Permit a CITY Y OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
''' '` �" COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00164
r"'' DATE ISSUED: 6/1/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
r PARCEL: 25101 DA -00100
SITE ADDRESS: 13010 SW 68TH PKWY ZONING: C -P
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 007 JURISDICTION: TIG
PROJECT: US BANK
Project Description: 2 low voltage systems: Fire alarm and access control.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: ACCES CONT X
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
PACIFIC NORTHWEST PROPERTIES PERFORMANCE SYSTEMS INTEGRATION
9665 SW ALLEN BLVD 7324 SW DURHAM RD.
BEAVERTON, OR 97005 PORTLAND, OR 97224
Phone: 503- 626 -3500 Contact #: PRI 503- 641 -2222
FAX 503 - 641 -1464
Reg #: ELE 34- 522CLE
FEES LIC 150747
Description Date Amount
[ELPRMT] ELR Permit 6/1/2007 $150.00
[TAX] 8% State Surcha 6/1/2007 $12.00 REQUIRED ITEMS AND REPORTS
Total $162.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire ' work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires yo to folio rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 1 i e `'.0 may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. i
Issued By: Permittee Signature:
1
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'N: 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.
Elect seal Permi Apr , N, �..,4:, A� t « TLS
r u W ` "` � - OFFICE =USE ONLY i Y`' '
� 1.,:.,,,, ., ..:mar. ■ . ,_ ._ ..:8 dr "� a- 'G'11.°�`'�..� 'l°11i `k,o,..+�vL' .s. <.�, a wk
Received // 7 to r o l l
I City of Tigard DateBy: / Q ? Penult No� 1 �1 7 1.
r ° 13125 SW Hall Blvd., Tigard, OR 1972 2007 Plan Review O�t.v
: ° - -+ ,<- l= Phone: 503.639.4171 Fax: 503590.196 Date /By: Other Permit:
T I C A R D, Inspection Line: 503.639,41 -75., y i k.')...7 q---:, Date Ready /By: Juris. ' ® See Page 2 for
• Internet: www.tigard- or.gdv ' /' h i - . .. Notified/Method: ` Supplemental lnformation
k , p !' ,. ; I 1 .. PLAN REVIEW
TYPE' �F �WORK 1 e �� +��
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w/itetns 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 ,'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 ", "I -2 ", "1 -3 ",
Job no.: Job site address: ` occupancy.
l 3010 S� L� a f w y 100HP or more.
0 or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: � � I U -' < 72.3 0 D Health-care a Hazardous (cation ❑ Supply voltage for more than
Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ?- ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
D ESCRIPTION OF WORK ' (with above sq. ft.)
Limited energy, multi - family 75.00 2
G X'/ c).- / (`. C i 44'a i ,,,� Sit. -- residential (with above sq. ft.)
(l Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER. ❑ TENANT . 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
{ 1 APPLICANT ❑ CONTACT PERSON`, . above service or feeder fee, 6.65 2
F� each branch circuit
Business name: .4ZP_ CORP 13. Fee for branch circuits
Contact name: C.
without service or feeder fee, 46.85 2
/ , first branch circuit
Address:
V4- ��coht----\ Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
') ��---/ 1 ( 722 !_ i dwelling, service and/or feeder 90.90 2
Phone: (G,) ....
C L,�? Fax: : (� 4.q / ¢ Reconnect only 66.85 2
E- mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
� ,�� Signal circuit(s) or limited -
Business name:
5 t wil. Gt5 AINV v energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.' / Suprv. Lic.: Industrial plant per hour 73.75
�Sa p 3 5�/
ELECTRICAL PERMIT FEES _ _
Suprv. Electrician signature, required: q A / j p -- Print name: 5 �� G�tL ! Date: Plan review (25% of permit fee): /
State surcharge (8% of permit fee): `a ,
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not ob:.. -a :..
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp. doc 05/23/06 440- 4615T(t I /05 /COMAA'EB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY :.
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY: • .
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
3X(Fire Alarm Installation
❑ HVAC •
❑ Instrumentation
❑
•
Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
• . Other '11c, �
Total number of commercial systems: 2.
*No licenses are required. Licenses are required
. for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2oo7 -00164
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 611 /2001
Phone: (503) 639 -4171 Ay /, ° , ����' k
Inspection Requests (24 Hrs.): (503) 639 -4175 .,-414 1 '.
INSPECTION WORKSHEET FOR DATE: 9/24/2007 TIME: 7:00AM PAGE: 52
SITE ADDRESS: 13010 SW 66TH PKWY CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 00 TYPE OF USE:
PROJECT NAME: US BANK
DESCRIPTION: 2 low voltage systems: Fire alarm and access control.
OWNER: PACIFIC NORTHWEST PROPERTIES, PHONE #: 503 °626-3500
CONTRACTOR: PERFORMANCE SYSTEMS INTEGRATION PHONE #: 503 -641 -2222
Inspection Request Scheduled For: Date: 9/24/2007 Pour Time:
Code # Inspection Description • . m # Contact # Message
199 Electrical final 056150 -0' 503. 969 -6949 Y
Corrections /Comments /Instructions:
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1/4
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A PASS PARTIAL APPROVAL CANCEL n NO ACCESS
1 FAIL 1 I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: "CG L Date: C r i n ' Phone #: (503) 718- ZLILIk