Permit CITY OF TIGARD ELECTRICAL PERMIT
1 : 111 1 q
• 0 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00496
T [GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2009
Parcel: 25101 DA00101
Jurisdiction: Tigard
Site address: 13190 SW 68TH PKWY 110
Subdivision: TRIANGLE CORPORATE PARK Lot: 3
Project: Business Objects
Project Description: Install (1) 200 amp or less service, and (7) branch circuits for office cubicles. 9/25/09 ADDED
restristed energy for voice /data.
Owner: FEES
PACIFIC NW PROPERTIES LIMITED Quantity Description Date Amount
6600 SW 105TH AVE #175
BEAVERTON, OR 97008 1 ea Services or Feeders - 200 09/23/2009 $80.30
amps or less
PHONE: 7 crt Branch Circuits w /Purchase 09/23/2009 $46.55
Service or Feeder
1 ea 12% State Surcharge - 09/23/2009 $15.22
Contractor: Electrical
PHOENIX ELECTRIC CO 0 ea 12% State Surcharge - 09/25/2009 $17.42
PO BOX 14037 Electrical
PORTLAND, OR 97293 1 ea Limited Energy 09/25/2009 $75.00
PHONE: 503 - 231 -8006
FAX: 503 - 235 -4300
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $234.49
Required Items and Reports (Conditions)
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. tt 0
Issued By: T 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.
`:, Sep 25 09 10:36a Terry Koch 503 - 266 -8394 p.l
• PAR .4.1' Wit,;: k
Electrical Permit Application i, � t r 1 4 wt FOR OFF KT. VSI ONLY
City of Tigard S E P 2 5 21 �:; `;� Permit No.: 8 - '
13125 SW Hall Blvd, Tigard, OR 97223
Milli Phone: 503.639.4171 Fax: 503.598.1960 Other Perm t: .,. , Cf 1 0 Inspection Line: 503.639.4175 CITY OF TIG . ,� ,: ® see Page 2 f °r
w Internet: ww.tigard- or.gov BUILDING DIVI Suppkmental Information
E OF WORK PLAN REVIEW
❑ New construction ddttion/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service three ice or feeder 400 amps or more ❑ Building over e 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 � Q �
❑ 1 - and 2 - family dwelling Comtnercia /industrial ❑ Accessory building
amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other 0 Fire pump. ❑ rrrstallaticn of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑Additionofnewmotorloadof ❑ "A ",`E ", "t- 2 ","1 -3 ",
3 S- Se /2 3 i ' 0 C � & m— � iooHP or-rare. occupancy. Job no.: .i 1` Job site address: l V J o 1
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/L,1P: j A-✓1 ;1 0 e e ') I 13 Health -care facilities. 0 Supply voltage for more than
41 f ill �i O � ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt no.: I Project name: . ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Des ripdas 1 QtY• I_ Fee. I Tam 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. S. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft) 75.00 2
_4 //
�� C 4/744E- �J Limited energy, multi- family
2) a 6X15: N4 14/2461.47 � I residential (with above sq. R) 75.00 2
Services or feeders installation, alteration, and/or relocadon
200 amps or less 80.30 2
❑ PROPERTY OWNER l ❑ 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
reloattlon
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This instal ation is being made on property that I own which is not 201 atnpsto 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 pand
Owner signature: Date:
A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
f each branch circuit 6.65 2
Business name: Pi/O£�J / X £/l.467k/0- B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: � emcee or feeder not included) Each
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: , ` !J Signal chalks) or limited -
� /� -�--/ /2.. / energy panel, alteration, or
Address: P 30 x / 1037 extension Describe: Page 2 V 2
City/State/ZIP: 7e)0.fe r ,4-J 0 2 9 7• ?3 Each additional inspection over allowable In an of the above
Per inspection 62.50
Phone: (SU 3) 02 3 i ... foo co Fax: (5-p 3 ) .•• c235-- #3 Investigation per hour (1 hr min) 62.50
CCB Lic.:l a 73- 3 1 Electrical Lic.: e t f Suprv. Li s7 6 �'i S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: X7,5,
Print name: Date: 9 7 L OC Plan review (25% of permit fee):
oi
7 �"/ / State surcharge (12% ofpetmit fee): 9.
Authorized signature: TOTAL PERMIT FEE: frt.
Print name Q , J / � % Date: �� } -�Q This permit application expires if a permit is not obtained within Igo
7 !'T V , days after it has been accepted as complete.
