Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 00274
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/09/2010
TIGARD 13125 2S113AB01201
Jurisdiction: TIGARD
Site address: 16290 SW UPPER BOONES FERRY RD
Project: Dow Aerosciences Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Low voltage for fire alarm modification.
Contractor: ADVANCED SECURITY & FIRE Owner: PACIFIC REALTY ASSOCIATES
2218 NE SUNRISE LN 15350 SW SEQUOIA PKWY #300
HILLSBORO, OR 97124 PORTLAND, OR 97224
PHONE: 503 - 519 -4550 PHONE: 503 - 624 -6300
FAX: 503 - 640 -8311
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/09/2010 $75.00
12% State Surcharge - Electrical 12/09/2010 $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: N Fire Alarm: Y
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 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 i ccordance wi - •proved 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. TENTION: Oregon la • equir- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 1 -0010 through OAR 95 ''01 -1090 may obtain a copy of the rules or direct questions to OUNC by calling 503}� 19887or 1.800.332.2344.
6144
Iss ed By: 0 / 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 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 Application � � Received FOR OFFICE USE ONLY g O /0,20 n 7
City of Tigard A�� Date /Ba Z/� c c - Li e it A
Permit No.:
I 131 25 SW Hall Blvd., Tigard, OR 97223 Plan Review
' 17 . Phone: 503.718.2439 Fax: 503.598.1960E( 9 2010 B Date : Other Permit: eaB
Inspection Line: 503.639.4175 l L Date Ready /By: re ds_ ® See Page 2for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE OF Viii,DiNG DIVISION 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El 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.
l �
n t,Lc ❑ Six ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l -3 ",
Job no.: Job site address:.) 9� SCN �9 ' 4 4 r/ /
'J � or more. occupancy.
� o Six o or r more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ; _--5, 1 ,,,, D � 9 �„�LI 7,,r � ❑ Haz dour fcation vo ❑ 600 voltage for more than
(f ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: / 0a) /?n f , n S i€ irlc $ ❑ Service or feeder 600 amps or more.
f� 3 FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
1 1
,�f _/ - 0 / Limited energy, multi - family 75.00 2
/ l u �t !` / / c' r J_ o 6a; Ice f /7� -l' re e /9 / /2 P rn residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
.52 5i-ern • 200 amps or less 100.70 2
❑ PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 133.56 2
/0,9 C Tp u ..5
401 amps to 600 amps 200.34 2
Name:
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
n relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy / 76-419 '
% . , F - panel, alteration, or extension. Page 2 2
Business name:
�d v/9 n e e d s e car, 1 t j 7 e Each additional inspection over allowable in any of the above
Address: cL 7 / 9 ) � f A /9 y c n u . Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: fO eS4 G f ove O/C Q 9 �/.4 Industr 1 mm) 78.28 /hr
� Industrial plant (1 hr min) 78.18/ hr
Phone: (503) S) eq. S SO Fax: (5 3 S-)-- g) 5 7 Inspections for which no fee is 90.00/ hr
specifically listed (V2 hr min)
CCB Lic.: /C t ) .n. Electrical Lic.: CL, ' g Suprv. Lic.: G f / ff ELECTRICAL PERMIT FEES
Subtotal: 75 as
Suprv. Electrician signature, required: b
Plan review (25% of permit fee): ---
Print name: LAY id o!'s9 V I k Date: /�- q - /D State surcharge (12% of permit fee): pc . 00
TOTAL PERMIT FEE: 8i/ . DO
Authorized signature P This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 12,9 V i ' 7)1 o r / 9 y, k Date: /,)-C4 - JO * Number of inspections allowed per permit.
1:\ Building \ Permits \ELC- PermitApp.doc 07/01/10 440- 4615T(11 /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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 07/01/10