Permit IICITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2013-00195
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
T t C:'\.[LO 9 Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 120
Project: Precoa Subdivision: VARNS ACRES Lot: 9
Project Description: Data telecommunications system.
Contractor: PROCOM TECHNOLOGIES LLC Owner: GK TRIANGLE CORPORATE PARK III L
PO BOX 22288 BY THOMSON REUTERS INC
PORTLAND,OR 97269 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD,CA 92013
PHONE: 503-797-0000 PHONE:
FAX: 503-233-8052
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/08/2013 $75.00
12%State Surcharge-Electrical 08/08/2013 $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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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.
ProCom 503-727-3397 p.1
Electrical Permit Application (:\\CC,S) . , .-, FOR. E USE ONLY
lig Received
- ...
. City of Tigard '� d
v 13175 SW Half Blvd.,Tigard,OR '40,4*; '��� Date.11y: e 1 ,_j• j l
-' Phone: 503.715.2439 Fax: 503.5: . ' `
�� Other Permit 6 �
Inspection Line: 503.639.4]75 ['.� y,;. ��0.1
r I :
• RD k,,,\§) �.`�Ca \ �; 0 Sec Page'far
Internet: wcvw.ti trd or.gev ` Sunptcmcntrd 6dormnuon I
1'!'PF. OF WORK r
\` •t? PLAN REVIEW
❑New construction ®Additiatl/alteration/rer ‘ It Please check rill that apply(submit 2 sets of plans wiiterns checked below):
El Demolition ❑Service or feeder 4:x1 amps or more 12 Building mgr three stories
Other:
where the available fault current ❑Marinas and t+atyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings
❑ ]-and 2-family dwelling ®ComnlerciaL'undustrial building less to ground,Cr orceerLss 14,0 0 ❑Commercial-use agriculi ad
❑Accessory building amps for all other installations. buildings.
❑Multi-family El Master-builder
El Other: ❑Fire pump. ❑Installation of 15i:fiVA or
JOB SITE INFURMATiUV AND LOCATION El Emergency system larger separately derived system
❑Addison of new motor load of ❑"A',-L"_- ^i.;
4 Job no.: Job site address: 13221 SW(81b Pkwy. 1001:1,or more. occupancy.
❑Six.or more resid,tntiat units. ❑Recreational vehicle parks
City/State/ZIP:97223 El kcalth care iaci lines ❑Supply voltage for more iron
❑Hazardous lo canons. 600 volts nominal Suite/bldg./apt.no.:120 i Project name:PRECOA ❑S xv i c of fanner 1k)amps or more.
ir,
Cross street/directions to job site: FEE SCHEDULE
sgt r cription I Qry. J Fee- I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
S;ibdiyision: Lot no.: 1,000 sq. or less 168.5 l t
Tax map/parcel no.: Ea.add'1501)sq-ft,or portion 33.92 1
Limited energy,residential 68.54 2
DESCRIPTION OF WORK (twill above sq.ft.) _
C VOICE AND DATA Limited energy,multi-family 75.00 2
residential l with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders Installation,alteration,and/or relocation
❑ PROPERTY ON NER I TENANT 200 amps or less 100.70 2
Name:PRECOA 201 amps to loll amps 13?.5G
401 amps to 600 amps 200?4 a
Address: 13221 SW(,8`I'Pkwy.Ste 10(1 601 amps to 1,000 amps 301.04 2
City/State/71P:Portland,012,97223 Over 1,000 amps or volts 552 26 _
Temporary scnices or feeders installation,alteration,and/or
Phone:(503)2 4-7755 Fax:(503)244-7585 . relocation
if. Owner installation:This installation is being made on property 200 amps or less 59.36 1
S p pert}that 1 own which is not 201 amps to 400
CN intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. "`p amps t2''n8 '-
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new.alteration.or extension,per panel
® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
V above service or feeder fee..
Y allSilleSS name:ProCom each branchcir,;uit '•�'2 2
B.Fee for branch circuits without Contact name:Shawn Giles service or feeder ke.first
branch circuit 56.18
2
I Address:PO Box 22238 Each add'l branch circuit 7.42 2
C— City:State/ZIP:Portiand,OR,97269
Miscellaneous(service or feeder nut included)
, Each manufactured or modular I
Phone:(503)797-0000 Fax::(503)233-8052 duelling,nervier and•'or feeder 67.84 2
Reconnect only i 67.84 2
E-mail:shawnnproeomn»'.cum Pump or irrigation circle 67.84 2
V CONTRACTOR
Sion or outline ligluing 2
G7.k4
Business name:ProCom Signal circtri[(sj or limited-energy Sec panel.alteration,or extension. I Page 2 75.00 2
Address:PO Box 22288 Each additional inspection over allowable in any of the above
City/StattlZIF':Pottland,OR,97269 - Additional inspection(1 hr min) 66-25•'hr
Investigation(I hr min) . 66.25,ht
Phone:(503)797-0000 Fax:(503)233-8052 Industrial plant(I lir min) 78.18'ht
Inspections for which no fee is
hr
CCB Lic.: 194272 Electrical Lie.: CLE2S2 Suprv.Lie.: 1172LEA specifically listed('.i hr min) }•ao'
Sups'.Electrician signature.required: �f .'/ �P ELECTRICAL PERMIT FEES
Li"'�"' .1• Subtotal: 75.00
Print name: 5H � /, �� Date: is-g_r 3 Plan charge(2540 of pe nit Ice):
Slat,surcharge(12%ofpermitfee): 9.00
Authorized signature: L o TOTAL PERMIT FEE: 84.00
Print name: 8}��•„- D , 'L Date: �'8 t 3 This permit.application expires ifs permit is not obtained within 180
`1v >N /v days after it has been accepted as comp Irk.
Number or inspoctirms allowed per panic.
I'iBuildin-viPennils'.ELC Peanitnpo_ELR_ERE.dne Ra'on.1/2013 410-I(IOT(l UOt)CONt'WEg