_ Sip 25 09 10:37a Terry Koch 503 -266 -8394 p.2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for a 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*
El Other
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems ff
Data Telecommunication Installation �i i45/.— /D� / O k 1577 �� dR,114.1
u ?i2 EE.0 aooY 0E91
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
a CITY OF TIGARD ELECTRICAL PERMIT
III COMMUNITY DEVELOPMENT Permit #: ELC2009-00496
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2009
Parcel: 25101 DA00101
Jurisdiction: Tigard
Site address: 13190 SW 68TH PKWY 110
Subdivision: TRIANGLE CORPORATE PARK Lot: 3
Project: Business Objects
Project Description: Install (1) 200 amp or less service, and (7) branch circuits for office cubicles.
Owner: FEES
PACIFIC NW PROPERTIES LIMITED Quantity Description Date Amount
6600 SW 105TH AVE #175
BEAVERTON, OR 97008 1 ea Services or Feeders - 200 09/23/2009 $80.30
amps or less
PHONE: 7 crt Branch Circuits w /Purchase 09/23/2009 $46.55
Service or Feeder
1 ea 12% State Surcharge - 09/23/2009 $15.22
Contractor: Electrical
PHOENIX ELECTRIC CO
PO BOX 14037
PORTLAND, OR 97293
PHONE: 503 - 231 -8006
FAX: 503 - 235 -4300
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $142.07
Required Items and Reports (Conditions)
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: Q
.40 _
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.
•
CaII 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.
Sep 22 09 08:33a Terry Koch 503 - 266 -8394 p.1
RECEIVED
Electrical Permit Application FOR OFFICE l'SE ONLY
City of Tigard SEP 2 2 2009 Received _', Permit No.: c i z,.. ,` 4, •
II 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 1 (} ��o
° ' Y OF TIGARD Other Permit A.fT LIM
Phone: 503.639.4171 Fax 503.598 i teiR J 0 See e 2 for
'I" I ,; A R I) Inspection Line: 503.639.4175 Date ( 0 See 2
Internet: www.tigard-or.gov BUILDI DIVISION T C
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plain wlitems checked below):
El New construction f E 'Addition/alterationfteplacement
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRRUCTION 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: ❑ Fie pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E", "1.2 ". "1-3",
Job no.: j. J s it e a T3 f q0 ,fit) t — p4 (,l o r
❑ Svc or tit LOO or more. occupancy. 3 S� � (/ more residential units. ❑Recreation al vehicle parks.
City/State/ZIP: f j ( JhQ(� /C
D n 6/7.7s3 ❑ Healthcare facilities.
❑ Hazardous facilities. ❑ Supply voltage for more than
� locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: ...5.4)0 ❑ Service or feeder 600 amps or mare.
FEE SCHEDULE
Cross street/directions to job site: ; ( z z (jot \3/SiAt P oe,ctpma 1 Qty. 1 ram 1 total 1 •
New residential single- or multi- family dwelling wilt
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft or less , 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
�J Limited energy, muhi- family 75.00 2
//US I rl +f u n - _ 4 al -i! 5 r .; l.. L...a 3rd. 1.-S id residential (with above sq. It)
__ Services or feeders installation, alteration, and/or relocadon
OF r (C a✓ / ► 200 amps or less i 80.30 op,3 , 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
Phone: ( ) I 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 1 133.75 _ 2
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: - A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 6.65 44.1V 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, q6 85 2
first branch circuit
Address: Each add'l 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: ( ) Fax : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
'
/ L � Signal circuit(s) or limited -
Business name:
�/ f X G / -R Ie re.. energy panel, alteration, or
Address: p0. X ,4 0 , R 7 �j extension. Describe: Page 2 2
City /State/ZIP: iSk fr _ 9762-93 2-93 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5(4 ) A 3 j — J G (o C o o l Fax: (5 .3 Aar- 43 00 Investigation per hour (1 hr min) 62.50
K CCB Lic.: !( )„ 75' �/ 3 Electrical Lic.: C' gy ,-/ Suprv. Lic.: / (,5r 5' Industrial Plant Per hour 73.75
ll
Skj,i thltrician signature, required: f t /�� ,.L l ICJ ELECTRICAL PERMIT FEES
Subtotal: /;26.
[ name: �C < , + Q Plan review (25% of penult fee): _
Ptm ! L/ A/ocee Date: 1 0 I State surcharge (12% of permit fee): (
Authorized signature PERMIT FEE: /'ffd . 0
Tub permit application ettplm if a permit is not obtained withirl 180
Pratt name: / l e i Date: 1 --?./... O 1 days after It bin been accepted as complete.
err OCh