Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 1 •• COMMUNITY DEVELOPMENT Permit# ELR2009 -00325
TIGARD 13125 SW Hall Blvd.. Tigard OR 97223 503.639.4171 Date Issued: 10/13/2009
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 190
Subdivision: Lot: 0
Project: Columbia Soft
Project Description: Voice and Data
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Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 10/13/2009 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 10/13/2009 . $8.14
PHONE: 503 - 624 -6300 •
Contractor:
TECHNOCOM INC
7929 SW BURNS WAY STE. F •
WILSONVILLE, OR 97070
PHONE: 503 -682 -4195
FAX: 503 - 682 -2781
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Type of Use: COM
Class of Work: ALT •
Total Number of Systems: 1 •
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N •
Other Desc:
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the 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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: MA✓ Permittee Signature: Sty Apr 0.
OWNER INSTALLATION ONLY 1 V
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
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CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 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.
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Electrical Permit Application RECEIVED
FOR 01:1:1CL USE ONLY .
7,1 City of Tigard (� i` T 2009 Reerivrfl
y Dat w a
13125 SW Hall Blvd., Tigard, OR 9722 Plan Revie
503.639.4171 Fax: 503 - 598.1 OF 'I'IGD Date /Bv: Other Permit:
. It U A It I ) Inspection Line: 503.639.4175 17otc Licatly /By. iwia• RI see Page 2 for
• Internet; www,tigard- or,gov BUIlDINGDIVISIO Notified/medial: Supplemental Information
. ... ..... i. ,. ...; - ,. Ida �$1'► +.. ,M ` %clti;• ?: g. .L ' `.'r. a+..... +` >::7'!
0 New construction . Addition/alteration/replacement Please check all that apply (submit _ sets of plans w /items checked below): 1
0 Demolition Other:
El Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
...... .... ;,a excee ound, amps 150 volts or ❑ Commercial-use .•. ...: „..�,... :.:,.;:,,,;,: ,..'.. ,...) , ,.,.... ' i r } 4r- _i:` { :_',� ; :; � i j: : P buildings,
less to ground, or exceeds 14,000 ❑ Commercial -use agricultu al
❑ 1 and 2 family dwelling � CnmmerciaiJindustrial ❑ Accessory building
amps for all other installations. bltildias.
Multi fauiily ❑ Master builder 0 Other, ❑ Fie Nato. . ❑ i,,,b.u«.am of 11 KVA Or
(+ •+ ( v (,. Emergency system. d m.
•. ,�:1�
.��1�j `ij -. :...:. !' = i' i �” I� 'k �.. . :•.,`.::'•' ;;� : ; ❑ 0 �geflY�
• v:: derived
system. . %'��t ;...: � Addition of new motor load of ••A" °E ", "1-2", °1-3 ",
Job no.: (1405-a Job site address; ( 5' ) 100HP or more. occupancy,
"�•� ❑ Si x et more residential units. .0 lt=re:aional vehicle parks.
L !
City /State / ZIP: „rd , / N/1 . /1'21 ; CI Heahh -care facilities. ❑ Supply voltage for more than
❑ Harprdous lucrtions, 600 volts nominal.
sulte/bldgJapt. no.: 1v�y t Y� _ ap / t l] 1rOject name 1 „ ❑ Service or [ewer ouU amps or more.
Cross street/directions to job site
. Dee `7:'. tripti5 a. '' .. :;.ay 715 13� � ",i;.:::,.ir,j :,' ,:i ot , : 1
t riptioo 101Y. I Fee. I T I •
New residential siugie- of' multi- family dwelling unit.
Includes attached garage. .
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. LL or portion 13.41 1
Tax map /pares .. -
.., Limited energy, residential
.:,.,
.:.: ..
� ... ... :::..., , ..
