Permit RI CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I "• COMMUNITY DEVELOPMENT Permit #: ELR2011 -00178
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 110
Project: Integrated Services Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Low voltage for HVAC
Contractor: GOHMAN MECHANICAL Owner: PACIFIC REALTY ASSOCIATES
14505 SE HWY 212 ATTN: N PIVEN
CLACKAMAS, OR 97015 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 658 -1892 PHONE: 503 - 624 -6300
FAX: 503 - 658 -6925
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/28/2011 $75.00
12% State Surcharge - Electrical 07/28/2011 $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: N Fire Alarm: N
HVAC: y 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 Cente hose rules - - set forth in OAR
952 -001 -0010 through OAR 952 - 001 -0090. You may obtain a .. . h direct questions to OUNC by calling 503.23 •87 or .800.332. '44.
11 11111 —
i r Issued By . Permittee Signature: raggt
/' 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 Applicatio Y!L CEWED FOR OFFICE USE ONLY
A
City of Tigard Received
II Date /By: 7,g (/ & e Permit No.: / , * // l 7
- 13125 SW Hall Blvd., Tigard, OR 97223 J1 1L 2 8 2011 plan Review
Phone: 503.718.2439 Fax: 503.598.19W Date /By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris: EI See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified /Method: Supplemental Information
ING5DWISION
a ,« p r .�,w : ;, ": .:,'I ".o-axs.,. .. : ° ' °,�_ he, :-;. ?:!. a.r a , '...1 . ' <z. ay. 1 . t X1 �i t..
.�, -. c „k4 � ' �T�YPE �O ', y <,. �:�r x.� � �.., �,t r r �,�,, r,)a.< PLAN ( . . , .... - tiz�.°a� r'e,« :
❑ 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 LI Other: where the available fault current ❑ Marinas and boatyards.
'- - A'' " " ° 4 r �` �'` s Tam . ` ` s CTIO <` '' p r exceeds 10,000 amps at 150 volts or s �a 4 r # )� t � >�, �;CA TEG®RYOF,�CONSTR ���4 w , � ['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
li 1 ....>. .,,,�_, _ ❑ Emergency system. larger separately derived system.
k- n l 30BSI7'EINFORMATION4ANDLO;CATION tt , , s . . ' ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", ` I -3 ",
100HP or more. occupancy.
Job no.: Job site address:
//'j SW 5 acne)/ P/2/A."/ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP:
/ -7 J m � !� ❑ Health-care facilities. Supply voltage for inure than
`� ❑Haza rdodous locations. ns. 600 volts volts nominal.
Suite /bldg. /apt. no.: a 0 Project name:IN re 9 044 56eY,eL-� Service or feeder 600 amps or more
' is I t ; x e Pfd ` IEEE :0:05077,. ":-W _ ",
Cross street/directions to job site: Description I Qty. 1 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no
Limited energy, residential
* .s: tm t . �' DESCRIPTION' ' O Wekteb 4 ; V r 4
_ r.. ... ,. I (with above sq. ft.)
., 75.00 2
"" "" Limited energy, multi- family 75.00 2
T 5 ' 7' 7, residential (with above sq. ft.)
'/ Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
=a: " . n0 PR OP ERTY OWNER :. .l 3 '❑. TENANT„ "°- . .... . . . . . . .n.. A , ps a a , . ,fir, . . , � ._„ _. , , ,, : , , , A. - , mom' . S
, -. 201 amps to 400 amps 133.56 2
,
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
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
' ' s> �
- [ APPLICAN? i _ ° i . t . 0, CONT 1" P s, above service or feeder fee, 7 42 2
�..: .7. , , , ,_ . , ,,,.,..�,m a � � aA ^ , P... z_ , m� ,,,, 6 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 mufacturd or modular
City /State /ZIP: dwell ng, service an /or feeder 67 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: 67 84 2
' a' /t ,r.,.1y` m, w- ''.'i. _ " ' °:., e0.,'TR'' ,, ;a °k;:w° `y° ; :"°1 .' Y;£. ; ' i''''_
Sign or outline lighting
4 2 ,, ,''' ,,, .t_.� _ AA,v I , , ,„< A,C. a,, A N , CTOR'4 . .7d . .,4 ra� t. E 4 S circuit(s) or limited- energy / 75-"e°
Business name: l� (7h LQ-i l N1 � C'IC , el i C ( 7 �, r panel, alteration, or Paget 2
OA I • Each additional inspection over allowable in any of the above
Address: /1-15-05 5 _ f_ ' , -t) is -( al gZ Additional inspection (I hr min) 66.25/ hr
(
�] (� f Investigation (I hr min) 66.25/ hr
City /State /ZIP:
CL 14C fltm
�+� S I ` v ! Industrial plant (I hr min) 78.18/ hr
Phone: tip, ( _ / 3Q Fax: ( ) Inspections for which no fee is
specifically listed (V2 hr min) 90.00 / hr
CCB Lic.: 1 Electrical Lic.• G > Suprv. Lic.
1 � Lf � � t 3y�GL L p i1037LEB q .3 t >. ' EL:ECTRIGALPERMTTFEES� , AW-in
Suprv. Electrician signature, required: ' >/ // Subtotal: 75: 0
�.. —∎: Plan review (25% of permit fee): .■-----•
Print name: Aot.r't[ CAD M v Date: _ � A State surcharge (12% of permit fee): 9.0o
• TOTAL PERMIT FEE: gq,00
Authorized signature: .V7e,,c,...
This permit application expires if a permit is nut obtained within 180
Print name: D 7- f days after it has been accepted as complete.
.� /� o 0 NA -11._ CA-- - 0?8 . Number of inspections allowed per permit
I.\ Building \Permits\ELC- PermitApp doc 07/01/10 440- 4615T(I t /05 /COM/WEB