Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
AA. DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00157
'- — 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171
DATE ISSUED: 6/19/2006
PARCEL: 2S 113AB -00101
SITE ADDRESS: 16101 SW 72ND AVE BLDG A -120 ZONING: IP
SUBDIVISION: PACTRUST BUSINESS CENTER LOT: JURISDICTION: TIG
Project Description: Voice and data
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE/IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
• INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES GG TELECOMMUNICATION CO
15350 SW SEQUOIA PKWY #300 -WMI 121SW SALMON ST STE P1
PORTLAND, OR 97224 PORTLAND, OR 97204
Phone: Contact #: PRI 503- 295 -2922
FEES Reg #: ELE 3907LEA
LIC 59692
Description Date Amount
[ELPRMT] ELR Permit 6/19/2006 $75.00
[TAX] 8% State Surcha 6/19/2006 $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 � mayy obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699. /` /""da'
Issued By: 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'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.
Zleetrical Permit Applicatioo6Fr ' A bi F(11t Ol I IclE: usl: (,,, ..
City of Tigalyd y 0 / /p6 36 oZ olDb — 90 /S7
4 Permit No.'
13125 SW Hall Blvd., Tigard, OR 9722311 J �l : 2006 Plan Revi Other Permit
'� o n . " Phone: 503.639.4171 Fax: 503.598.1960 J Date/By.
T I G A It D Inspection Line: 503.639.4175 Date Ready/By: tags .....I ®See Page 2 for
I nternet: www.tigard- or.gov LA i y (F' 1 WflIIYW Notified/Method: </ L Supplemental Information
TYPE OI goRKTNV'' 1 V 1 SI 0 N PLAN REVIEW
❑ New construction in Addition/alteration /replacement Please check all that apply (submit 2 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 171.Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire 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 ", "I -2 ^, "I -3 ", •
Job no.: Job site address: CC r ^^-- `` ��--- ^ M 1001 P or more. occupancy.
I I ,,,,3 /� r C A -200 ❑ Six or more residential units. ❑ Recreational vehide parks.
City / State/ZIP' —n Cr,Ft(U ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: A_ 20D Project name: 0OA OM 1Y\ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Up2E9 5! E2 - / -1 J E Description 1 Qty. I Fee. I Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. it or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
� Limited energy, multi - family 75.00 2
VC(C -C ■ 1 r l A'i - 1)I I I3 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less . 80.30 2
❑ PROPERTY OWNER I ❑ 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
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel •
gn A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: I G LECOrn W1U NI 0'0 CC B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
r- y c _ - first branch circuit
Address: ? St,� SALVylo . Sr S pi Each add'I branch circuit 6.65 2
•
Miscellaneous (service or feeder not included)
City / State/ZIP: r .A2 - LAN , 0._ 97 � Each manufactured or modular 90.90 2
I (���/ dwelling, service and/or feeder
Phone: (51}3) 99,5 2L n Fax : : ( ) 5 `'V �1O Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited- •
energy panel, alteration, or
Address: 9 extension. Describe: I Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( i, 1 2 Fax: ( ) 7 - / -0 ir Investigation per hour (1 hr min) 62.50
CCB Lic.: 596 Electrical Lic.:3`j07 Suprv. Lic.: Industrial plant per hour 73.75 _ •
ELECTRICAL PER FE ES
Suprv. Electrician signature, required: Subtotal: -
7�
Print name: — / r' Date: q �40 Plan review (25% of permit fee):
I �7'LJ 1 l G /I / State surcharge (8% of permit fee):
,1 /3,,,
Authorized signature: TO PERMIT FEE
�^ r ^ / This permit application expires if a permit is not obtained within 180 •
.
Print name: l u Date: '( 7! / days after it has been accepted as complete.
1 • Number of inspections allowed per permit.
I:\BuildinglPermits\ELC- PennitApp.doc 05/23/06 440- 4615T(1t /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 -260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation .
❑ HVAC
❑ Instrumentation
E] 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 \Pamits\ELC- PamitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR200G- 001'67
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/19/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/22/2006 TIME: 7 :01AM PAGE: 9 G
SITE ADDRESS: 16101 SW 72ND AVE BLDG A -120 CLASS OF WORK:
SUBDIVISION: PACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: QUALCOMM
DESCRIPTION: Voice and data
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: GG TELECOMMUNICATION CO PHONE #: 503 - 2115.2922
Inspection Request Scheduled For: Date: 6/22/2006 Pour Time:
C•de # Inspection Description Confirm # Contact # Message
199 Electrical final 032114 -01 503 -490 -7611 Y
Corrections /Comments /Instructions:
CAkO
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 6 e L Date: •32 6 4 Phone #: (503) 718 -