Permit � CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELR2010 -00101
Date Issued: 06/03/2010
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S112DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY
Subdivision: PACIFIC CORP CENTER Lot: 0
Project: PacTrust
Project Description: Low voltage for access control.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 06/03/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 06/03/2010 $8.14
PHONE: 503 -624 -6300
Contractor:
CONVERGINT TECHNOLOGIES
16575 SW 72ND AVE
PORTLAND, OR 97224
PHONE: 503 - 228 -8522
FAX: 503- 228 -8521
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: N 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: Y
Other Desc:
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 -0100. You m- • •tai - • • •tions to OUNC by calling 503.246 -699 or 1.800.332.2344.
Issued By � ��T 111- i�mittee Signature: /
Alaw
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.
Electrical Permit Application _ �t� l'''','D'''x:'.0.,,',.,,,,`]..:':';:;.;;',.:,,--=',--, ,, �I oR o � I ICI U 0 N ' ► Y ' "
-. c '' t V \ S.,,‘; Rece
City of Tigard y (� Permit No.: rt t v (0 (
Date
a 13125 SW Hall Blvd.. Tigard, OR 97223 faxv p Plan B Review
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® Ph o ne: Other Permit:
503.639.4171 Fax: 503.598.1960 `\� J Da /B :
TIC R A D
Inspection Line: 503.639.4175 J Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov � � C . I f l e . ied /Method:
— 17
..,u Inform d e .
TYPE OF W \ ,� . , PLAN REVIEW
• ❑ New construction ❑ Addition/alteration/reNatement 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 ❑ 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" " F ". "1 -2" "1 -3"
1001-1P or more. occupancy.
Job no.: Job site address:
X5333 5 se" fvaia &1/4 y ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: �!j7� /n� ❑ Health -care facilities. ❑ Supply voltage for snore than
•e �� ®� ' q7, ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: C ❑ Service or feeder 600 amps or more.
1J p Gµ ,�(fi Project name pR-d_ urj7�
. . ` 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 500 sq ft or portion 33.92 I
Tax map /parcel no.: Limited energy, residential 67.84 2
. DESCRIPTION OF WORK (w ith above sq. ft.)
..--, Limited energy, multi - family 67.84 2
../- '14'/ /�k - 4i6.--0 • ` n - ? residential (with above sq. 0.)
/ r 7� 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
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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, per 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: 13. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84
Y dwelling, service and/or feeder
Phone: ( ) Fax:: ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy / 67- �(f
Page alteration, or extension. ( age ' _ 2
Business name: j„ V 21il ry ;x 1 inspection ✓ T� lla'> L� Each additional ins action over allowable in any of the above
Address: /65`53' 5 i,../ ,2.d A Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: / I Investigation (1 hr tnin) 66.25/ hr
r ole I 4€ 7 --, % Industrial plant (1 hr min) 78.18/ hr
Phone: ( ),22„,77 �� Fax: ( �; ) � �c�f Inspections for which no fee is
specifically listed ('/ hr min) 90.00 / hr
� �
CCB Lic.: / j Electrical Lic. / , -4/,4 Suprv. Lic.: i ,/ ELECTRICAL PERMIT FEES -
Suprv. Electrician sig 7 / 1 1 7 /1 /))
— 7/' hi �� '7. ��
��/ j ��� Plan review (25% of permit fee):
Print name: f� /erT / - Date: /7/ State surcharge (I of permit fee): �S �I
��� / TOTAL PERMIT FEE: 7 5 , 95<
Authorized signature: /� ,i 74 if This permit application expires if a permit is not obtained within 180
/ days after it has been accepted as complete.
Print name: f Date: /, * Number of inspections allowed per permit.
I: \Building'Pemnits \ELC .doc 1 hI��1 410- 4615r(11/05i('OM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
1'RESIDENTIAL WORK'ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
• COMMERCIAL WORK ONLY: - 7- 77
Fee for each commercial $67.84
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 1\ledical
❑ Nurse Calls
n Outdoor Landscape Lighting*
X 1 Protective Signaling
Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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