Permit " CITY OF TIGARD ELECTRICAL PERMIT
'' �' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00647
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2011
Parcel: 2S 101 AD03500
Jurisdiction: Tigard
Site address: 6600 SW HAMPTON ST
Project: Quest Diagnostics Subdivision: WEST PORTLAND HEIGHTS Lot:
Project Description: (1) branch circuit and (1) limited energy for readers w /transformer and reader expansion boards and CAT -6 cable
between main controller and expansion chassis.
Contractor: METRO ACCESS CONTROL Owner: PACIFIC REALTY ASSOCIATES
2525 NE COLUMBIA BLVD ATTN: N PIVEN
PORTLAND, OR 97211 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 258 -7568 PHONE:
FAX: 503 - 285 -1793
FEES
Quantity Description Date Amount
1 ea Limited Energy 11/16/2011 $75.00
Specifics:
1 crt Branch Circuits wo /Purchase 11/16/2011 $56.18
Service or Feeder
Type of Use: COM 1 ea 12% State Surcharge - 11/16/2011 $15.74
Class of Work: ALT Electrical
Type of Const:
Occupancy Grp:
Total $146.92
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 -00 9 . . u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987
� / � 32..1987 or 1.800.332.2344. /
Issued By: Permittee Signature: n/1/ e. /n47---7 /OA
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 603.639.4175 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 r FOR oFtict USE ONLY
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''':v City of Tigard R it „ /0 7 Augi -
Pennit No.: EZ_C oil —efe, 6
li . .. 13125 SW Hall Blvd Tioard OR 9722RE 1
Plan Review '
'' s "I ' Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit.
T1G AiD Inspection Line: 503.639.4175 NOV 1 5 20111 Date Ready/By: RI See Page 2 for
• Internet: www.tigard Notified/Method: Supplemental Information
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O New construction [X] Add iti onialteatEnPURLY isiON Please check all that apply (submit 2 sets of plans w/1tems checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
E Demolition 0 Other: ,
( where the available fault current 0 Marinas and boatyards.
16
, 11-, - •VO ,,,, , i ,...,....,. 44.4,0*, , ,,,,,,, . , ',.`,"rff.' vri
A'''''',,•e7Ciki '; .tiy.c:Ai-*N*Itoi:1-41KIVe exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling 0 Commercial/industrial El Accessory building amps for all other installations. buildings.
0 Multi-family D Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
iiikiib r
'
liVekiiol■P'-=
, ,'r.TvtvA-1 ,-, vf ,, !: - K, 0 Emergency system.
'' ' ' ' ' - —" ''''81' . '''' 0 Addition of new motor load of larger separately derived system.
Job no.: 98521 Job site address: 6600 SW Hampton St 100HP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg/apt, no.: Project name: Quest Diagnostics 0 Service or feeder 600 amps or more.
J ,. f:-EVS.elifi),iff , ',EitiAiR..:*4 4
Cross street/directions to job site: . Description I Qty. 1 Fee. I 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. adcfl 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: ' Limited energy, residential
$11'f101,':VP:3,;„* . - . 14R , 011101.4)**042,: , :t . Spilk,WIANN4? (with above sq. ft) 75.00 2 _
Limited energy, multi-family
75.00 2
Install 11 prox readers w/transformer, reader expansion boards. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
Pull 1000' CAT-6 cable for wiring between main controller & expansion chassis. 200 amps or less 100.70 2
itiai,ififveeiwA i*::,4_,=-.m Wit Eplifil 201 amps to 400 amps 133.56 2
IC.-....i: , X, ,, , ' , , .7 ,' , i :..::--r- -,,,,, ,:.7,,:e17X-7, t ' .;-,•17A-"':%Iffr ...A ...F.... r0-4-4. -...0, .' ii-N%
401 amps to 600 amps 200 34 2
Name: Quest Diagnostics
601 amps to 1,000 amps 301.04 2
Address: 6600 SW Hampton St Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: Tigard, OR 97223 relocation
Phone: (503)306-1292 Fax: (503)306-1294 . 20h amps Of less 1 I 5936
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
: `:. , ' '.., iri,ViVirgillatTifiVAWfVrk,Z.P 0. 4 tfittli.,671111,56...A'16.40iS6-1(1-N above service or feeder fee,
7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 50. ii3 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: 67 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle . 67.84 2
E
MVeAnkrre. V 4, ,41-y. Sign or outline lighting 67.84 2
04;!:1414rfl-i,.*n'"6$1,Adio te.in?6,4..V.4.,RAVIrfg(ii . . .
--7 5 00
panel, alteration, or extension. "• Page 2 . ' 2
Business name: Metro Access Control
Each additional inspection over allowable in any of the above
Address: 2525 NE Columbia Blvd Additional inspection (1 hr min) 66.25/ hr
' --- --- — -- --;
Investigation (1 hr min) 66.25, hr
City/State/ZIP: Portland, OR 97211
Industrial plant (1 hr mm) 78.18/hr
I;'1" (503) 258-7568 Fax: (503) 285-1793 Inspections for which no fee is
90.00/ hr
specifically listed (/ hr min)
j" Lic.: 46091 5p/r Lic.:(2Virf3C.,L Su . Lie.: 4459S 14,;:gt'".64;74.A.W1.14:-.K.W',.0:E.R.19.M.a.t.',:..Si,l',::-TA:
Suprv. Electrician signature, required: / 7
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,
- ''# ID Plan review (25% of permit i b t t f o e t e a ) 1 : : 1 3 I , tO
Print name: Kerry Pauley Datel State surcharge (12% of permit fee): i 5 1
TOTAL PERMIT FEE: \ Alp , ci 2_
- Authorized signature: .. /4*
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Kerry Pauley Date: 11/10/2011 * Number of inspections allowed per permit.
1ABuilding \Permits \ELC-DermitApp doc 07/01/10 440-4615T(11/05/COM/W813
Electrical Permit Application- City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
[ RESIDENTIAL:WORKcONLY . ITT;
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORIK ONLY # Z MIN
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
I I Outdoor Landscape Lighting*
❑ 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