Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
n
1: COMMUNITY DEVELOPMENT Permit #: ELR2012 -00251
T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/07!2012
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7272 SW DURHAM RD, STE# 100
Project: Indio Spirits Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 25 -27,2:
Project Description: (1) Data/Telecommunications and (1) CCTV for TI
Contractor: NORDISK SYSTEMS Owner: PACIFIC REALTY ASSOCIATES
6400 SE LAKE RD #450 ATTN: N PIVEN
MILWAUKIE, OR 97222 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 252 -1462 • • PHONE:
FAX: 503 - 252 -2343
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/07/2012 $150.00
12% State Surcharge - Electrical 11/07/2012 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: Y 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 $168.00
• 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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. T
Issued By: Ada t � �'(•a Permittee Signature: od rt P 1 Cl? t I Okl
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.
Nov 06 12 04:53p Pacific Communications 3604332936 p.2
Electrical Permit A Iic FOR OFFICE USE ONLY
City of Tigard U Deceived Permit No.: a.- QOo-S/
.7 - 1 3125 SW Hall Blvd., Tigard, OR ' • 6 Plan Review ����
Phone: 503.718.2439 Fax: 503. ► 2012 Date/B -
inspect ion Line: 503.639.4175 Date Ready/By: l l 1 ® See Page 2 for
T l GA RD '^ • ^l N SuppSupplemental Info^oation
Internet: www.tigad- or.gov W � W Of T J
L
.. uta� � INOC PLAN REVIEW
� teratiion/re Please check all that apply (submit 2 sets n
of plans whites checked below):
❑ New construction. Ptdditionlalteration /repl acement ❑ Service or fader 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the mailable fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- 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
, ,/��, ❑ Emergency system. larger separately derived system.
JOB SIT!; INFORMATION AND LOCATION l (ff � : ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
10011P or more. occupancy.
' Job no.: Job site address: 7 2- S i�7�" ' `u' ' • ❑ Six or more residential units. ❑ Recreational vehicle . parks.
City /Sta /� 9.n. J ❑ Health -care facilities. 1:1 Supply voltage for more than
te/Z1P: t �et r 0/i q--77- Z e ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./ t. no.: I ecct ��11 t\D ❑ service or feeder 601 amps or more.
Utz Project /� t1 FEE SCHEDULE
Cross street/directions to job site: Description I on. 1 Yee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Lot no.: 1,000 ft. criers 168.54 4
Subdivision: Ea. add'I 500 sq. U. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. II.) ,
Limited energy, multi-family 75.00 2
6 40A f /u�G €._ Ox epos res idential (with bove sq. ft.)
/ J JC�f� Services or feeders installation, alteration, and/or relocation
1 /+ A T t V / 200 amps or less 100.70 1
❑ I �PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
. 401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2 '
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation. alteration, and/or
City /State/ZIP: relocation
Phone: ( ) l Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not amps to 599 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, r- panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee. 7 42 2
each branch circuit
B. Fee for branch circuits without
Business name: service or feeder foe, first
branch circuit 56.18 2
Contact name: Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
City/ State /ZIP: dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( ) Fax: ( )
Pump or irrigation circle 67.84 2
E-mail: '
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy A
t panel, alteration, or extension. Page 2 2
Business name: No ��-6 f/ v C�7 — e _ w Each additional inspection over allowable in any of the above
r s
•
r Additional inspection (1 hr min) 66.25! hr Address: (� ��n S I i�� //� "e " q - ��
Investigation (1 hr min) 66.25/ hr
City /State/ZIP: f/4 4 l aiLvjC Q r C 7 Z z � Industrial plant (1 hr min) 78.18/ hr
f ! F ax: ({ Inspections for which no fee is 90.00/ Phone: { G ) 25:2. —1 �rD (s b� _15 �� l specifically listed (V: hr min)
CCB Lic.: p 5'6 z7 Electrical Lic 2 ,,t 1. I Suprv. Lie.: j7 j84p4 ELECTRICAL PERMIT FEES
�1 i �,(�,,�� � Subtotal:
Suprv. Electrician si gtf� t (t1 , required: -1 �l r 1 !O t � tF Plan review (25% of permit fee): •
Print name :i UPI S I `360 .�470�,j��te: j f l r/' Z State surcharge (12% of permit fee): r1 . TOTAL PERMIT FEE:
Authorized signature: / /i/ f il / �— This peroitapplication expires if a permit is not obtained within 180
p�' days after it has hero accepted as complete.
Print name: I Date: • Number of inspections allowed per permit.
t:tautld'mgtPermaslEr.0
- venmuapa.doc 07,01(10 440a615111 trosIc)M,wEB
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Nov 06 12 04:53p. Pacific Communications 3604332936 p.3
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
`El—Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other C 61 r
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
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