Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IS COMMUNITY DEVELOPMENT Permit #: ELR2010 -00191
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/21/2010
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 290
Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project: Fairway America
Project Description: Data telecommunications system.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 09/21/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 09/21/2010 $9.00
PHONE: 503 - 624 -6300
Contractor:
ORE COM TELECOMMUNICATIONS LLC
9828 E BURNSIDE ST STE 100
PORTLAND, OR 97216
PHONE: 503 - 597 -3700
FAX: 503 - 953 -8501
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 a - her 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 issuan e, or ' • k is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C‘ 'ter. hose rules are set forth in OAR
952- 001 -0010 through O ' : 952- 001 -0100. You may obtain a copy of the rules • -' : uestions to OUNC by calling 503.246.9 .8' .2344.
Issued By. �i_.��: / _� l� Permittee Signature:
Ij 4 .-.."
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.
Electrical Permit Application l 1 )R fIFFici; Hsi.: (\l.V
City of Tigard OCVINI
Vj 1 Received _
Date/By: et )- j ft) I:517 Permit No.: R L-1e a01c> Lei t
. � • 13125 SW Hall Blvd., Tigard, OR 97223 ri Plan Review l
Phone: 503.639.4171 Fax: 503.598.1960 q , Other Permit:
A L t-' ' Date/By:
TIC I , Inspection Line: 503.639.4175 S -Q ate Ready/By: twis: El See Page 2 for
Internet: www.tigard -or.gov c � ^ A o i ed/Method: ' 3 Supplemental Information
[[ V n
TYPE OF WORK C - (`��t' PLAN REVIEW
❑ New construction Addition/alteration/ref n t Please check all that apply (submit 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 jgCommercial/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.
04 12.171,3 ['Addition of new motor load of Job no.: Job site address: `S D C/ IOO ao s. occupancy ❑ v .1 "r/ �N ❑ Six or more a re residential units. Recreational vehicle parks.
City/State /ZIP: 1 '0 / 7 Z Z / y ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 2 90 I Project name: Aw N / Ce7L c94.,❑ Service or feeder 600 amps or more.
/ FEE SCHEDULE
Cross street/directions to job sitr 7 � �� Description 1 Qty. 1 Fee 1 Total 1 •
s7 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'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
`� ^ Limited energy, multi - family 75.00 2
V U 1c .4— bA s-Ay r ^I� � �Q `) . / Gl_, residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 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 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
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
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 ex_ tension, er panel _
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. 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 2
tY 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
Business name: D I2 ,./' �� ,� �/ - 7 /�
panel, alteration, or extension. / Page 2 2
`-c L'GF v� Each additional inspection over alrowable in any of the above
Address: 918 Z 8 E. / /ba.� d� s� c o/rt e ---, Additional inspection (I hr min) 66.25/ hr
/] I ,,� n (� Investigation (1 hr min) 66.25/ hr
City /State /ZIP:
�l�`�./1 7'llU 2 L 2 7iz y Industrial plant (1 hr min) 78.18/ hr
Phone: (� 3 est. 77 8 u Fax: (c 3) 7 3 ''' $ 5 -b ( Inspections
listed w which no
min) is 90.00 / hr
{ p� Y (
CCB Lic.: ) S Z8J y Electrical Lic.34/_61 Car Suprv. Lic.:3Q'87LE7g ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: xc )
Plan review (25% of permit fee):
Print name: r ----h e --(2_, Date: 8 L) / D State surcharge (12% of permit fee): ei, VD
—
TOTAL PERMIT FEE: 8 (' � �
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Num o inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(l t /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all 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*
❑ 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
❑ Data Telecommunication Installation
❑ 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:
*No licenses are required. Licenses are required
for all other installations
1: \ Building \Permits\ELC•PermitApp.doc 07/01/10