO , n2 9 q - / 0 Per inspection per hour (min. 1 hour) 62.50
Phone: :O 5 y 2 - 9111 Fax: ,* / -111., ( p,1_6._ Investigation fee:
CCB Lic. #: /5""/ . ' / 9 / 2_ Lic. #: ? 4 Ocher:
- - ' oe *''$.F,'-' -. a,: �� . • '.. -
signature required: Plan Review (25% of Permit Fee) $ DU y 60
Supervising electrician
Print Name: ji511 rF4op14C4. I Lic. #: 3,5" L�.4 . State Surcharge (8% of Permit Fee) $ /p.r)9 v 2 (a"t
TOTAL PERMIT FEE $ 0 I. 00 u a- jp.-
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set.by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
. •
Electrical Permit Application - City of Tigard . _ ~'
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: •
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
El Burglar Alarm
Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
▪ Audio and Stereo Systems
❑ Boiler Controls
O Clock Systems
Data Telecommunication Installation. , . . .
0 Fire Alarm Installation
HVAC
O Instrumentation
i
Intercom and Paging Systems
Landscape Irrigation Control
•El Medical
O Nurse Calls
Outdoor Landscape Lighting
Er Protective Signaling •
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \ElcPemiitAppPg2.doc 01/03