Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 00548
Date Issued: 10/05/2011
T l CARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 160
Project: Verizon Corp Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: (2) branch circuits for power.
Contractor: WEST SIDE ELECTRIC CO INC Owner: PACIFIC REALTY ASSOCIATES
1834 SE 8TH AVE ATTN: N PIVEN
PORTLAND, OR 97214 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 231 -1548
PHONE: 503 - 624 -6300
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 10/05/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/05/2011 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71 23
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 952- 001 -0090 You ma - • - - • • of the r = - e • irect questions to OUNC by calling 503 232 1987 or 1 800 332.2344
Issued By: ` Permittee Signature:
OWNER INSTALLATION O S ALLATION ONL Y
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.
Oct 04 2 0 1 1 6 : 35PM West Side Electric 503-73G-0656 p . 1
RECEIVED
. ,
Electrical Permit Application OCT .
v I ,„1,
0 5 2011 .
City of Tird Received j ti
III --- ' 13125 SW Hall ga Blvd., Tigard, OR 9:2TY OF TIGARD Date/B : 1 Ef ffiritiMMrEEMV,
Plan Review .
II
Phone'. 503 639 4171 f fax 503.013
J1POING DIVISION is Date/13 : Other Permit 1.4 1 ,:, Gji
r ,, , ,.„ ,. ,• „ Inspection Line: 503 639 4175 Date Resdy/By Agts e. El See Page 2 for
rn
Inteet' www lizard-cm:4ov NOtifIGIUMethOd: SU pplasental Information
gRttggaOgggneIIWVitiOrig*Wikt40itgtRNNiOqgWargYg*g ''da,W:4414,40C
0 New construction Addition/alteration/replacement Please check all that apply (submit /sets of plans wfitains checked below)
0 Service or feeder 400 amps or more 0 Building aver three stories
0 Demolition Other: where the available fault current 0 Mannar and boatyards
.4/NOUR-a4..0.4NROXAWIWI*;.K5.,,angit,i,:::1:4NR4,-Z- exceeds 10.000 amps ai 150 volts or 0 Floating buildings.
less to ground. or exceeds l4.000 0 Commercial-use agncultural
0 1- and 2-family dwelling gr Commercial/industrial 0 Accessory building amps for all other installations buildings.
I: Multi-family ID Master builder 0 Other. El Fire pump. 0 Installation of 75 KVA or
['Emergency system larger separately derived system.
IW. ,K IL NF' r K . 1*t**gkii i tljfgRrt; = At;ttikjfitiItilill ' INJiWfte; : il 0 Addin on of new mmor load of
100HP or more occupancy.
Job no.: J 64 Job site address: / c7 s 1,3 S ,,,,,, i c ,.. p 4,4,y Ps
more residential mum. 0 Recreational vehicle parks
City/St-ate/ZIP: 77 € ie /Cie 9722 y
/
i* or
01 facilities.
0 Mean:taus locations 0 Supply voltage for more than
600 volts nominal
Suite/bldg/apt no.: ,ifei40 1 Project name: year; Ar 0 Service or feeder 600 amps or More
I .? • 1. ivr : lgi
Cross street/directions to job site: Description I )ti. I Pee. 1 Total I •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168 54 4
Ea addl 500 sq. ft or portion 33 92 1
Tax map/parcel no.: Limited energy, residential
1 •1M. 1 1 1 6..* . n41 1 ANAIrl'l-WI:' 4 ' .1 -4 4 1''''''' 'DOC 'ex (with above sq. ft) 75 00 2
—
Limited energy, multi-family
75 00 2
2 Zit i fh A. Aolect,-.A0Ar. residential (with above sq ft.)
Set-tiers or feeders installation, and/or relocation
200 amps or less 100.70 — 2
6...,-,...,,pg. ,,,. nZ, ta • . : '.V.C. :- - .T'i l - ` 1 10; 201 s to 400 13336 2
. ' , • ' z ' - . .' , ••• • % ,,,' , . , ..• L. : .A.,E•6:5-444;• 4 43, 1 vi:',;. '.., ;,, 41 ``. S, ' 't / A ,:,..::. :1`.0W. 401 amps to 600 amps 200.34 2
ain -• amps
Name: ...
601 amps to 1,000 amps 301.04 2
Address: Over1,000 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 1
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 _
i ":-•! ti ii ..",::::.' ''..3**01.-tagqi4R-41g above service or feeder fee,
742 2
each branch circuit
B Fee for branch circuns withour
Business name:
- service or feeder fee, first
Contact name: branch circuit / 56 18 s-6
i, 2
9 t
Each add' I branch circuit / 7 42 '7 — 2
...
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E •l:
Pump or irrigation circle 67 84 2
-ma
, Sign or outline lighting 67.84 2
areFILAM111*.4.fRallnl.,'!;;Ygatetteilittkit . S osnulc(s) or limiied.e„ergy
pane], alteration_ or extension. Page 2 2
Business name: West Side Electric Co., Inc. . Each additional inspection over allowable in any of the above
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66.25( hr
Investigation (1 Iv min) 66.25/ hr
City/State/ZIP: Portland/OR/97214
Industnal plant (1 hr min) 78 18/ hr
Phone. ( 5 0 3) 231 Fax: (503) 736 Inspections for which no fee is
90.00/ hr
?e caliy (hrmin) ., , , ,
CCB Lie.; 13306 Electrical Lie.: 26-135c I Suprv. Lic.: 4654 _ s - 4•7'.-.,' i , , i, ;:?-;:' ' .-.'''.' ' _ g4(01gliar ” — 7.A.:Yfit'aglit*.3
Subtotal- 63 °
--
Suprv. Electrician signature, required: ja&
Plan review (25% of permit foe).
Print name: Randall F Roberts I Date: /0/ i i/ State surcharge (12% of permit fee): 7
TOTAL PERMIT FEE: "7/ 2 - 5
Authorized signature:
This permit application expires ifs permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date:
• Number of inspections allowed per permit
(114141441Perrints\ELC•PermitApp.444 07/t1/10 440-4615T( I 1/05/C064/WEB