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Permit • REVISED . CITY OF TIGARD I L L ,13 'l�1 ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2012 -00249 TI GARD 13125.SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/01/2012 Parcel: 2S112DA01400 • Jurisdiction: Tigard Site address: 14945 SW SEQUOIA PKWY 150 Project: Clarity Subdivision: 1996 -048 PARTITION PLAT Lot: 2 Project Description: (1) low voltage for Data/Telecommunications. 11/13/12, reprinted to correct address from 15350 SW Sequoia Pkwy #300 to 14945 SW Sequoia Pkwy #150. Contractor: PACIFIC NETWORKS INC Owner: PACIFIC REALTY ASSOCIATES 16869 SW 65TH AVE, STE 373 ATTN: N PIVEN LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 753 -0836 PHONE: FAX: FEES • Description Date Amount Specifics: Restricted Energy Permit 11/01/2012 $75.00 • 12% State Surcharge - Electrical 11/01/2012 $9.00 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 Intercom/Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Total $84.00 Other Desc: Required Items and Reports (Conditions) 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. ATTE • • `: . •:gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0• 0 through OA 952 -• • -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. .. 87 or 1.800.332.23$4. Issue. By: - Permittee Signature: 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' Date: LICENSE NO. Call 503.638.4175 by 7:00 a,m. for the next available Inspection date. 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. CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT I N COMMUNITY DEVELOPMENT Permit #: ELR2012 -00249 T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/01/2012 Parcel: 2S112DA01400 Jurisdiction: Tigard Site address: 15350 SW SEQUOIA PKWY 300 Project: Clarity Subdivision: 1996 -048 PARTITION PLAT Lot: 2 Project Description: (1) low voltage for Data/Telecommunications Contractor: PACIFIC NETWORKS INC Owner: PACIFIC REALTY ASSOCIATES 16869 SW 65TH AVE, STE 373 ATTN: N PIVEN LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY #300 PORTLAND, OR 97224 • PHONE: 503 - 753 -0836 PHONE: FAX: FEES Description Date Amount Specifics:, Restricted Energy Permit - 11/01/2012 $75.00 % 12% State Surcharge - Electrical 11/01/2012 $9.00 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 Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N • Security Alarm: N Other: N Total . $84.00 Other Desc: Required Items and Reports (Conditions) 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 0 952 -001 -0 90. You may � obtain / a c of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: b�(�c—llvl Permittee Signature: p&J 4 P(� 33 ue47o& I 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' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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. Electrical Permit Applicatio EC IVEa FOR OFFICE USE ON I..v r. City of Tigard Recaved — / 1 Date/Oy: � f ( Y Fermis No. E a � ° 13125 SW Hall Blvd., Tigard, OR 97223 NO V O 1 2012 Plan Review ' \ — � 9 • Phone: 503.718.2439 Fax; 503.598.1 60 Date/By: Other Permit: r [ l n K I] Inspection Line: 501639.4175 OF T pn Date Ready /By; furls: el See Page 2 for Internet: www.tigard- or.gov Notified/Method; Supplemental Information TYPE OF WORK PLAN REVIEW . ❑ New construction Addition/alteration /replacement Please cheek all that apply (submit g sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over throe stories. ❑ Demolition Other: whore the available f;tult current ❑ Marinas and boatyards. • CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. Ices to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ I - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE IJVFORMATION AND LOCATION JOB system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1.3 ", Job no.: Job site address: � , ` 0 I IOOHP or more. occupancy, 11 . ❑ S ix or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: 11`li ►�!1 . �. /�7 - � 3 .a i u ❑ Health -care facilities. El Supply voltage for more than ��' "W /fl ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt, no.: Project name: yI ❑ Service or feeder 600 amps or more. Cross street/directions to job site: FEE SCHEDULE Dercrt,tion 1 0U Foe. I Total I - New residential single- or multi - family dwelling unit. Includes attached garage. • Subdivision: Lot no.: 1,000 sq. ft. or less 168,54 4 Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.42 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) I - . Limited energy, multi-family 01 A TP _ g J ' / 0 ( residential with above ft. 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 PROP RT Y ( OWNER . ! 0 TENANT 201 amps to 400 amps 133.56 2 Name: pt:t�� R RAI tN/0 A4, 401 amps to 600 amps 200.34 2 601 amps to 1.000 amps • 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax; ( ) 200 amps or less 59.36 i 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, . er panel Owner signature:. Date: A. Fee for branch circuits with a APPLICA 1:1 CONTACT PERSON above service or feeder fee, 7.42 2 i t each branch circuit Business name; t . �; B Fee for branch circuits without PM service or feeder fee, first Contact name: Pv 1 `' G, e >I) N branch circuit 2 ��x Address: Irf R • ( (Ai . /t ^ Each Miscellaneous circuit 2 Each manufactured or modular City/State/ZIP: r 0 dwellin , service and/or feeder 67.84 2 Phone: .iu ,t+ • it .. W /M Fax:: ( .. — a, • Reconnect only 67.84 2 Pump or irrigation circle 67,84 2 CONTRACTOR . . Signal circuit(s) or limited-energy Sign or outline lighting 67.84 2 • Business name: Each additional inspection over allowable in any of the above Address: 4 Additional inspection (I hr min) 66.25/ hr City /State/ZIP: Investigation (1 hr min) 66.25 / hr Industrial plant (1 hr min) 78,18/ hr Phone: ( ) F ax: ( ) Inspections for which no fee is CCB LiC.:' 81... Electrical Lic.: C p specifically listed ('A hr min) 90.00 / hr Su Suprv. Lic.: 1V 0 S' . ELECTRICAL PERMIT FEES • Suprv. Electrician signature, required: y y Plan Subtotal: review (25% of permit fee): Print name: v Irtt A ' tie D. e: i a — C /1 ' 1 -'Zr. State surcharge (12% of permit fee): Authorized sigtlatur .. rte TOTAL PERMIT FEE: - • i _ This permit application expires if a permit is not obtained within 180 Print name: Nut,iv Date: 1 — IL F days after it has been accepted as complete. Number of inspections allowed per permit. I:1 Building \Pcrntile\ELC- PcrmitApp.doc 01 /O I/!0 44 0- 4015T(I I /05 /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 $75.00 system (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Data Telecommunication Installation Fire Alarm Installation ❑ HVAC ❑ Instrumentatiion ❑ 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 1:1BuiIding1Pczt k \ELC- PcrmitApp.doc 07/01110