Permit u p, ,nt Q d Qd Cif yes.4 ct9d -12-ne
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
N.,. COMMUNITY DEVELOPMENT Permit #: ELR2009 -00194
T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
. Parcel: 2 S 113A B00600
Jurisdiction: TIGARD
Site address: 16125 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: St. Jude Medical Center
Project Description: Install Card Readers and Access Control Panel. 7/22/09 ADDED (1) more restricted energy to
permit.
FEES
Owner: Description Date Amount
PACIFIC REALTY ASSOCIATES
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 07/21/2009 $75.00
#300 12% State Surcharge - Electrical 07/21/2009 $9.00
PHONE: Restricted Energy Permit 07/23/2009 $75.00
12% State Surcharge - Electrical 07/23/2009 $9.00
Contractor:
HUGHES ELECTRICAL CONTRACTORS INC
9640 SW SUNSHINE CT #600
BEAVERTON, OR 97005
PHONE: 503 -626 -3344
FAX:
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: N Fire Alarm: N
HVAC: N Instrumentation: N Total $168.00
Intercom/Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: y
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 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 thro gh 0 952 - 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: CO Qr 1 nq Q �
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.
. J From: 07/22/2009 12:25 #984 P.003/004
Electrical Permit Applicati ` �9 � - VED ro►( O FF I CI L'SI. O L .
.:....:.::..... .
Ptr
R eceived ar/ - �� '
City of Tigard JUL 2 2 2009 n, ' a11 •
Date /Bv:
13125 SW 11al1 Blvd.. Tigard. OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.59 Date /Bv: (hhcr Permit:
Inspection Line: 503.639.4175 Cyr Date Rcad
OF TIGARD dBy: hn s
"G " 1 BUILDING DIVISION S pple e n t 2
Internet: tvtvtv.ligard- or. � t Notified'Methud: Supplemental lemental
TYPE.OI>Y4%ORK .: = •
..:.; PLAi%,REM1'IEN
EJ New construction n Addition /alteration/replacement Please check all that apply (submit 2 sets of plans %villeins checked below):
['Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: [there the available fault cw rem ❑ Marinas and boatyards.
CATEGORY OF CONSTRUC71ON e 1 0. 000 amps at 150 volts or ❑ Floating huildmgs
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 0 Other: ❑ Fire pump ❑ Installation of 75 KVA or
.. . . .. JOB SI 1NFOR�IATIO A ND "LOCATION erg " u% iico nt. larger derive em.
❑Ern e I ds -st
: ::. .. ... ❑ Ad dition anew motor load of
Job no.: 910262 Job site address: 16125 Sn1 72'x/ ASE oP or r occupation.
❑ Si Si%c or more a reesist dential units. ❑Recreational v ehicle parks.
City /State /ZIP: t CR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. (00 volts nominal.
Suite/bldg. /apt. no.: Project name: st. t7lI: m cater more. ❑ Service or feeder 600 amps or me.
Cross street/directions to job site: I Qtv. I Fee. I Total
- FEE SCHEDULE- -
n nc rt p r ion :
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Tess 145.15 4
Ea. add 500 sq. 1t. or portion 33.40 1
1 ax map /parcel no
Limited energy. residential
D ESCRIPTION .OF WQRK. (ttith above s 8) 2
Limited energy. multi - family 75,(10 2
Install Card Reacizs and Amass ecntral pEtre.l. residential (with alxwe sq. ft.)
Services or feeders installation, alteration, and /or relocation
0 PROPERTY OWT TER : - -0 . TENANT ` 20 amps t 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 I own which is not 201 amps l0 400 amps (00.30 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 panel
Owner signature: Date: A. Fee for branch circuits with
la `APPLiCANT , 0 CONTACT PERSON` - ; above service or feeder fee,
each branch circuit 6.65 2
Business name: 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
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
90.90
dwelling. service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
.'CO;\TRACTOR ;, - • , _ Sivi or outline lighting 53.40 2
Business name: Electrical Signal circuit(s) or limited -
r Inc. energy panel, alteration. or
Address: 9640 a' &ratline qtr S.fite ( extension Describe: 1 Page 2 75.00 2
City /State /ZIP: pelmet—tin, CR 97005 Each additional inspection over allowable in any of the above
Per
Phone: 603 )626-3344 Fax: ( 503 ) 626 -3377 Investigation 62.50 onn on per hour (I !v mini 62.50
CCB Lic.: 49850 Electrical Lic.: 34_281C 4_$upn•. Lic.: 5350 g Industrial plant per hour 73.75
ELECTRIC'' P ER M IT :FEES:,'
Suprv. Electrician signature. required: / /'j'� 75 -
Subtotal: 00 0
Plan review 125% of permit fee):
Print name: Etivi i t Date: 7/17/09
State surcharge (12% of permit fee): 9,00
Authorized signature: TOTAL PERMIT FEE: 84,00
This permit application eipires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
. Number of inspections allotted per permit.
