Permit /v
CITY OF TIGARD
71 I ' ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00027
TIGARD DATE ISSUED: 1/30/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 25101 DC -00200
SITE ADDRESS: 13535 SW 72ND AVE 200 ZONING: C -P
SUBDIVISION: 72ND AVE OFFICE BUILDING LOT: JURISDICTION: TIG .
PROJECT: OPTI LI N K
Project Description: Low voltage for access control - panel located at entry door to second floor.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: ACCESS CON X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC NW PROPERTIES LTD PTNSHP SELECTRON INC
9665 SW ALLEN BLVD STE 115 7225 SW BON ITA RD
BEAVERTON, OR 97005 TIGARD, OR 97224
Phone: Contact #: PRI 503- 639 -9988
FAX 503- 684 -4357
FEES Reg #: ELE 26- 497CLE
LIC 64341
Description Date Amount SUP 974LEA
[ELPRMT] ELR Permit 1/30/2008 $75.00
[TAX] 12% State Surchai 1/30/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are in 952 -01 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503.24 .6699 or 1.800.33- ' /1
Issue By: I i / Permittee Signatu '—
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'N: 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.
Electrical Permit Application FOR OFFICE USE ONLY.
•
City of Ti and p y r eceived D n_, Q •r�
`J g i Date/13y: ' a Permit No. fa_a.0JO �0Q7 147 v
° 13125 SW Hall Blvd., Tiga ? Plan Review /
`, ' — : ' Phone: 503.639.4171 Fax: 503.598.1960 a Date/By: Other Permit: 1
TIGARD Inspection Line: 503.639.4175 i A 1 29 2006 Date Ready/By: El See Page 2 for
Internet: www.ligard or.gov .jM 1\rotified/Method: 1 Supplementallnformatio�
TY P Cif !W"P)RU.. } 'I�' `E PLAN REVIEW
❑ New construction A [e ��(r 1pC n VISION Please check all that apply (submit 2 sets of plans w /items checked below):
J ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Ot where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings. i
less 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 0 Master builder 0 Other:
❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
El A Addition of new motor load of ❑ ".4 ", "E ", "1 -2 ", "I -3 ",
- I00HP or more.
Job no.: "-10"21-1 3 Jlry / 1' -' Job site address: 135' C, _' 7 ' ? R Ai
�. ❑Six or more occupancy.
residential units. ❑ ecreational vehicle parks.
City /State /Z 1 Ai d 0p_ 4-ID-D.A..' ❑ Health -care facilities. ❑ Supply voltage for more than
"1 ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Dp l p r, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: No. FL. Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
1(lSW1 aCCe (\ 1 .FS1 S' 0 residential (with above sq. (L)
aA4 It . Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 I 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 'p/re... , N, 14) -- p>o( e 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: K tiara C , _ 1 � f ei d i9 / S7 / /,Ste- Over 1,000 amps or volts 454.65 2
City/State/ZIP:
l Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panei
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fcc for branch circuits
Contact name: 0 I. 72.9 2 without service feeder fee, 46 85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
. Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: SELECTRON, INC
energy panel, alteration, or
Address: 7225 SW BONITA RD extension. Describe: I Page 2 75.00 .2
City /State /ZIP: PORTLAND, OR 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 639 - 9988 Fax: (503) 684 -4357 Investigation per hour (1 hr min) 62.50
CCB Lic.: 64341 Electrical Lic.: 26497CLE Suprv. Lic.: 9A Industrial plant per hour 73.75
. ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Z -- Subtotal: 75.00
Plan review (25% of permit fee):
Print name: JIM LEPPER Date:
�� —
State surcharge (' t, of permit fee): — q .tI>
Authorized signature: TOTAL PERMIT FEE: i•1•(X)
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Perrniu \ELC.PcrmitApp.doc 05/23/06 440- 1615'r(1I /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 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data 'Telecommunication Installation
❑ Fire Alarm Installation
❑ .HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
KI Other aa-zSS (214WX - vt)\
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
l:\ Building \Permits'ELC- PermitApp.doc 03/23/06