Permit .'
CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00260
'� I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/30/2006
PARCEL: 2S113AB-01201
SITE ADDRESS: 16505 SW 72ND AVE BLDG F 16505 -16535 ZONING: I -
SUBDIVISION: PACTRUST BUSINESS CENTER LOT: JURISDICTION: TIG
Project Description: Limited energy for card access system.
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: CARD ACCES X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES CONTROLS AND MORE
15350 SW SEQUOIA PKWY #300 -WMI 4775 CHRISTOPHER AVE SE
PORTLAND, OR 97224 ALBANY, OR 97322
Phone: Contact #: PRI 541 -981 -0501
FEES Reg #: ELE 22- 178CLE
LIC 153079
Description Date Amount
[ELPRMT] ELR Permit 10/30/200E $75.00
[TAX] 8% State Surcha 10/30/200E $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
rule direct questions , O - .03-246-6699.
Is ed A /„
Permittee Signature: _
By: i ✓,/
■IL/ • /Am.- r ;0„.
OWNER INSTALLATION ONL
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.
Electtital Permit Applicat r' ), , . rule (,FrIcI: usl ONI.\
Received
City of Tigard Date/B . c, , /effLJ Permit No.`e " -
° 13125 SW Hall Blvd., Tigard, OR 97223 E P
S 100 Plan Review Other Permit:
e • Phone: 503.639.4171 Fax: 503.598.1960 `+ U Date/By.
T I - n It o Inspection Line: 503.639.4175 / Date Ready/By: tun•/ ® See Page 2 for
• Internet: www.tigard- or.gov �I i i , 4 t. y I . A 1450fied/Method ) Supplemental Information
TYPE OF - VOW ., ,TTlTtr` --,Ti T 7' PLAN REVIEW
❑ New construction I23 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wbtems 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 ® 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.: Job site address: /6 ,2Q ,7 S f,{f or more. occupancy.
� q ?Re t/P ❑ Six x o or r more residential units. ❑ Recreational vehide parks.
City /State/ZIP: / Ar.J )/A 0, �7 °1 / 7.31y ❑ Health -care facilities. ❑ ply oominaolrmorethan
600 ❑ Hazardous locations.
Suite/bldg. /apt. no.: Project name: Saf e- P J- S — ( --, n — ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Taal 1 •
PaCi-i-Las-t" New residential single- or multi- family dwelling unit.
B ri 5 i h e r r i- 1-' Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK . (with above sq. ft.)
J d (� Limited energy, multi - family 75.00 2
I S' ''-a // v Gd N Gl A c C T-f..$ s ct o residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER OWNER I ® TENANT 201 amps to 400 amps 106.85 2
Name: Sa -e n y/ S U Y'a of 2 C' 401 amps to 600 amps t 60.60 2
n m y ) — 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
j/tri2L>j j /i rtit, Signal circuit(s) or limited-
Business name:
. .. ... ��� N'S - energy panel, alteration, or
Address: A/7 7s C1fQ / � i P !/ 12 411E- __ extension. Describe: / Page 2 2
City /State/ZIP: et" d3 r eiti G 9 7 3 2-2-- - - — Each additional inspection over allowable In any of the above _
uu' Per inspection 62.50
Phone: ' 5y/ – ?e, _.65-0 ` Investigation per hour (I hr min) 62.50
' CCB Lip.: /5 % ? / r ?lectrical Lic - / 7g` ..rv. Lic.: //7/ L A Industrial plant per hour 73.75
A ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: s / / Subtotal:
j ( } Date: 9 _ Plan review (25% of permit fee):
Print name:
t' / a L(f' / .l
' c -e T. Lip J'J C — D State surcharge (8% of permit fee):
Authorized signature: t K 44.tr -c.e La — TOTAL PERMIT FEE:
Print name' y� D ate G _ This permit application expires it a permit is not obtained within 180
t; / 1 4 Li) r / c < T �,@ cp _� _ / ,� days after i t has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Pamits\ELC- PennitApp.doc 05 /23/06 440.4615T(II /05 /COM/WLB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: 1
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.
I COMMERCIAL WORK ONLY:
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
❑ 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 \Pmnits\ELC- PennitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2006 -00260
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/30/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/16/2006 TIME: 7:ODAM PAGE: 62
SITE ADDRESS: 16505 SW 72ND AVE BLDG F 16505 16535 CLASS OF WORK:
SUBDIVISION: PACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: SAFECO
DESCRIPTION: Limited energy for card access system.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: CONTROLS AND MORE PHONE #: 541 - 98
Inspection Request Scheduled For: Date: 11/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 039845-01 541- 981 -0501 Y
Corrections /Comments /Instructions:
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X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: "tJ Date: 11 `6 O.b Phone #: (503) 718 - 2Li16,