1 /Building \Permits\ELC•Pcmhit Opp dot 0572370 44O- 4I5T(I1,05.(O \1AVEB
I
r �� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 1 COMMUNITY DEVELOPMENT Permit#: ELR2009 -00194
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
Parcel: 2S113AB00600
Jurisdiction: TIGARD
Site address: 16125 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: St. Jude Medical Center
Project Description: Install Card Readers and Access Control Panel
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 07/21/2009 $75.00
#300 12% State Surcharge - Electrical 07/21/2009 $9.00
PHONE:
Contractor:
HUGHES ELECTRICAL CONTRACTORS INC
9640 SW SUNSHINE CT #600
BEAVERTON, OR 97005
PHONE: 503 - 626 -3344
FAX:
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: N Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: Y
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 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 95407 $ 100. 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:
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.
-- Ffbin; 07/17/2009 14:53 #976 P.001/002
RECEIVED
Electrical Permit Application R FO O
�u� i zoos FFICI: USE ONLY'
City of Tigard Received
g • g CITY OF TIGAR I► Dare93v. k J • Permit No : £ �e q ,,
13125 SW Hall Blvd.. Tigard. 97223
C Phone; 503.639.4171 Pax: 503.598 H tILDING DIVISI I! ' other Pennn:
TIGARll Inspection Line: 503.639.4175 Lv ,i .to Ready /By: /urn ® See Page 2for
I nternet: wit '.tigard or.gov Notified /Method Supplemental Information
PLAN RE\ IEW
❑ New construction ] Addition /alteration /replacement Please check all that apply. (submit b sets of plans sw:items checked beim%1
❑ Sery ce or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
„CATEGORI OF.;CONSTROC770N, exceeds 10,000 amps at 150 volts or ❑ rioating buildings.
... : • - .. .. .... - .. . - - ........ less In grout id. 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: ❑ Fire pump. ❑ Installation of 75 KVA or
_. .' - .- system. tatper at
sepatehderiveds "stem
.
JOBrSITE INFORMATIOA AND'LOCATION" Addition of new motor load of ❑ A - . - E "..1 -2 - 1.; .
Job no.: 910262 Job site address: 16125 SW 72 t1 Ave ' oP or more. Re c Te ancn.
❑ Six or more residential units. ❑ Rrcrcarional vehicle parks.
City/State /ZIP: Tigard QZ 97224 ❑ Heahh -care facilities ❑ Supply voltage for mote than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: st J mEdical cuter ❑ Service or feeder 600 amps or more.
Cross street /directions to job site: Description FEE SCHEDULE ;.. . T a
1 Qn " . 1 Fn. 1 Thal � 1 ^
' New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. H. or less 145.15 4
Ea. addl 500 sq. R. or portion 33.40 1
Tax map /parcel no.: Limited energy. residential
DESGRIP.TION,OF WO (w all abo csq. 5) 7'00 2
Limited energy, multi - family 75.00 2
Install Qa d Readers and P,axMS ur>tal) car el residential (.with abns•e sq. n.)
Services or feeders installation, alteration, and /or relocation
200 amps or Tess 80.30 2
O PROPERTY.. OWNER 0I T 201 amps to 400 amps 106.85 2
Name: 401 amps to 60(1 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 /L1P: 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 201 amps to 400 amps 100.30 2
intended for sale. lease, rent. or exchange. according 10 ()RS 447. 449. 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new. alteration, or extension. per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT 0 CONTACP PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name:
B. Fee for branch circuits
irirhout service or feeder fee.
Contact name: first branch circuit 46.85 2
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: ( ) i Fax :: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 5.3.40 2
_ . , ,_'CONTRACTOR .. _ Sign or outline lighting 5340 2
Business name: Signal circuit(s) or limited -
r energy panel, alteration, or
Address: 9640 aJ arlshine C&2tt ate extension. Describe 1 Page 2 75.00 2
City/State /ZIP: BEEfiertal, eR 97005 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 5 0 3 ) 6 2 6 - 3 3 4 4 Fax: ( 503 ) 6 2 6 - 3 3 7 7 Investigation per hour i l hr min) 62.50
CCB Lic.: 49850 Electrical Lic.: 34_281e ___I-Suprv. Lic.: 5350 g Industrial plant per hour 73.75
L/ b / ::ELECTRICAL PERMIT FEES, ..
Supt•. Electrician sign re. required: /./ --'- 7/1/I, 7 / �i � Subtotal: 75.00
!� Plan review (25 °ru of permit fee):
Print name: Laid T ram Date: 7/17/09
State surcharge (12% of permit fee): 9.00
Authorized signature: TOTAL PERMIT FEE: 84.00
This permit application expires if a permit is not obtained within 180
Print tattle: Date: days after it has been accepted as complete.
" Number of inspections allmsed per permit
I `Building \Pcrmils1ELC- PomitApp dor 05123I5e, .140- 46I5T(114151COIiAVEB