Permit :. �
� ' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
� 5
'` � ` :- COMMUNITY DEVELOPMENT Permit ELR2012 00265
•.
TIGA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Date Issued: 11/28/2012
Parcel: 25112AD01000
Jurisdiction: Tigard ��«
Site address: 14945 SW SEQUOIA PKWY 150
Project: RTM Investments Subdivision: PACIFIC CORPORATE CENTER Lot: 1
Project Description: (1) low voltage to prewire demark to Tennant space for Comcast cable
Contractor: BRIDGETOWN ELECTRIC Owner: PACIFIC REALTY ASSOCIATES LP
5701 N LOMBARD ST ATTN: N PIVEN
PORTLAND, OR 97203 -4113 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 621 -7122 PHONE: 503 - 624 -6300
FAX: 503 - 621 -7123
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/28/2012 $75.00
12% State Surcharge - Electrical 11/28/2012 $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 OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 .�1 !► 1`
Issued By: Permittee Signature: �/� ' ` r �` ��1' L `�'�
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 28 2012 11:47RM Br etown Electric 503 - 621 -7123 page 1
Electrical Permit A lice CEIVED
1111 City of Tigard V 2 8 2012 tom" X AO i a. . ?meme.: - 4, ao / a-- Dv a- iris
. i ,f 13125 5W Hall Blvd., Tigard, OR Plan Review •
Phone: 503.639.4171 Fax: 503.5 � Other Pamir:
a••
. Inspection Line: 503.639.4175 ( I Y OF TIGARD Date Ready /By: h I B See Pap 2 for
Internet: www.tigard.or.gov . 1 1 t► a �.: Notified/Method: 61, 1" Soper bltntorts.eiee
Irk-'' I.,1,!
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i ? , i (( M �� Y 18 ' • , " �4 • � ' ' • t ` r X �, • t 1 , ! � .1 f
i i .:Sit > �:.. ,Q J: N. '�" t,� -;i �i�n 1 , \I ' �Rl'�'L�l•'_ .•. !�'u. :. ._ rL-1.. S'.�7f..�i
❑ New construction .s Addition/alteration/replacement check alt tfiatisff / (edbiult2.et. plru v/Inae e1,00kod below):
❑ Demolition ❑Other: CI Service- orfrcde 800 amps o1,' c . Building mroc ewe stories.
s - • ;r±v , x ,1�••,.;�:c,:�Y I ,
i where the awash* awash* fault ouReat O Mariam and boatyards.
' ", T •JrTT Y ,anr�' ` a�V l : • :1 •� . .
i ' .. t ' " ' ' '1,.‘ r h 1, i ta- r ` j , ..1, : . ° h hiAv ,•: • r { i z? . ,a" i1"± ‘4,74.14 � : : . r l n; '. exceeds 10,000 input I SO 'ohs or O Floodn6 buildings. ., . �Y. i IdOY.i: JttY- �Ki'( li. r .•L:. •� t. ¢ t;!�
:ti, crn.i:u uc i?- i : !' % � less to ground, or exceeds 14,000 0 Commorciat -nose agricultural
❑ 1 - and 2- family dwelling g Commercial/industrial ❑ Accessory building amps for all other instillations. balding.
❑ Multi- family ❑ Master builder ❑ Other. 0 Fin pump. D Installation of 75 KVA or
rs' +►• ,coq a 1•t[txi-lwav - s ez -yaY 1 nGLnr. .�s�T1 .x .�:e,rrv < . ; �,. •:;t,. ,). DtSnergency •p asse 1. larger eepe tely derived spear yy��{{,,,, ` ` .{ ' , r 1 , 'u. ,,w t. y I i -` p , 1 + .i 1 a ►- ;y •..,•-
#.`alta t• ,,i (• ti1nA?trbkw r�,�tGc: �,.1. ! ?. 1, �, Lc .,, lY �� £ �n .u�],:t�A4.wL'Fyric:3:{i®L •. q :�:!^�<. . ,><<fF��l OAddition of new /law toad of ❑ =A ^. "R', °1,1° a1,3 ^.
Job no.. ' I., ( Job site address: 1 LI tens 51 SFC LMt1AVAR0cw/a/ Sra or no m more. oow eutioo
0 sac or more residential uW more. D Resl vehicle poles.
city/state/Z1P: r T , C.ARO Mk. Tit 14 13 Health-ewe Seilines. OS�plyvoimge more than
0 Hazardous laoatiao. 600 nests nominal.
Suite/bldgJapt no.: I Project name: tvodikewar.45 "RTM O Service orfeed r coo . or mom
Cross street/directions to job site: i *irrii ii IF4 T , '' [. • 1, . 1 : 4
New residential s ogle- or molt!- fandly:dwelling unit.
Includes attached garage..
