Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00161
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/30/2007
PARCEL: 25101 DC - 00200
SITE ADDRESS: 13535 SW 72ND AVE ZONING: C -P
SUBDIVISION: 72ND AVE OFFICE BUILDING LOT: JURISDICTION: TIG
PROJECT: LOBBY
Project Description: Reactivate north and south lobby doors at signal panel in suite 200. Add (1) door to access
crontrol system located on first floor. (See other)
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: OOR ACCES : X
TOTAL # OF SYSTEMS:
Owner: Contractor:
PACIFIC NW PROPERTIES LTD PTNSHP SELECTRON INC
9665 SW ALLEN BLVD STE 115 7225 SW BONITA RD
BEAVERTON, OR 97005 TIGARD, OR 97224
Phone: Contact #: PRI 503- 639 -9988
FAX 503- 684 -4357
FEES Reg #: ELE 26- 497CLE
LIC 64341
Description Date Amount SUP 3645LEA
[ELPRMT] ELR Permit 5/30/2007 $75.00
[TAX] 8% State Surcha 5/30/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued B • j1 / /1 1 • /1 / Permittee Signature: Ay I; (when
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'N: 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 FOR OFFICE USE ONLY -
City of Tigard f ,"•, r ., . * . Received 5 D Permit No.: E R , > _��
Date/By. •
13125 SW Hall Blvd., Tigard, OR 97223' __ - - - Plan Review ,
Phone: 503.639.4171 Fax: 503.598.1960 ,,i5'7�'tir ;: Other Permit:
Inspection Line: 503.639.4175 MAY
�. I 'i Date/By.
2 9 200 -_ ^� �:, Date Ready/By: luris: EU See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: G' Supplemental Information
TYPE OF WORK, PLAN REVIEW • 1
❑ New construction Additionlaltertrtion /rttiplaceme,it Please check all that apply:
❑ Demolition Other: ❑Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2- family dwelling Commercial /industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑ Multi - family Master builder ❑ Other: ❑Building over three stories [Weeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park
Job no.: 6S10 Job site address: 13535 S.J — I) t oml 4.ve, ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/ State/ZIP: j ( p ro d 6 4 Gis7)... The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: Th61;, j 4 -p , 6S Description Q Fee' Total ' .
Cross street/directions to job site: �`T� New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less . 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
l- J�
I 4 dwelling, service and/or feeder 90.90 2
re 'a C�Va 0 t S )0 ")by d�S. Add 1 dcor Services or feeders installation, alteration, and /or relocation
a c.. e s' C-ur4. -6) / SyS-fel•• 200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 1 201 amps to 400 amps 100.30 1
intended for sale. lease. rent. or exchanee. according to ORS 447. 449. 670. and 701. 401 arup, iu 600 amps I I 133•75 I 12
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: B. Fee for branch circuits -
without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 I 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
I -- - extension. Describe: I Page 2 1--x,0 2
Business name:
Se-le-c-- I hC--
Address: — 7 7_,)__S S1xj �j - ty„1 -a, �� Each additional inspection over allowable in any of the above
�� --�r �r �� Per inspection 62.50
City / State/ZIP: t r () " 7 4 Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: 503 )(, , 0A% Fax: ((53) ip$ I 1 --4-15-7 ELECTRICAL PERMIT FEES*
CCB Lic.: i 1 Electrical Lic.: J f ti Lc ii Suprv. Lic.: Subtotal - !°
Suprv. Electrician signature, required " Q ‹Z.:-/ =`s ' Plan review (25% of permit fee)
Print name: //11 Date: 'S State surcharge (8% of permit fee) b . 00
IGhin U'Inn I r'C�� TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
'• Number of inspections per permit allowed.
is \ Building \Pennits\ELC - PermitApp.doc 12/03 440-4615T(10/02/COM/WEB