Permit •
a CITY OF MARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00372
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/25/2007
PARCEL: 2S113AB-00600
SITE ADDRESS: 16195 SW 72ND AVE BLD.D ZONING: I -L
SUBDIVISION: PACTRUST BUSINESS CENTER LOT: JURISDICTION: TIG
PROJECT: COMMUNITY HOME CARE
Project Description: Data cabling.
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 ALLPHIN COMMUNICATIONS INC
15350 SW SEQUOIA PKWY #300 -WMI 23220 SW BOSKY DELL LANE
PORTLAND, OR 97224 WEST LINN, OR 97068
Phone: Contact #: PRI 503- 698 -9000
FAX 503- 638 -9100
Reg #: ELE 3- 406CLE
FEES LIC 107548
Description Date Amount
[ELPRMT] ELR Permit 9/25/2007 $75.00
[TAX] 8% State Surcha 9/25/2007 $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 95 - 01 -0100. You may obtain copies of these
rules or direct questions to OUNC at 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'N: DATE:
LICENSE NO:
Cali 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.
, i
Electrical Permit Applicatio EIVED FOR OFFICE USE ONLY
City of Tigard S E P 2 5 i! n! 1 Date /Be ♦ e Permit d"E''• / 4". 7 - Lb 8P7 y
III
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev ew
C Phone: 503.639.4171 Fax: 503.598. I 0OTYOF riGpaip Date /B : Other Permit:
T I G A R D Inspection Line: 503.639.4175 BUILDING ING O Date Ready /By: ® See Page 2 for
Internet: www.tigard- or.gov W tVl7 1V1NT0^I Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction 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.
Tess to ground. or exceeds 14,000 ❑ Commercial -use agricultural
D i- and 2- family dwelling J Commercial /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.
❑ Addition of new motor load of ❑ "A "E "1 -2 "I -3 ",
Job no.: y5(0 Job site address: qc.s 72 fl . a e Six or o more. occupancy.
❑
❑Six or more residential units. Recreational vehicle parks.
City / State/ZIP: -L /I W ' / ❑ Health -care facilities. ❑ Supply voltage for more than
�f 1 N 2-.)- `I ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Ga Project name: C i"1 p.Id -V � Cie ❑ Service or feeder 600 amps or more.
9 FEE SCHEDULE •
Cross street/directions to job site: Description I Qty. I Fee. ) 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. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
QA A -A C a WIN C / Al s44 IL c4,,p residential (with above sq. ft.) _
J Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 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
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 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
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name:
without service or feeder fee, 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 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
/! Signal circuit(s) or limited -
Business name:
r rj Co v`1 M f U - j111 C o. 'I"r bi✓S -- N C. • energy panel, alteration, or
2
Address: 7 7 Z a S' 14) QpS y 0 LN extension. Describe: ! Page 2 7S "Q
City /State/ZIP: 1 x t es + c r � I� i„, 0 9) 0 (p a Each additional inspection over allowable in any of the above
/ // Q Per inspection 62.50
Phone: (So3 ) (03 S , 97000 Fax: (5 10 3 ) 3 8 %/�+ (00 Investigation perhour(l hr min) 62.50
CCB Lic.: / 07,5140 L Electrical .: �D(aC 4 - Supry . Lic.: Industrial plant per hour 73.75 _
` ,(/ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, U Ulre Subtotal: '75 - .60
Print name: lA �� Date: Plan te surc review (25 (8 %of permit fee) :
►fit G t Staharge % of permit fee)
Authorized signature: " N �'j TOTAL PERMIT FEE: y
(� This permit application expires if a permit is not obtained within ISO
Print name: Date: CO-SA') days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 05/23/06 440.4615T(11 05iCOM'WEB
■
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FI_I22007 003%2
. A 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/2EI2607
Phone: (503) 639 -4171 , u,
Inspection Requests (24 Hrs.): (503) 639 -4175 _•
INSPECTION WORKSHEET FOR DATE: 12/27/2007 TIME: 7 :OOAM PAGE: Q0
SITE ADDRESS: 16195 SW 72ND AVE Bl D.D CLASS OF WORK:
SUBDIVISION: PACTRUS•f BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: COMMUNITY HOME CARE
DESCRIPTION: Data cabling.
•
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ALLPI-iIN COMMUNICATIONS INC PHONE #: 503- 691 -9070
Inspection Request Scheduled For: Date: 12/27/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 062183-01 503-807-1810 N
'°'a,
Corrections /Comme /Ins ru ctions:
piL%L\ .
\\\ ,
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr" M Date: i�� 2 0 1 Phone #: (503) 718 -�.