Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
j pi ` COMMUNITY DEVELOPMENT Permit #: ELR2010 -00129
13125 S W Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/22/2010
:TIGARD � Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Stash Tea
Project Description: Data/Telecommunications
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 07/22/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 07/22/2010 $9.00
PHONE: 503 - 624 -6300
Contractor:
XTREME COMMUNICATIONS, INC.
24023 NE SHEA LANE, #215
WOOD VILLAGE, OR 97060
PHONE: 503 - 618 -8816
FAX: 503- 618 -9985
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 $84.00
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 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 may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /(
Issued By: Permittee Signature: (9"/ /32-7°,43 p/32-7°,43 . / C�� /c
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 503.639.4176 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.
07/20/2010 08:15 5036189985 PAGE 01/03
Electrical PermitA,pplicatio FOR OFFICE USE ONLY
City of Tigard Received r, .
Permit No.��2(I /0 — 00 ,., I
tY g Datc/B : - d
n . 13125 SW Hall Blvd„ Tigard, OR 97223 I 0 L J . ° ^ t 0 Pinn Review
q Phone: 503,639,4171 Fax: 503,598,1969 u l ° DOOM : Other Pcrmi - V/0 -00/
T 14r A RD Inspection Linc: 503.639.4175 El $ee Pagel for
Internet: www.tigard- or,gov CITY OF TIGARD Supplemental Information
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P ienso chock all that imply (stthmlt 2 acts of ohms whims checked below):
0 New construction Addition /alteration/rcplaccment Service or feeder 400 imps or more ❑ Building over three stories,
0 Demolition ❑ Other: where the available tkult current ❑ Marinas and boatyards.
- ..,, OSar.150voltsor Floating .... ,
..;
.. , �': ,. ,, . ,:: � •. + C�F+�'Ic;",., .,,h- � ----,— y <� ;,�s ., �„ a;A�? r i�� exceeds l o.vov am ❑ r buildings,
i� r4 dl~blvsttf (� I 1 i ,•. > 1
_ . '' ",,.,_�..�`.••��„ ` ,'. "; " . "T "'• ':'."'• ,• ''' '!>«! °, ' ; �` ;'`' "' IcaS t0 Rrnund, OT CXCCCdB 14,000 ❑ Commet'clnl -use agrictdtuml
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps fbr all other instnllntions, btdldings,
❑ Multi - family ❑ Master builds ❑ Othtr:
,
r � Q Pirc pu ❑ Installation o f 75 KVA or
,., ❑ Emergency system, limier separately derived system.
d : j r ' ' n.,t :), YI ! 0 .4.4W , 010110) , : :, � ! :,: " 'r CI Addition of new motor load 00 ❑ .,A. . "1-3",
' 1001-IP or moro. ocmtpnncy.
Job no.: 7583 Job site address: /(fj &cc s w
ID Six or moro residential unite. ❑ Recreational vehicle parks,
CI /$fate /ZIP: i : • i / '� ❑ Health-sore facilities. ❑ Supply voltage for more thnn
j I f - ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: .t - 0 Projcct name: /MA Te ❑ Service or fccdcr 600 amps or more,
.
Cross street /directions to Job site: D cre It rtpnoa i i .• : Pte. 1 rmat 1 ' _
""-` — — New residential single- or multi - family dwelling trail:.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R, or less 145,15 4
Ea. add'I 500 sq, ft. or portion 33.40 1
Tax Wrap /parcel no Limited energy, residential
:, r x w t ltm a ra I r +a 1 tr'1 • t h` with nbovo S 75,00 2
V0 1, Limited energy, multi -family 75.00 2
ce- ado residential (with th n above s g 0.)
""-""' Services or feeders Installation, alteration, and /or relocation
200 amps or less 80,30 2
f , 1 �reMi'. " i.il r , ' y t 4 ?J 4 i t u " hey _,. 11 wIi11 ` s 10 amps ; 'CJY��/S{tr�.�JK t�, Y f;l .. �1 1� , �'fY�7i ll.l: 201 em 400 s 106,85 2 P•. p
Name; 7 401 amps to 600 amps 160.60 2
--•• - 601 amps 10 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454,65 2
City /Statc/7TP: Temporary services or feeders installation, alteration, and/or
__ _ relocation _
Phone: ( ) Fax: ( ) 200 amps or leas 66.85 1
Owner installation: This inslnllation is being made on property that I own which is not 201 imps 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
Owner Signature: Date: Branch circuits- new, alteration. or extension, per panel
A. Fee for branch circuits with
It tt ;; ' t �h t , o� tV �, t . c P& ry 4° �- t, !'� e s or , *. w ))P,hI}V�V t 11 t L l , h 711 „ r ,f , 4j irl C b1�Y'I'A f" Pt�a�ST!E P -:' r above fccdcr fee
6.65 2
each branch circuit
Business name: B. fcc for branch circuits
Contact names without service or fccdcr fee, 46,85 2
first branch circuit
Address: : • Each add branch circuit 6.65 -
2
. Miscellaneous (service or feeder not included)
City /State /ZiP; Each manufactured or modular 90.90 2
dwelling. service and/or feeder
Phone: ( ) rFax: : ( ) Reconnect only 66.85 2
E -mail: . - Pump or irrigation circle 53.40 2
I, ' ta;' K ! nt , M ! t +'' r 11,' 1 t "w;1 id i r trU k• r �1 { Sign or outline li IBih
, ;'I I t � '?: , 4 .a r t �b��,��, ,�aq . i, .t,:, � ., ,,,,.. � '�, r 4» 8 $ S 53.40 2
""•' Signal circuit(s) or limited-
Business namo:
/ CO h - / A r / __ C.• energy panel, alteration. or
•
Address: PO P � y extension. Describe; / Page 2 9S e 2
City /State /ZIP :. 1 teke f e ,e_ 47106,0 Each additional inspection over A llownbic in any of the above
/ _) Per inspection 62,50
P onc: ( 5"o3) f /8' ' '8 / (p Fax: (9 ', 9 9 $ j Investigation per hour (I hr min)
62.50
CC13 Lie.: / 4#2. 24, 4 Electrical Lie.; ;..5/5" es. Suprv. Lie.: wk . Industrial plant per hour 73.75
C', f
' - i-,5$ 9�i:7` r$E'Cntlr M,fl,1!1;iii� IT<:4�)F '11;75'., + Irtw t i h
Suprv. Electrician signature, rcgnircd:� Subtotal;
Print name: 't / ---L4 1 Date: 7 M t o Slate review (25% of permit fee); q 9 • �r[�
ate surcharge (8% of permit fee): d
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtnined within ISO
Print name: Dater days after it has been accepted as complete. 1----
• Number of inspections allowed per permit. 1
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07/20/2010 08:15 5036189985 PAGE 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
. . :Rtgli RIIW EV FM1'it '1 ;,,,'• ?FTf.,F,t7,g
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ T3urglar Alarm
n G arage Door Opener*
n
H eating, Ventilation and Air, Conditioning System*
❑ Vacuum Systems*
❑ Other:
; ' ,'Y'�'�i�"�: !' t 7 i ' w ; P F,
�ar,a �:� „� �,� . .,.'�s �.w)� 1 :�� }�
Fee for gask commercial $75.00
system
(SET; OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and. Stereo Systems
❑ Boiler Controls
❑ Clock Systems
g Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
LI Landscape Irrigation Control*
❑ MedicaI
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ P rotective Signaling
❑ Other
Total number of cotrunercial systems:
*No licenses are required. Licenses are required
for all other installations
I Muilding \Peumits \ELC -Pc mitApHdoc 03/23M6