Permit •
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
� � DEVELOPMENT SERVICES PERMIT #: ELR2005 -00330
s' ' ,.� I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/10/2005
PARCEL: 2S112DD -01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 140 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG
Project Description: HVAC
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 GOHMAN MECHANICAL
15350 SW SEQUOIA PKWY #300 -WMI 412 S BEAVERCREEK RD #602
PORTLAND, OR 97224 OREGON CITY, OR 97045
Phone: 503- 624 -6300 Phone: 503- 650 -1588
Reg #: LIC 119952
• FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/10/200f. $75.00
[TAX] 8% State Surchar€ 10/10/200E $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 •
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: � Permittee Signature: filth
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.
1.
. - Electrical Permit Application soli o i i i c l•: i s i.: t) N` l .V
City of Tigard 1 n e/By� / 0 /U' U' 7 Permit No.:6, 1/0 exi a
13125 SW Hall Blvd., Tigard, OR 9 J CEVED
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 C Y-- ', 1 . Date/By: Other Permit:
Inspection Line: 503.639.4175 OCT 1, 0 205J , _ . ' L 1 Date Ready/By: Jam: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method .1 Kr _ Supplemental Information
(Unit T ry�y (Q�l�i PLAN REVIEW
❑ New construction [ )W ItEt'a�b"rilre acement Please check all that apply:
❑ Demolition ❑ Other ❑Service 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 ["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 RV
❑Egress/lightingp1an park
Job no.: .T3685 Job site address: /5'/9S S&). SzCW01 a pkIM74 /yd ❑Health care facility ❑��.
` Submit 2 sets of plans with any of the above.
City/State/ZIP: q a ,, d The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: A r FEE* SCHEDULE
L Description I Qty. I Fee. I Total I **
Cross street/directions to job site: 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'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no. Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
��A G Con ono 1 T = �Sr fs , dwelling, service and/or feeder 90.90 2
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
r 401 amps to 600 amps 160.60 2
Name: PA c i F c_ R Ft ..1i h - 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/StateJZIP: 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: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: C 1 n vvl 1 FLha/Alc a l
Address: 4./, S , g ain „ 1 2d ii 60� Each additional inspection over allowable in any of the above
Per inspection 62.50
a City/State/ZIP: O 9 e)4 / g t S - Investigation per hour (1 hr min) 62.50
Phone: ( Ca) ) (, SO . 1 s � 8 8 Fax: ( '03) 6 Cr. SS. 0 �1 % Industrial plant per hour 73.75
C ELECTRICAL PERMIT FEES*
fN CCB Lic.: /1 9 9 5- 62 El Lic.: aSS1 LE Suprv Li
I Subtotal
N Suprv. Electrician signature, required: !,. �:7 Plan review (25% of permit fee)
State surcharge (8% of permit fee)
int name: iht of . K. s u Date: i0 / / oJO5-
g TOTAL PERMIT FEE
Authorized signature: Z i This permit application expires if a permit is not obtained within 180
•,`'). days after it has been accepted as complete
Print name: a s 1,1, 6.4.\d - n Date: / 0l/ 0 /os • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440.4615T(10/02/COM/WEB
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 system. $75.00
(SEE OAR 918 260 - 260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
ent O
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ 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:\BuildingWernits ELC- PamitApp.doe 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00330
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/10/2005 .
Phone: (503) 639 -4171 l�l
li
Inspection Requests (24 Hrs.): (503) 639 -4175 _ -_-_—, �
INSPECTION WORKSHEET FOR DATE: 10/12/2005 TIME: 7:04AM PAGE: 46
SITE ADDRESS: 15495 SW SEQUOIA PKWY 140 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: AIG
DESCRIPTION: HVAC
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 -624 -6300
CONTRACTOR: GOHMAN MECHANICAL PHONE #: 503-650-1588
Inspection Request Scheduled For: Date: 10/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 018084 -01 503.650-1588 N
1 rncc
Corrections /Comments/ Instructions:
P ASS 111 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /O q2 - 0 Phone #: (503) 718-