Permit rikri CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00250
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2010
TIGARD Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16290 SW UPPER BOONES FERRY RD
Project: Dow /Das Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Low voltage for data cabling.
Contractor: OREGON ELECTRIC GROUP Owner: PACIFIC REALTY ASSOCIATES
1709 SE 3RD AVE 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97124 PORTLAND, OR 97224
PHONE: 503 - 234 -9900 PHONE: 503 - 624 -6300
FAX: 503 - 535 -2763
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/18/2010 $75.00
12% State Surcharge - Electrical 11/18/2010 $9.00
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: y Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit issued subject to e regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done accordance with appro -d plans. This permit wit expire if work is not started within 180 days of issua e, or if work is suspended for more the 180
days. TTENTION: Oregon I- , r -. ires you to follow the rules adopted by the Oregon Utilit i
o'' c5fon Center. Those rules are set forth in OAR
952 -0 1 -0010 th ough OAR 9 - 001 - 0/9s ou may obtain a copy of the rules or direct questions to OtJ C by call 1987 or 1.800.33 .2344.
Is ed By: f . /II ..��..� P ermittee ' Signature: o' '' 1(11 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 the next available inspection date.
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 Applacati Iv t FOR OFFICE, USE ONLY
City of Tigard Received
`.1 g DatelB :
m p.m. , /y0 -/C,
13125 SW Hall Blvd., Tigard, OR 9722 % 4 2010 Plan Review
Phone: 503.639.4171 Fax: 503.598.1980v ' Date/By: Other Permit: • .
TIGAltD Inspection Line; 503.639.4175 7 • (. ARp Date Ready/By: rum' ® See Page 2 for
Internet: www.tigard- or.gov CAN OF Two' Notified/Method: tt 6 Supplemental Information
it/L: - r .41 :: � .141 x 14 ma ..z.1 4,..1i. - 3 .:t ai
Please check all that apply (submit 2 sets of plans w /ites checked below):
❑ New construction ®Addition /alteration /replacement m
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault c urrent
❑ Marinas and bualyttrJs.
7 a e ' "a6 ' ti 0 .� e - - - rtrant , exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
d ' . 1 I,..ta„u a• 3Ez� u tip? sat 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 El Other: ❑ Fire pump, ❑ Installation of75 KVA or
t o4
, e - gtW� ; ❑ Emergency system, larger separately derived system.
acf ..a �6 � o, �, 0p. ® i.
a-p ,I.d: -. _r�r . s �' s �,r3 t sr �'a! L. i .„, El Addition anew motor load of [] "A "13 ", „ 1 , 2 „ "1_3
Job no.: 62294 Job site address: 16290 SW 1001{P or more. occupancy.
,Q _...__ " "__. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: PORTLAND, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nornuml
Suite/bldg. /apt. no.: I Project natne: DOW / DAS REMODEL ❑ Service or feeder 600 amps or more.
5 s C 3 .t` t t� 1 3� .'- _ �. 1 { M4IN`t
Cross street/directions to job site: Description Qty. pee. Total . *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or Tess 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
U m a „ r _ Limited energy, residential II ,fr,... . 301. , i, - 1 : 4 ,..8 � 4 - , ,421.„.. .. r r ,„ AO s * " r $1,. . ( with above sq. it.) 67.84 2
Limited energy, multi- family
VOICE / DATA CABLING residential (with above sy. 0.) 67.84 2
Services or feeders installation, alteration, and/or relocation
fi r. ,. �la +;, fi e ;� s * a xga { 1, y a y 200 amps or less 100.70 2
4 1 : ''y �9 t of a i i ' 1 . al' s i. . ..l rF , % ;? .1 201 amps to 400 amps 133.56 12
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59,36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 atnps to 599 amps 168.54 2
Branch circuits -- new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
iw a te; - -rca f r a 1 = r 374,0 '.. ' f .' a " ', above service or feeder fee
'tb rr�. . .... a w fbd . � , : n.11. "a.. , k v 7.42 2
each branch circuit
Business name: OREGON ELECTRIC GROUP B. Fee for branch circuits
Contact name: JAMES FITZGERALD without service or feeder fee, 56.18 2
first branch circuit
Address: 1709 SE 3 AVE Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not Included)
City/State /ZIP: PORTLAND, OR 97214 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 234 -9900 I Fax: : (503) 234 -1001 Reconnect only 67.84 :2
E -mail: Pump or irrigation circle 67.84 2
-i . ; s us rv - H ,', nz,z ti
. , ' ez , I ' i . p . . _ . ;'a A — . 4 - . , - , ? • J t ul Sign or outline lighting 67.84 2
Business name: OREGON ELECTRIC GROUP Signal circuits) or li mited - _
energy panel, alteration, or
Address: 1709 SE 3" AVE extension. Describe: 1 Page 2 x' r 2
VOICE DATA CABLING 7S
City/State /ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in any of the above
Phone: (503) 234 -9900 I Fax: (503) 2344001 Per Inve inn 66.25
gation per hour p hr min) 66.25
CCB Lic.: 203 Electrical Lie.: 26 -95C Suprv. Lic.: 4818S Industrial plant per hour 78.18
�� ° 'butt , h, 0 e"
Suprv. Electrician / e r uirc / f O ' _.
P J 1 j �l Subtotal: 6
r A! ll jl h. ' h r ' Plan review (25% of permit fee):
Print name: MA . ' ai as /910 e $ � Ab
State surcharge (12% of permit fee): 9.
Authorized signatu FAT l i 7' / TOTAL PERMIT FEE:
i v;± s vrf 1 , 7`I This permit application expires if a permit Is not obtained within 180 00
Print name: MARK WEINBENDER days after It has been accepted as complete. •
Number of inspections allowed per permit.
I :1Building\Permits\ELC-PermitApp .doe 10 /01/D0 440.4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a. residential systems combined $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems»
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems"
❑ Other:
I,kr Y 9u • tikTro�}G 'Wc m �\ 1. ( B ,
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
[] Intercom and Paging Systems
❑ Landscape Irrigation Control"
El 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
I1Building \ Permits \HLC•PermitApp.doe 10/01/09