Permit (151) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.'- COMMUNITY DEVELOPMENT Permit#: ELR2016 00269
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/30/2016
Parcel: 2S112DC00201
Jurisdiction: Tigard
Site address: 15865 SW 72ND AVE, BLDG#C
Project: ChemWest Subdivision:HERN PACIFIC TIGARD INDUSTRIAL Lot: 3
Project Description: Voice and data telecommunications system.
Contractor: HATFIELD COMMUNICATIONS LLC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 83825 ATTN: N PIVEN
PORTLAND, OR 97283 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-978-8888 PHONE:
FAX: 503-978-8899
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/30/2016 $75.00
12%State Surcharge-Electrical 11/30/2016 $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 •rk 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 or or: the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rule's : et o' in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a c•• • t=;s or direct questions to OUNC by calling 503.2-•.19-5 , 1. 00. ei' '
( /r /
Issued By: /L �,� ,,_� Permittee Signature: GAVE '
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.
-: FO‘
Electrical Permit ApplicatiI#` _. ,F l'O lR O I I'l( l: l s l:O\I.\
City of Tigard Received
10 /Date/B : - ��
EMI
13125 SW Hall Blvd.,Tigard,OR 97223 c Plan Review s
Phone: 503.718.2439 Fax: 503.598.196((}114
Related Permit#: � 3
A + Date/B : f
Inspection Line: 503.639.4175 1 Ready Date/By: ® See Page 2 for
1IGARD l.i�-'3�
Internet: www.tigard-or.gov .- +, Notified/Method: Supplemental Information
TYPE OF WO ` 1 PLAN REVIEW
0 New construction Addition/altera. /replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
t t 0 Addition of new motor load of system.
Job#: Job site address: /S G4�,�S ,s cJ 7 n De �j ti,„
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: i ❑Six or more residential units. occupancy.
� O` G jZRecreational vehicle parks.
/ ( [ 0 Health-care facilities. ❑
Suite/bldg./apt.#: Project name: ('4 fp,/i.''-'S' V 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total 1 *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
� ' ' (with above sq.ft.) 75.00 2
,41• 7/1" V31''1^ of e e / ✓' �T 4'' Limited energy,multi-family
�� 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER "TENANT Services or feeders installation,alteration,and/or relocation
Name: C4.e j-4 e S' 200 amps or less 100.70 2
Address: /Cg 6 !S--' s L.J 7� A V-e j�>%/ 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: ;,!%/9_, e/? 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
�; A.Fee for branch circuits with
Business name: /74/. /c/ i ,l tC,,�/„..,..„�.. e` G above service or feeder fee,
7.42 2
Contact name: t 0, (pi �c'� P / each branch circuit
B.Fee for branch circuits without
service or feeder fee,first
Address: f 80 ' ;0 2 c branch circuit 56.18 2
r C,
City/State/ZIP: i.,yc//9G�. L/? 972 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ///,714/le a-f.,r,, I,U,•..S' L.L G Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. ErS'r Page 2 ?c 41— 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(iii3) 7g - gge Fax:( /13 )7g Reg Investigation(1 hr min) 90.00/hr
Email: /� / � 6/.... Industrial plant(1 hr min) 78.18/hr
/C �(.�%I'2 ?c� V eInspections for which no fee is 90.00/hr
CCB Lic.: /Vt 7 el Electrical I .: r Suprv.Lie.:ii2:Gi U=5 specifically listed('/=hr min)
) L ELECTRICAL PERMIT FEES
Suprv.Electrician• tetu>=e, lr . 'VSubtotal:
Print name:lee ,�•) Date: j 0 Plan Review Required(25%of permit fee):
w ,n ` /�� ��(/6.
State surcharge(12%of permit fee): q,
��� TOTAL PERMIT FEE: r
Autho ' it) � . '.:.';4-
This
This permit application expires if a permit is not obtained within 180
Print n e:/4--tat!...) 6 6'1 e lZ Date:j� Zt,// days after it has been accepted as complete.
/ka * Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 44046 5T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description IQty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
COMMERCIAL CIAL WORK ONLY: ELECTRICAL PERMIT;FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
,Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
Q Other:
Total number of commercial systems: J_
*No licenses are required. Licenses are required for all
other installations
1\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015