Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2014-00078
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/25/2014
Parcel: 2S113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Project: Copytronix Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Data telecommunications system.
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 03/25/2014 $75.00
12%State Surcharge-Electrical 03/25/2014 $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
a
Issued By: `c� `�- - 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 503.539.4175 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.
Electrical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard ,,� _ Permit No.: — . , - . ; _�,7;all
114 • 13125 SW Hall Blvd.,Tigard,OR 97223 ■ P a'Review ,"
I Phone: 503.718.2439 Fax: 503.598.1960 ri I`� 7- DatrlBv: Other Permit: /'1 iy J�he�
TI G A R p
Inspection Line: 503.639.4175 . Date Ready/By Juris ® See Page 2 for
Internet: www.tigard-or.gov Notified Method -r ,; Supplemental Information
1
TYPE OF WORK PLAN REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
'47 ;s,+ ❑Service or feeder 400 amps or more ❑Building over three 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 ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling Ili Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: 1 (16,q0 S W a,, e. 100HP or more. occupancy.
V ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: cr d.0,� p f4)G n JIT C� J ❑Health-care facilities. ❑Supply voltage for more than
Q V l f ❑Hazardous locations. 600 volts nominal.
Suite /apt.no.: Project name: CO P,1 b X ❑Service or feeder 600 amps or more.
t" FEE SCHEDULE
Cross street/directions to job site: Description 1 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 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 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
L 0 1,�f V Q 1—0 L e 6 1�() ( residential(with above sq.ft.)
J 0 > Q Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,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 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) 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 sale,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
0 APPLICANT ❑ CONTACT PERSON A.Fce for branch circuits with
above service or feeder fee,
Business name:
each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:( ) Fax: :( ) Reconnect only 67.84 2
I:-ma i I: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Po(' I L I V 64 works 1116. Signal circuit(s)or limited-energy See ba 2
panel,alteration,or extension. Page 2
Address: I 6 g' ,q 5.W 6,s 41. Aye. k373 Each additional inspection over allowable in any of the above
City/State/ZIP: LG k•ed () we A 0/Fax: q 3 Additional inspection(I hr min) 66.25/hr
0 Investigation(1 hr min) 66.25/hr
Phone:(503 ) , L(5._ L�d0(, Fax:(6,03 ) 3$ - O AO ei Industrial plant(1 hr min) 78.18/hr
r inspections for which no fee is 90.00/hr
CCB Lic.: I gLjQ 1a Electrical Lic.: ,�7 X Suprv.Lic.: , LJ8�5 spccificulh listed i'.Jr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal: —]5, 0 0
Print name: EyOt vi g0b./8 Date: 3 -Zy.. 1 q Plan review(25%of permit fee):
State surcharge(12%of permit fee): .Q 0
Authorized signature: I„- TOTAL PERMIT FEE: i gL f t o O
Print name: (k
I(A 01/ U6 r :3 — 1 3- l This permit application expires if a permit is not obtained within 180
/ Date: _i ill days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\PermitssELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(II/05/COM/WEB