Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
,n COMMUNITY DEVELOPMENT Permit #: ELR2013 -00148
Date Issued: 06/27/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 180
Project: Docu Source Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: 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 - 645 -4000 PHONE: 503 - 624 -6300
FAX: 503 - 352 -0202
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/27/2013 $75.00
12% State Surcharge - Electrical 06/27/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation' 0
Landscape Lighting: 0 Medical: 0
Nurse Calls 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 -0 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232 1987 or 1.800.332 2344
Issued By: Permittee Signature: O A/ /9
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 603.639.4176 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 A licatio L'J �7 __
De ceive d // Vi -5 PermitNo.;� ad/3 odi yep
II City of Tigard Receive (O 'e p
d OR 97223 JU 2 6 2 013 plan Review other Penne/C 20/3 Do / V6 '
m • 13125 S50 I Blvd,, Tigard, Dace/f3
Phone: 5 .71 Line: Fax: 503.598.1960 D ReadyBy, r u n / - See Page 2 for
C ITY OF TIGARD Notified/Method. i (1 Supplemental Information
1'16 A t; a Inspection Line: 503.639.41 r _
Internet: www.tigard or.gov Notifieet
'I hat ■ e 1 'PLAN REVIEW PYRE OF W011' Please check all that apply (submit sets of plans whtems checked below):
----_ - or £ceder 400 amps or more Ci Buildin over three stories.
CI New construction 15 Addition /alteration/replacemen
El Demolition II the available fault commit Marinas and boatyards
II Other: commit CI exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
CATEGORY ',OF CONSTRUCTION less to ground, or exceeds 14,000 0 buildings thuse agricultural
0 1- and 2- family dwelling C ommercial/industrial 0 Accessory building amps for all other installations. Maho o5 or
n f 7 KVA
❑Fire pump. ❑ larger Stio o 7 y KVA o system.
❑ 1 ily _
Master builder ❑ Other: _ ❑ Emergency system deriv
Addition of new motor load of CI "A", "E", "1-2", "1-
JOB SITE II ANI) LOCATIO ! �� p iOOIlP or more. occupancy.
Jo site address: ISI 1 W : -, • R , L'1 -t -S . O ❑ Six or more residential amts.
3",
❑ Recreational vehicle parks.
Job n0.' Cl Health -care facilities CI Supply voltage for more than
❑ Ha2ardoua locations.
0 Q / �� 600 volts nominal.
City/State/ZIP: ‘7,,,,r ❑ Service or feeder 600 amps or more.
Suite/bldg. /apt. no.: Project name: FEE SCEDUL = � Totai p ESS � q B a-s /AI
- Cross streeddirections10 job site: ��` L{ 'Z A New residential single - or multi - family dwelling unit.
g S ' -C Includes attached gars' e.
1,000 sq, fL or less I 168.54
33.92
Subdivision: Lot no.: Ea add'1500 sq. ft. or portion ��
..________ Limited energy, residential 75,00
Tax map / p arcel no.: with above - • . R
DESCRIPTION OF WORK _ Limited energy, multi - family 75.00
_
residential with above sq. It.
a p S ervices or feeders insta 200 amps or less llation, alteration, and/or relocation
� 100 70 2
201 amps to 400 amps 133.56
2
❑ PROPERTY OWNER ❑ T ENANT'
401 amps to 600 amps 200 2
601 amps to 1.000 amps 301.04
Name: 7l �f 552.26 2
Over 1,000 amps or volts
Address: Temporary services or feeders installation, alteration, and/or
- relocation 59.36 l
City/State /ZIP: 200 amps or less
Fax: ( ) 125 2
Owner installation: This installation is being made on property
Phone: ( ) 201 amps to 4D0 crops 2
that I own which is not 401 amps to 599 amps 168.54
h Branch circuits - new, alteration or extension er and
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. A Fee branch circuits with
Date: 7
Owner Signatures � _ — above service or feeder f ee,
- ` . ❑ CONTAC P ERSON each branch circwt
1:1 APPLICANT - B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Business name: ----- branch circuit
Contact name: Each add'i branch circuit
7.42 2
Miscellaneous service or feeder not included)
Address: - Each manufactured or modular 67 84 2
dwell service and/or feeder 67,84 2
City /State /ZIP: Reconnect Only _
Phone: ( ) Fax:: ( ) — Pump or irrigation circle
67.84 2
Signor outline lighting 67,84 2
E Signal ciretrit(s) or limited- energy �M 15 00
B 2
CONTRACTOR I OR .anel alteratio' or extension.
usiness nam 9,-.... 1 L ■ ii,... I i c, Each additional ins eetion over allowab16 hr of the above
_ Additional inspection (1 hr min)
Address: • a �' c �� Investigation (1 hr min) r 66.25/ hr
/� 41 lndustnal plant (1 hr min) 7818 / hr
City /State /zIP: "A, O r � "* Inspections for which no fee is 90.00 / hr ill
�� � ' ' ) �D7r0 Z
Fax: r • Inspections listed which hr min
CCB Lic.:
Phone: --4';•• ) 6 _ ELECTRICAL PERMIT FEES
Lg °�� Suprv. Lic.:OQ� Subtotal: 7 , 6
Suprv. Electrician signature, required Plan review (25% of permit fee): �:��
Ai Date: r - - State surcharge (12% of permit fee): 4.
Print narrte: N/ r �rO � TOTAL PERMIT FEE: '- ' , C am&
Authorized signatur =' `
This permit app expires ii a permit is aot obtained within 180
► �_ . ` days after it has been accepted as complete.
i t T , Date: � ,,
* Number of inspections allowed per permit. / t
Print name: / � ( �1 /
440 -467ST(t I/OS /COM/WE9
i iBuildingc 1ts1ELGPerralWpp doe 07/01/10