Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELR2013 -00097
T t G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/01/2013
Parcel: 2S 112 DB00300
Jurisdiction: Tigard
Site address: 7257 SW KABLE LN 100
Project: Trane Subdivision:'HERN PACIFIC TIGARD INDUSTRIAL Lot: 5
Project Description: Low voltage for data
Contractor: PACIFIC NETWORKS INC Owner: PACIFIC REALTY ASSOCIATES
16869 SW 65TH AVE, STE 373 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 645 -4000 PHONE:
FAX: 503 - 352 -0202
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 05/01/2013 $75.00
12% State Surcharge - Electrical 05/01/2013 $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 a ce 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. ATT TION: Or n law requires you to follow the rules adopted by the Oregon U ' • `otifi - - iter. Those rules are set forth in OAR
952 -001 010 through OAR 9.52 -0 090, You may obtain a copy of the rules or direct questions to OU C by calli : - • • r 1.800.332.2 4.
Iss ed By: U�/Y[il 1...? Permittee Signatu :. ,1 /B--...--
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.
v Electrical Permit ApplicatiO l OFI I( I. I SE ONL\
City of Tigard IC Received
Date/By: 5 / / 3 ( Permit No.:
L...2,20! 3-a )
" 13125 SW HaII blvd„ Tigard, OR 97223 Plan Review
e Phone: 503.718.2439 Fax: 503.598.1 Y 1 2 3 Date/Bv: Other Permit:
T i A R D Inspection Line: 503.639.4175 Date Ready/By: fair VI See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE or BI )INU DIVISION
REVIEW
❑New construction • Addition /alteration/replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over thrtx stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ floating buildings.
less to (pound, or exceeds 14.000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other ❑ Fire pump, ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger E" ely derived system.
❑ Addition o of new motor load of El "A", "]r'. , "1-1- Z ^. "1-3 ",
kb no.: Job site address; 7, 5 7 fj W k a big I a lie :00HP or more.
❑ more re
R cr eation
Six or more residential units. ❑ Recreational vehicle parks.
City /StalelZlP: T [}l,( t� Gi 11 b �f�y ) ) ID Health-care facilities. ❑ Supply voltage for mom than
I `f L (It d y ❑ Hazardous lt>cations 600 volts nominal.
IMIE bldg. /apt. no.: 1 O O Project name' , / ❑ Service or feeder 600 amps or more. • b r FEE SCHEDULE
Cross street/directions to job site: I KAly Description I Qtv. I Fee. I rotas 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 n0.: Ea. add 500 sq. R or portion 33.92 1
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. It)
V Limited energy, multi - family 7500 2
l� a & G a, L/ 11 residential (with above sq. ft.)
Renewable Ent _-s ❑ See P • : e 2
07 ,a_ Ti// f-P rb k 7 7 zAhr ^6 a y , Services or feeders installation and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301,0d 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 59.36 I
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 salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
13. Fee for branch circuits without
Contact name: service or feeder fee, first
branch circuit 56.18 2
Address: Each edd'I branch circuit 7.42 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
d welling, service and/or feeder
Phone; ( Fax: ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
r f � C / ONTRACTOR Sign or outline lighting 67.84 2
Business name: Pa t t tl G (1/ e l , ,,.0, , --.(� / sS c.1 Signal circuit(s) or limited -energy - 7 6.: O � 2
panel, alteration, or extension. , Page 2
Address: i (O 24 q < V 6 5 f l' 1 v e.. 4 4-3 73 Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: a k 4 < tom./ e, v r 47 0 35' Investigation (1 hr min) 66.25/ hr
Phone:(joj ) 645 — goDO 1 Fax: (,�b3) ,3 aIQ Q� Industrial plant (1 hr min) 78,18 /hr
( � y Inspections for which no fee is 90.00 / hr
CCB Lie.: 1 dLf< g A I Electrical Lic.: - 6 5 a Suprv. Lie.: 5 06 5 , specifically listed (V, hr min)
Suprv. Electrician signature, required: ,, f4 / f " y , ELECTRICAL PERMIT FEES •
N ( (.T l a
Subtotal: --] , 0 I
Print name: l E ck "t . co 4 I Date: 5,/ — ` 3 Plan review (25% of permit fee); l
( State surcharge (12% of permit fee): . GO
Authorized signatu - TOTAL PERMIT FEE: :. ,
te S (\./ This permit application expires if u permit is not obtained within t
Print name:/' Cite (\/ .. ' bate: �—' /-- / days after it has been accepted as com»Q �((>L(( etes J
Number of inspections allowed per permit. r y f �
t: Bulldina \Permiir \ECC PermitApp 040913.doc 410.4615T(I1 /05 /COM/WEB
P412
for all other installations
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees:
. P.
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ B urglar Alarm
❑ G arage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: •
Fee for each commercial system $75.00
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
fig Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
0 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
I ;\Building \Pcrmii \ELC„PcnnitApp 040913.doc