Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00173
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/07/2010
Parcel: 2S 101 DA00100
Jurisdiction: Tigard
Site address: 13010 SW 68TH PKWY 100
Subdivision: TRIANGLE CORPORATE PARK Lot: 7
Project: US Bank Equipment Finance
Project Description: Low voltage for (2) systems, fire alarm and security.
FEES
Owner:
PACIFIC NW PROPERTIES LIMITED PA Description Date Amount
6600 SW 105TH AVE #175 Restricted Energy Permit 09/02/2010 $150.00
BEAVERTON, OR 97008 12% State Surcharge - Electrical 09/02/2010 $18.00
PHONE:
Contractor:
PERFORMANCE SYSTEMS INTEGRATION
CORP
7324 SW DURHAM RD
PHONE: 503 - 641 -2222
FAX: 503 - 641 -1464
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: Y
HVAC: N Instrumentation: N Total $168.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: Y Other: N
Other Desc:
This permi sue. s• to the egulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do = in accordance with ap• •ved •tans. 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 a - ui es you to follow the rules adopted by the Oregon Utility Notifi . •• • Center. Those rules are set forth in OAR
95 001 -0010 t rough OAR • 2 -00 Is 0. You may obta' a copy of the rules or direct questions to OUNC by . "rig . . : 6.6699 or 1.800.332.2344.
ssued By Permittee• •!nature:
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.
('Q : 'kW 22-
Electrical Permit AppLCaho E GIVE t FOR OFFICE USE ONLY
UPI 2 O 1 0 Recei /
City of Tigard SEP /O Permit Nat.:jj0 '"05/ 73
Date/Bv: i
a 13125 SW Hall Blvd.. Tigard. OR 97223 Plan Review
Phone: 5(13.639.4171 Fax: 503.598.1 Dale /B v: Other Permit:
Inspection Line: 503.639.4175
BUILDING IN DIVISION Date Ready /By: turfs: 1:21 See Page 2 for
I I C Alt IJ
Internet: www.figard-or.gov G DIVISION
w'w.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction gi Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /Ite1n. 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 10.111)11 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.))110 ❑ 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' .. = ' .... 1 _�..
1(OHP or metre. occupancy.
Job no.: Job site address:
vSmo SW 650., A vq. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: — 1 - ;&„e4 2 , pit- / 9722.3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 6011 volts nominal.
Suite/bldg. /apt. no.: /AO Project name: Vs s K Ea ,C0.,NN�.- - ❑ Service or feeder 600 amps or pure.
FEE SCHEDULE
Cross street /directions to job site: S W NAtrApeoeJ et SW 684, Ave - Description 1 Qty. 1 Err. 1 Total 1
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 1
Tax map /parcel no.: Limited energy. residential
67.84
DESCRIPTION OF WORK (with above sq. 0.)
Limited energy. multi-family 67.84 2
PAD IJOLit■CAliOw) CtR.c 10 E c&e∎ FAZE A■Mrkr1 Sysoc\ residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
+ ANN $i.CuR:Vy Diwwe; N cent\ -16 SI-C-t. %. y SyST . 200 amps orless 100.7(1 2
❑ PROPERtY OWNER I ❑ 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 2
Address: Over (.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 125.1)8 2
Owner installation: This installation is being made on property that 1 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 1 shove service or feeder fee
CONTACT PERSON 7.42 2
each branch circuit
Business name: B. Fee for branch circuits trithow
� ERF0 2Mn-- ....tE CySS�'tS service or feeder fee. first
56.18 2
Contact name: 1-I HN ' N \At2c r tt� branch circuit
{ Each add'( branch circuit 7.42 2
Address: - 3-3 24 Miscellaneous (service or feeder not included)
Each manufactured or m 67.84 2
City/State/ZIP: �OzStntrtfl /OR- /�1�Z� -`E }
y dw ellin service and/or feeder
Phone: ( o ff) / Fax: (So3) Reconnect only 67.84 2
S �D� -2222 �� t 1
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84
CONTRACTOR Signal circuit(s) or limited- energy 0/
Business name: ;7 panel. alteration. or extension. 2 Page 2 ti0 2
iS .'roR - - S■ .,-,∎ Each additional inspection over allowable in any of the above
Address: - 12i-1 SW DJ2Hgr4 1e" . Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr pain) 6625/ hr
City/State/ZIP: poRT N, 7 of 9122 l ` L Industrial plant (1 hr min) 78.18/ hr
Phone: ( So) ) 1.. _222 Fax: (S03) 6,4 (_ 146 Li-, Inspections Ibr which no fee is 90.00/ hr
specifically listed ('h hr min)
CCB Lic.: 1 5 u .. 4 _4 4 . 3, Electrical Lic.: 14 -522- Suprv. Lic.: ELECTRICAL PERMIT FEES
1 I Subtotal: r
Suprv. Electrician signature. required:
Plan review (25% of permit fee):
Print name: - a V Im 0., L & 3v3 Dale: G 1/ `J /., / t , 0 State surcharge (129r of permit fee): rB ,,00
(obit( TOTAL PERMIT FEE: / to / vd
Authorized signature: This permit application expires if a permit Is not ohtaihendifi'in 180
days after it has been accepted as complete.
Print name: '� � �e• Date: q� /Zpl 0 * Number of inspections allowed per permit.
I:\ Building \I'erntitAELC- PermitApp.doc I0/51/04 4411 - 46151111 /n5 /COM/V,'EB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener* '
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
• Other S viP-iry
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building \Permit.. \ELC - Permit App.doc 10/01/09