Permit CITY OF TIGARD ELECTRICAL -
ENER
RESTRICTED ENERGY
-•- iIi" DEVELOPMENT SERVICES PERMIT #: ELR2004 -00317
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/14/2004
SITE ADDRESS: 15575 SW SEQUOIA PKWY 150 PARCEL: 2S112DD -01600
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy for voice & data cabling.
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 OMNI WIRE INC.
15350 SW SEQUOIA PKWY #300 -WMI 15621 SE MORRISON
PORTLAND, OR 97224 PORTLAND, OR 97233
Phone: Phone: 503 - 261 - 8789
Reg #: LIC 151222
ELE 26- 1132CLE
SUP 3525JLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/14/2004 $75.00 Elect'I Final
[TAX] 8% State Surchart 10/14/2004 $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
yo o o - -s adopted by the Oregon Utility Notification Center. Those rule are set forth in OAR 952 -001 -0010
rough OAR 952 401 -0 ! I. Y•u may obtain copies of these rules or direct que• to to OUNC at 503) 2 -6699.
ssued by 1_ I !; // Permittee Si • • ture _ a
OWNER INSTALLATION NLY
The installation is being made on property I own which is not intende sale, leas • 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
Electrical Permit Application FOR OFFICE USE ONLY � I /
City of Tigard Received
Date/By: lt7 /V p PennitNo.: � Q ,O 0 c 3/7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Ge2adl•61 Date/By: Other Permit:
Inspection Line: 503.639.4175 e_ Date Ready/By: Ju. • El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 7 /I Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 13dition/alteration/replacement Please check all that apply:
El Demolition ❑Other: ❑Service over 225 amps, comm'l ❑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 O'Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family 0 Master builder ❑ Other:
['Occupant load over 99 persons :Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
•
Job no.: Job site address: 5 Si 5 51.4..N S u►e �A ❑Health - care facility ❑Other:
e'� / Submit 2 sets of plans with any of the above.
City/State/ZIP: T, biol ( OR e - goo.
Descri ption The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: I Sc Project name:C \ % flss • T 1 FEE* SCHEDULE
I Qty. I Fee. I Total I .•
Cross street/directions to job site: CA Q vr14 s) `' 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
• 1 dwelling, service and/or feeder 90.90 2
V 0 % �- 4- D A �T A c. A G I t NIG) Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ P PERTY OWNER
t'--- ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 1,000 amps 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
L A), _ / _ /, relocation
Phone: (, [� zj 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 ❑ 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,
each branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: 1 Page 2 2
Business name: V N1 W , irja... ( �I.iL •
Address: % 6 Sa % � vv∎ ) So a Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Del \Ai oQ co a „ 3 - Investigation per hour (I hr min) 62.50
( 5 C% t) b _ 4 S5 I Fax: (5e ;) a b Industrial plant per hour 73.75
Phone: � � $ 7C
ELECTRICAL PERMIT FEES*
CCB Lic.: l 5t tea., Electrical Lic.: 11. t 13 g . Suprv. Lic.: 1 ge Le A Subtotal 75 O
Suprv. Electrician signature, required: G,,,s/C1 Plan review (25% of permit fee)
Print name: v� State surcharge (8% of permit fee) 0
J IAveS D . �O 1 t - I 10 TOTAL PERMIT FEE, :b
�b l
Authorized signature: . �'� Date: " : I . This permit application expires if a permit is not obtained within 180
\ ' 1 days after it has been accepted as complete
Print name: Jh 0 C'1 �� I, Date: t b \ . h O 1 Fee methodology set by Tri -County Building Industry Service Board
` l �1 •' Number of inspections per permit allowed.
i:\ Building \Permits\E1.C•PennitApp.doe 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:
. El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
El 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
El Clock Systems
Q Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El 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:\ BuildingTermitsELC- PermitApp.doc 04/03