.,,;:.,.�. :.:;... ........... ... t� "1i1i1 i ... .. ''ti ,, (with above SCI it)
VOL l ,,/ • Limited energy, multi- fllmiiy 2 • b �.C�/ Cti �i{ V /� ��/��1 residential (with above so, it) 75.00
Services or feeders installation, alteration, and/or relocation ,
or
o f
:. �:- ' ' .:. .. 201 amps to 400 amps 106,85
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.6U 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 T 66.85 I I 1
Owner in Eta llntinn: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.3'0 2
' intended for sale, lease, rent, or exchange, according Iti ORS 447, 449, 670, and '701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
. er ......
„..
. ,. rr u1 with
RIfi�►Ai7' 1 " _.... (7Q ' above service or feeder fee 65
,..... i,., ..4:;..,.. •.....:. ll?'i<'A��t�I � 6
13uSineSS name: n each branch circuit 2
B; Fee for branch circuits
r y �� �d � � with br a scrvc ur feeder fee, 46.85
Contact nam F � i first branch circuit 1
Address; '7q'�JJ / 3 //t 1.04u1 '
Each add't branch circuit 6,65 2
'f Miscellaneous (service or feeder not included)
City/ State/ZIP: ( J y/ In►!I 1k Q C(1b t 1 Each manufactured or modular
90.90 2
Phnnrr ej p2 t (0 Z p p � f Fax:: ) 6 ' gz � g 1 dwelling, service and/or feeder
t� t�ICJ t f Reconnect only 66,85 3
E -mail; i . .Q t,ndf, ?f(21) 001n C OM Pump or irrigation circle 53.40 2
,,,r,,
. . .. - 1 1 40
.• :..:: ... ... 't�Q$- .:�.' " " " > ;a " .', ,.,. ... "•:j� `;; i Sign or outline lilting 53
Signal circuit(s) or limited -
Business name:
�� �� ` n 1 r � 1 - - �
� energy panel, alteration or
Address: '7q 9 q .5 r / � Y � 4 , )5 extension. Describe: i Page 2 '75 D 2
City /State/ZIP: _ 1 / ..' e i ) L a 7 '7 (') Each additional inspection over allowable in any of the above
Phone: (5 3) 4 I / I Fax: 0±) ) . 3 --f Per inspec 62.50
[a � -(_ 1 q5 ;} T_l/,'Y 6. f32- Z! � _ Investigation per hour(l hrtnin) 62.50
CCB Lie.: , J3 '72 Electrical Lic,� `t r2( prv. Lic.:22g f LEA IndusVi plant per hour 73.75
Suprv. Electrician signature, required: `7 /ai� ....... -...' .... ; .R. CAL IPE Subs ■ E_Si'; : :..j:.:
_ Subtotal: 'x 019' gjsti
Print name: •-.. Plan review (25% of permit fee):
. , Date: �.
S tate surchnrgF (1244 of permit fee): $• j 1
Authorized signature: / , i • TOTAL PERMIT FEE: �y1
Print name: V Dote. t ` V /,, This permit appys Gc>after fter it expires if a xc¢e perm ptnd it is as w sot mplete obtained within j' t
/ U� - da has b een .
ntyr� r �p � J / I n� • • Number of inspections allowed per permit.
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L1BI111GinglFa
o5FJ /lit 440.461.5'T( I
I.6 1/ QA11.$dv .
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES;
Fee for all residential systems combined........ $75.00
Check Type of Work Involved;
El Audio and Stereo Systems*
O Burglar Alarm
• Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
. El Vacuum Systems*
El Other:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
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Check Type of Work Involved:
II] Audio and Stereo Systems
El Boiler Controls
D Clock Systems
LE Data Telecommunication Installation
ID Fire Alarm Installation
• HVAC
El Instrumentation
El Intercom and Paging Systems
[ii] Landscape Irrigation Control*
El Medical •
12 Nurse Calls
▪ Outdoor Landscape Lighting*
• Prutectiv Signitliug
El Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
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