Permit 7l ELE „�� CITY OF TIGARD
CTRICAL RESTRICTED ENERGY PERMIT
' q
a COMMUNITY DEVELOPMENT Permit #: ELR2010 -00018
T tG 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/28/2010
Parcel: 1S136DD05300
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 100
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: Spec Space
Project Description: Install restricted energy for voice /data.
Owner: FEES
PNWP LLC #2 & Description Date Amount
PNWP LLC, 6600 SW 105TH AVE #175 Restricted Energy Permit 01/28/2010 $67.84
BEAVERTON, OR 97008 12% State Surcharge - Electrical 01/28/2010 $8.14
PHONE:
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503 - 419 -3300
FAX: 503 - 419 -3695
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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
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 AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: - e W 1 L „ . LtitSAA 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.
• . JAN -28 -2010 THU 09 55 AM CHRISTENSON ELECTRIC,INC FAX N0. 95034193695 P. 01
Electrical Permit AJplic ip CEIVED
mil,
City of Tigard
• R at e/ By: PemtitNa.. e?MO). C•00.143 DatclPy: pit
+ 13125 SW Hall B1vd.,Tigard, OR R7 3 Plan Review OtherPcrmit: P2,q .a6
• A. Phone: 503.639.4171 Fax 5031998Y9� 2010 DateI Y SeePage2
Dole Ready/13y; lu
Inspection Line: 503.639.4175 Notified/Method: � Supplemental toformuclon_
IIC ; nIt {� `' OFTIG.' S_
interact: www.tigard�r.govCIT h Q,+ 5 }e1 r � ■
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Please check all that apply (submit 1 sets of plans w /items checked below):
iew conStfuction :+ Addition/alteration/replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories.
■ M arinas and boa antis.
1 a then where the mailable fault current ❑ ri
[] Demolition `c , , { , y , exceeds 10.000 amps at 150 volts of ❑ Floating buildings.
e ( I t �' ? d � r /nr J . t r f .. a .N' [tr. QK � ., , , , i:7 , ..:07 , .; . ; r ! ; ., !l1 1 N , 1 . .rte :, � .Ii 0 Commercial-use agricultural
.. f i, : �i . ::1 h i l , l i : r r ' : ∎∎� iii', .. I . Ne ; / Q T d .. " less to ground, or exceeds lA,()QO {„J
1 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ 1 - and 2- family dwelling tr--�tt 0 Fire pump. 1:3 installation of 75 ICVA or
D Multi -family 0 O 0 I ., ❑ Fir ett cncy system. natal , tion o ely derived system.
' o ii.'a'� �. 1 r S 1. Moterb�71d ` � n '''.!.7,.',.. •'E" ••1 -2•' ••1.3 ",
y Other:
� J�13 �� � � � 0y!zru° I � DAddition ofnewmotorloadof ❑ "A" ,
s , I..,•. , . v ' 10011? or more,
G Job site address: A b l 1 h :> t Q Six or more residential units. . ❑ Recreational vehicle parts
Job no.: i 0 Health-care oca ns. 0 Supply voltage for more than
Tg ^ - 3 500 volts nominal.
Ciry /StatdZlP: �' N O` ❑tta.^�rdou locations.
Suitc/bldg. /apt. no.: D .,1 in Service or feeder 60D amps or mom
Project name i (.114N1 Scr r , �, . >:"� r I«P,A1 .r`
J -�• ,�: ,.r .1.� t der I l :r r o U JT• 1 .1 rr
. pncrMngn _ l QtY• 1 Pra 1 'total 1 '
Cross street/directions to job site: `�ti iii New residential single- or multi-family dwelling unit.
mai
I. ` includes attached garage.
Lot no.:
1,000 sq. (t. or less 145.15 4
Subdivision: Ea. addi 500 sq. ft. or portion Ell 33.40 III
Tax map /parcel no
Limited energy, residential 75.00 2
i (vridt above so ft.) 'I '.,` ,Ia +' T?9CA 1P7}AN,QF ryO,RIC�. ,t, ;: I -. ° v
Limited energy. multi- family 75.00 2
' residential (with above s. • fl.
a /� Services or feeders Installation alteration, and/or relocation
200 amps or less 80.30
,, i ,o a r . c'" r., 201 amp to 400 amps 106.85
::•.1,..;;,..,.1.:','.: r( r- �I([>ktE1YIU.,. :'' 1 ., ' ar " r :I,.`i fad. :1 l r 401 amps to 600 amps 160.60
601 amps to 1,000 amps II 240.60 2
Over 1,000 amps or volts 454.65 2
Address: Temporary services or feeders installation, alteration, and /or
relocation 1
200 amps or less 66.85
Fax: ( ) 201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not 401 amps l0 599 amps 133.75 2
intended for laic, lease, Tent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration. or extension, perpanel
Date: - A. Fee for branch circuits with
Owner signature _ . :. , above service or fattier tee. I 2
each ranc
y�0 ( K " ' +f: '' _m, „ ' ,(alV t;d�G,7
.:.1. �, J[1{.��M(�1 �J rl .a�.. :.'u In... /I I Il 4, bh circuit
13. Fee for branch circuits
Business name: without service or feeder fee,
46.85 2
Contact name: first branch circuit 2
Each add'l branch circuit 6.65
Address: Miscellaneous (service or feeder not included'
leach manufactured or modular 90.90 2
City/State /ZlP: dwelling, service and /or feeder
Phone: ( ) Fax: ( ) Reconnect only 66.85
Pump or irrigation circle 53.40
E
53.40 2
1 , r .;. : ','I Sign or outline lighting
t l I bN 1!RACTQR i Signal circuit(s) or limited -
energy panel, alteration, or i 2 Li �(�
Business name: Christenson Electric, Inc. extension. Describe: ( Page 2
Address; 111 SW Columbia, Suite 480
Each additional inspection over allowable In on of the above
City/State/ZIP: Portland, OR 97201 per inspection 62,50
y,,� "'
Phone: (503)419 - 3300 MI ax: (503) 5 S - : S Investigation per hour (I hr min) 62.50
I plant per hour 73,75
CCB Lic. 458 Electrical lc. 6 -34C Suprv. Lic.: .i * $ iC'A7�L!ERiVUIT.'FTESt
d,' i
r % Subtotal:
Suprv. Electrician signature, required: l 0 , , , + Plan review (25 "/0 of ixrmit Subtotal:
D Stat surcharge (12 %, of permit fee): le111:2 1 "l
Print name: Robert , �1t,Q/Y1Jl_� �r
TOTAL PERMIT FEE: a
torizcd signature:
Tole permit application aspires If a permit is not obtained • y in iaD
Date: days after It has been accepted us complete.
Print name: • Number of inspecliottyt�sslloa ¢ d per per mit.
440-4615 TI 11105r('OMAYER ' // ( t1 . L���'
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