Permit
` a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00003
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/08/2010
Parcel: 2S113AA00700
Jurisdiction: Tigard
Site address: 16600 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK I Lot: 0
Project: Benchcraft
Project Description: Installation of low voltage for voice & data.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 01/08/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 01/08/2010 $8.14
PHONE: 503-624-6300
Contractor:
TELEDIGIT INC
PO BOX 22287
PORTLAND, OR 97269
PHONE: 503-722-8084
FAX: 503-722-9914
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 Total $75.98
Intercom/Paging: N Landscape/Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is 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 i accordance 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. AT ENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 010 thro gh OAR 952 0 00 You ~m~a/yfob~ta~in a~cop%y of the rules or direct questions to OUNC by calling 503.246.6699 or 1.8101D2 2344 ~y
Issued 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 an inspection that business day.
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.
-El~trical Permit Application FOR W FICE USE ONLY
Cl"✓ of Tigard Received Permit No.: C
Date/B 8 s'r7 C~ Q
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
❑ 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 J<`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 separately derived system.
❑ Addition of new motor load of ❑ "A", "E", "1-2", "1-3",
10014P or x or momore. occupancy.
ful~'~ t,i n
Job no.: Job site address: 7 Z
"~/7!.("' ❑ Six or ore residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 7 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: 1✓e_drC-'4 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description Qty. Fee. Total
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'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK with above sq. ft. 67.84 2
- y Limited energy, multi-family 67.84 2
l C ~I✓ residential (with above sq. ft.
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
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
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
first branch circuit
Address: Each add'1 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
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: - _ Signal circuit(s) or limited-
~
e /e r ~ H L: energy panel, alteration, or 6'7.
Address: 0 2~ extension. Describe: Page2 2
City/State/ZIP: Each additional inspection over allowable in an of the above
'V Z7 Per inspection 66.25
Phone: (Sp,?j) 7 ZZ` 8~ Fax: (5-4)) 7 2- 7-' MY Investigation per hour (1 hr min) 66.25
u
CCB Lic.: Electrical Lic.:Suprv. Industrial plant per hour 78.18
LL ELECTRICAL PERMIT FEES
V Suprv. Electrician signature, required: - Subtotal: ;17.
Print name: ~y Date: Q Plan review (25% of permit fee):
State surcharge (12% of permit fee): g, / y
Authorized signature: TOTAL PERMIT FEE: , a ~f Q
~ This permit application expires if a permit is not obtained within 180
Print name: / idT 7L~~ Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
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