Subdivision: I Lot no.: 1.000 sq. ft. or less 168.54 4
•
Tax map/parcel no.: Es. add'l S00 sq. ft. or portion 3192 1
Limited energy, midental
.
T; �'IC;�i tSCil:I ;�iy �^ ��, �1L i v ,w I ry ;a T 7'.
, 4 Yr . t Y fi s ',,;"f"1 i v r a ale . f � � (with eliove s4:$) . 73.90 2
s . :' ' .. 1 .IhV �a,.s.�.,n.... -.zt, •w. r .k �.1. ?
, __ Limited �gy' multi -family 75.00 2
WV/ 1 Va tOtst. 1;;14,1Arti to �+..tf1AA.. 011.v1 .VAL AV A residential (with above sq.
Services or feeders installation aiteratloo, and/or relocation
;Al v., tjl • .1 • • 1 200 amps or le s 100.70 2
,f�l ti. ° t� Y. jf:_ 1 i `Y�J- f.W,gY: f; ^1 Ml!➢Ftt. 1 ,..11 : •l tf l .w •
� I'• ,1 "1 . 1 +1.1!1. twekl.3\titar' � i a tn'r,:a� : '41 • WI amps to400aIrP] 133.56 2
Name: 401 amps to 600 tarps 200.34 2
601 ampeto 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders lostallatlap, alteration, and/or I
•
relocation
Phone: ( ) I Fax: ( ) 200 ampsor less 59.36 ' 1
Owner installation: This installation is being made on:property that 1 own which is not 201 amps to 400 an 125 _ 2
intended for sale,. lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 399 tarps 168.34. i 2
Branch ciretdep Vie, etteraRon. or extension. per Panel
Owner signature: Date: A. Fee for branch chcgits with
"• � (( �� , pti r;ry ,1L:wta\/��� !"i +.�:� v 7 � "' x a ..,yKkcur.. pp,,�.v�:s;Y. 1� •'•
ry' `.0 4 11M - ::1? c•'�i �p t . T!n;�I.ZG'::r + Z' {-91' - ve servlasar f4e�d er he' -
Wt' . 2, s: 1..' ` -'��:. ,y.^SR,�i, • ����j} �oyb� rji{ zA.'.': 4Da: iu�ui,'1�sriLMU,u\{�e- ':.u:tr•.4 �a .r.'s abo oaQS:b¢ID�h CircOR 7.42 2
Business name: 15. Fee for brink tirade without
serviceorfeeder fee, first 56 2
Contact name: branch circuit
Forth add'l brands circuit 7.42 2
Address: Miscellaneous {service or feeder not Included)
CityiState/7.IP:
Each mematbcpued sr modular 67.84 2
dwelling, service mrdfor Seeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E-mail: Pumper hr gation circle 67.84 2
`� p ,Y e , \-L A. w Saga or outline Lighting 67.84 2
':# . i iv�'i'.'r:_. �t �n1,; �' \' �.+� `fi� ^€-+ °fir ''Y�'�'`�"
Business name: :' �� nand. arteatian, er:extmniaa 1 Pare 2 _ 17. ` i i r /� s 1 r2. ��p Ce Each addiddaid t rtpection over allowable in any of the above 2
Address: S 7 Q i N L L- 0 M• 6 f 1 � ! rJ Addltionalihspectldn (1 hr min) 66251 hr I
, r,� ----?� - ‘112 - - nvasdgtttica (L .In min) 66251 fir
City/State/ZIP: e/ZIP: 1 0 ►hg> O : CO -411 3 I
Industrial plan (I .hr mils) ' 78.181 br
Pion: (Sty; v .. 71 2 I Fax :. (54$ ) 441 11 2.3 !ens for which no fees
- • ■ listed ;4 & m(n
CCB Lic.: Z �r Uc• : "a Su L,ic. f'�" •l' t 1 \ {s \ J sr.•rr
�� J glr�' E cal p/ I N / 7 aRBi!✓� ..��.. [� :: t !.. :,
Electrician signature, 'r' ^
Suprv. . ;'
!, �qu�"•" ',
P lansevlew(2 5.ko it See):
` Print name: � y� S 0-As /rd I Date: State surcharge (12!36 o Pereikteeji '
TaTAL°OERAfrgfW ..- , , ' '
Authorized signature:
This permit asidleadaa nptrle ifi•p igllii }4141111Rd 380
Print name: I Date: do. atter litius . been aixspirs d eampleeic
• Number of in 0nsa/limedperpentii
1 11diag'Arteiu\E.C•ArmkAppdee 01101110 4 0 4611tO IAS/C01MIWEB
Nov 28 2012'11:47FM Bridgetown Electric 503 - 621 -7123 page 2
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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SEE OAR 918 - M09 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
X Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
• ❑ Other
Total number of commercial systems: _
*No licensee are required. Licenses are required
for all other installations
1:1BnJmng\P nitAELC- rermrtApp.da 07/01/10