Permit IN p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00089
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/14/2011
Parcel: 25113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 400
Project: Micro Interconnects Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Data Telecommunications system.
Contractor: XTREME COMMUNICATIONS, INC. Owner: PACIFIC REALTY ASSOCIATES
24023 NE SHEA LANE, #215 15350 SW SEQUOIA PKWY #300
WOOD VILLAGE, OR 97060 PORTLAND, OR 97224
PHONE: 503 - 618 -8816 PHONE: 503 -624 -6300
FAX: 503 - 618 -9985
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/14/2011 $75.00
12% State Surcharge - Electrical 04/14/2011 $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 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 • ',•1 -0090. You may obtain a copy of th= • - or •1 - questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
. / n
Issued By � y . _ :/ PermitteeSignature: __ /#d. — i_.
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.
04/14/2011 08:27 5036189985 PAGE 01/03
Electrical Permit Au licati4ECEIVED roil OFFICE USE ONLY
City of Tigard Reeei�ea
TSatelB : P e rmi t Nn, C k —
11111 44 13125 SW Hall Blvd., Tigard, OR 972N)R 1 4 2011 Flna Review ��
Ii Phone; 503.639.4171 Pax; 503,598, 9 0 Dere/13 . Other Permit: L, • • -- `It •
T I GAR o Inspection Line: 503,639,4175
CITY OF TIGARD Date Ready /13y: t HI Bee Pile 2 For
Internet; www.tigard- or,gov Notified/Method: SP ' g
DING tlpPlrmrnly Information
r -
., : ,.(e,v;,''!J'7i !E IbY• : : _... .: ; REVIEW. .
❑ New construction CZ Addition /alteration /replacement Please cheek all that apply (submit 1 rata of plans w /itcma checked below):
❑ Scrvicc or feeder 400 amps or more ❑ Building over three stories.
e
D
❑ Demolition El Other: 0 De - where the available f.,ntr current 0 Marinas and bany.,r is,
'" . • • , :,. ' t.li#O ''t 111' •ci 0010 }`,.;' •' ' exceeds 10,000 amps of 150 volts or ❑ Floating buildings
lees In ground, or exceeds H,000 ❑ Commercialome agricultural
O 1- and 2- family dwelling N Commercial /industrial ❑ Accessory building amps for all other installations, buildings,
❑ Multi - family ❑ Master builder CI Other: ❑ Fire pump. El instnitntion of 75 KVA or
•i d Em
• ..•„ 5 larger Ica 1- 2","1 -3", system.
• •' ' •' . '�i+ 013. . �' d' 4,'' INFi:' 11t1Vli�i:: �' i{ �iN' rlil�Fl3 ::'[i�Ci�7'lflp�f•'';,� t-, noi,x l o • „ p r "1
., Emergency system.
'.. •'•: • r�l f p "A'. .
., - 2 " "I -7"
,lob no.: 1 - rte fob site address; If$65' 4' �J irnon, I ecreaeereoncy.
rr +C' [J ❑ Silx x o or nrr more residential units, 0 tttional vehicle parka.
C cc/ZIP: _Badjamcf O e... 172-VI �/ ❑ Heelth -cute faeilitica. En Supply voltage for more than
�J ❑ Hazardous locations. 600 volts nnmiaaL
Suitc/hldg. /apt, no.; Project name: t C G In Service or feeder 600 steps or more.
hL� I . _ - PEE sottout;F •
Cross street/directions to Job site: b eprlpann L 0t7. 1 PM I -row I •
New residential single- nr multi -family dwelling unit.
Includes attached garage.
Subdivision: 1,ot no.: 1,000 sq. ft, or less 168.54 ' 4
Tax map /parcel no.: Ea. add'l500sq. ft, or portion 33.92 1
Limited energy, residential
: .. Il' t1 't1ON 41k �R'.(C ' •, _Jwith above 3%) 75,00 2
Limited energy, multi - family
_ _ e � cir.l_ residential (with above sq. tt) 75,00 2
gedi Services or feeders Installation, alteration, and/or_ re locttion
20D amps or lace Pn �. 100.70 2
C1 P*0 1. :'tea Frio''. '::1.:r:' ' _r,• ' 1. 1 ;„... ;.. .:: - ; ' .••' a : ! 'Whit', 201 Amps to 400 amps 133.56
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 aerviccs or feeders installation, alteration, and /or
relocation
_
Phone: ( ) Fax: ( ) 200 amps or leas 59.36 I
201 snips 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 I68.54 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
.�_ 'ti'�I IICi?k i�'1. ..: D CCifrtir ar
: ;, : I {, above service nr feed fee,
.!;, . ... �i x.1000 7,4Z 2
each branch ci
Business name: 13. i'ee for branch circuits without - ..,_
^---- -- •— — service or feeder fee, first 5G. 18 2
Contact name: branch circuit
Each add'I branch circuit 7,42 - 2
Address; Miscellaneous (service or feeder not included)
City/State/T.1P: Each manufactured or modular 67.64 2
dwelling, service and/or feeder
l'hone: ( ) Fax: ;( ) Reconnect only 67,84 2
1: -mail;
- Pump or irrigation circle 67.84 2
— Sign �y� /v y,�,(t� ,� Sign or outline lighting 67,84 2
. _,. -• ,
' • '''"':::..1-':....
._'ll.. .. ,..';. e'... Yr'V C 1 "OR•^' , :� ' ,. Signal circuit(s)
gn aI or limited - energy
Business name; C' - C P 9 LL � b 4 O�. J panel, alteration, or extension. Page jam 2
1 !l /��1 I'1 r, - a Ench additional Inspection over allowable in any0f the above
Add ress : 211'i0 t�9 , r '3 Additional Inspection (I hr min) 66,25 / hr
City/Stale/ZIP; GQ APR- s , Investigation (I hr min) 66,25/ hr
/� f CO_ industrial plant (I hr min) 78.1 8 / hr
�) j ,
Phone: ( / t r 8 G p 4 n rl rl l7 (l f..1 5p;� G (P 9 9 6r lnspe f Cions for which no the is 90.00 / hr
v 7 6.5 1. specifically l (lh hr min)
CCB Lie.: t Z Electrical Lie.: - 5 - 15 -004 Suprv. Lie ; 33 ; . ' . '> ELECTRTCAL:':PERlfftT FEES' .• . .
Suprv, Electrician signature. required; . IF 7J4 ! - a Subtotal: t --
(/ 1 Plan review (25% of permit fcc);
/2.,j� J
Print namc: 1 4 I: „I �.. ! Date: 9. ! r . - i 1 State surcharge (12% of pcmtit (i c):
1 tP TO'1'A I. FF..RMTT FEE;
Authorized signature:
�� This permit application expires Ifs permit is not obtained within 180
Print name; days after it has been accepted as complete.
Date: Number of inspections aliuwcd per permit.
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RIJSIDEI b ` •
Fee for all residential systems combined. ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Ileatin.g, Ventilation and Air Conditioning System*
• Vacuu.,n Systems*
❑ Other
COMM ERCIALVbittr 31VI
Fee for ,ach commercial $75.00
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
Data Telecommunication installation
❑ Fire Alarm Installation
Fj l-I
❑ Instrumentation
Fr Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
7 Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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