Permit f _ i
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
4 A DEVELOPMENT SERVICES PERMIT #: ELR2005 -00344
;.� I 13125 SW Hall Blvd., T igard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/13/2005
PARCEL: 2S112DA-01400
5112 112 DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 140 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: 002 JURISDICTION: TIG
Project Description: Limited energy for data telecommunications.
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 DRISCOLL COMMUNICATIONS
15350 SW SEQUOIA PKWY #300 -WMI P.O. BOX 33402
PORTLAND, OR 97224 PORTLAND, OR 97292
Phone: 503- 624 -6300 Phone: 503- 255 -4685
Reg #: ELE 26- 116CLE
LIC 119620
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/13/200` $75.00
[TAX] 8% State Surcharl 10/13/200f. $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
st within 181 • - s of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
ou to follow rules ad. • - • 4 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OA 952 -00 ` 10 • may copies of these ruleor dect questio • Permittee Signature: /,�j
r -
OWNER INSTALLATION A
•
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.
Eltect Permit Application FOR OI FICE USE ONLY
City of Tigard Received. /p ®a Permit No.: / „ - 00
13125 SW Hall Blvd., Tigard, OR 97223
-, n., Plan Review
, ti :;
Phone: 503.639.4171 Fax: 503.598.1960 Il' Date/B . Other Permit:
Inspection Line: 503.639.4175 _A Date Ready/By: Mill See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method �Q /SupplemeltalInformation
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: OService over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft,
CATEGORY OF CONSTRUCTION of 1 - and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling ,0-Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: /513_0"0 5" ,,;41 4/> ❑Health care facility ❑ er
Submit 2 sets of plans with any of the above.
City / State/ZIP: / ,` t.,p p e 97 1 The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: /V. / .9 Project name: Cl.{ Mel I"ti FEE* SCHEDULE
Description I Qty. I Fee. I Total I '.
Cross street/directions to job site: �� A4 D�)- New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
7�e,A/Al 2-41 � 4 . dwelling, service and/or feeder 90.90 2
j G r � !/ ��� 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
401 amps to 600 amps 160.60 2
Name: • 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Q,Q4s4p,(( ( m/rn 4.. / y� " branch circuit
B. Fee for branch circuits
V
Contact name: 12g A,Sted /7 without service or feeder fee, 46.85 2
each branch circuit
Address: A d �(c' _' Each add'I branch circuit 6.65 2
City/State/ZIP: ,42;4/64/0 4 ,€E41.- Y2'F.' Miscellaneous (service or feeder not included)
Phone: (,.05) �3�5 �A� Fax: : (5c3 ) ;,y'' ,6' Pump or irrigation circle 53.40 2
n Sign or outline lighting 53.40 2
E -mail: ! /JGD/,remer4 ® /�?�G • Cdyl Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: 7 ticy extension. e: / ( Page 2 7y 2
Address: A 4 X • J ?3 clpd7 Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: / 447-, 4 0: 4 0 ' 9 %J4) e7 Investigation per hour (1 hr min) 62.50
/
Phone: (� O� o?.�j' � 4 Fax: (fcL3) .:.✓ � l�1�v� Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: // Electrical Lic.:. r - _ uprv. Lic.: Subtotal 75 ,ad
Suprv. Electrician signature, require.. 1. ` / Plan review (25% of permit fee)
eee��� State surcharge (8% of permit fee) ee . O D
Print name:1;6 \ / ; ,4 D ate: /Q /,-- pS
TOTAL PERMIT FEE S 1 .Ov
Authorized signature: • This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\FLC- PermitApp. 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard f
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
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
. El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
is\ Building \Permits\ELC- PermitApp.doc 04/03