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Permit
,, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00011 TEGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2012 Parcel: 2S113AB00600 Jurisdiction: Tigard Site address: 16125 SW 72ND AVE Project: St. Jude Medical Center Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 30 Project Description: Data telecommunications system. Contractor: IES COMMERCIAL INC Owner: PACIFIC REALTY ASSOCIATES LP 16135 SW 74TH AVE ATTN: N PIVEN TIGARD, OR 97224 15350 SE SEQUOIA PKWY #300 PORTLAND, OR 97224 PHONE: 503 - 648 -1900 PHONE: FAX: 503 - 670 -9572 FEES Description Date Amount Specifics: Restricted Energy Permit 01/19/2012 $75.00 12% State Surcharge - Electrical 01/19/2012 $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 $84.00 Other Desc: Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344. k Issued By: ✓% /mot Permittee Signature: G Ii /rt _�_�. I OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 01/17/2012 14:22 5036709572 IES COMMERCIAL INC PAGE 01/03 • Electrical Permit Applic,FnCEIVED Foil OFFICE USE ONI.Y City of Tigard 17 2012 Dale/t3 d l - e ; � Permit. ./ 13125 SW Ball Blvd., Tigard, OR 9 2 Reiv Plan Review 11 ` Phone: 503,718,2439 Fax: 503.598.1 nntell3y: Other permit • 1 T I C.: A R D inspection Line; 503.639,417$ Ci 1 y uF TI aARD Data Ready/13y: Itari.; ial See Page 2 for Internet: www.tigard- or,gov BUILDING DIVISION Not.ifcd/metltocl: _ -' 'L7fi Supplemental Information 7 .�. . \�.r � .. ��:. k, �.,..... .., ., ..� .�..m ,.. ...1 .: Y . 6,� i, "'Yil ' , ";7t, ",,t,' :,S, .: � .. ♦ 1. . ... , i. ... � ..., „ , .x I .., .:. : ::.,, . '; } ;I.. i:l " r':ftp .r::::.1'..',� V . P lease check all that apply (submit .. ,. ❑ Now construction ® Addition /alterationh•eplacemeni • PP Y (• bmit / sets of plans Wilting checked l)oiow); El Service or fccdcr 400 amps or moro ❑ Building Over three stories, ❑ Demolition ❑ other whom the available limit current In Marinas and boatyards, '' , 1 l :i:' 1 ' dAiiidoitiigdF , CO1 STRY7,CTIOIY oxccodg 10.000 amps at 1$0 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 0 Commercial -use agricultural ❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: Cl Firc pump. © Installation of 75 KVA or , r '' �,` t°-• ,� ,y, e5SPA i]lmcrgc"cy Mimi. larger deriveds•stem,, h, , . 1, 71: '1 w,ll� 3' Si`..; r i� (1ilr'(A A, V1`I 1� V T)( :.. 4 1 1' Y 1 "' © Additimt of new motor land or © "n " "I" ", "1 -Z' "1.3 " I Job no.: ` 1 Job site address: 1001'rm or more. ncy, ❑ Six or more residential units. Q Recreational vehicle parks, City /State /ZIP' / / G.r`d (/1° 4 , 9 Q Health -care facilities. El Supply voltage for more than 0 Hazardous locations. G00 volts nominal. Suite /bldg. /apt. no.: F' `- O service or nr mote, f eeder 600 amps h /�✓Gt+.' �A —Tip . �✓_ � p. job site: rolE/ /ti .�U ,. Ileecrr I lc Ffi' i 1 SC Iy>7J 1 :ii l'�v.` :'g'„!i ,C a i /c;',, Cross street/directions to ; t.4M. Tan,t f . ' New residential single- or multi - family dwelling unit. includes attached garage. Subdivision: ., Lot no.: 1,000 sq, ft, or loss 168.54 4 Ca. ode r' 500 sq, ft. or portion 3392 1 Tax map /parcel no -: t 1 — ; ,.,, w: .,,, residential .. , ,, Limited esi H 1 ; �I�J�aPCIi(f .01~`.',1tii n r.., i (with tlbovesq, fl;,) - — 75 00 2 g Limited energy, multi-family 75,00 2 - t- - -C" -- 47 4 -1-(-- 47 41.4,...1 ./ 4 - iiU ',. residenti: (with above sg• ft.) 1 Scrviccs or fccdcr$ installation alteration, and /or relocation 200 amps or less 100,70 2 - rz;,,.,,,,.. ".:.;,,:., r :.,,:...',,,,,. ry > :., .. l; S i Ui:PROIiitI T,1f,1151'v,tER,i ` ' t,l K _I i . 1t'4ANT s. 201 amp la 41)0 amps 133,56 2 Name: 401 amps to 600 amps _ 200.34 2 601 amps to 1,000 amps 30 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or (ceders installation, alteration, and /or relocation Phone: ( ) F ( -) 200 amps or less 59.36 t 201 amps to 400 amps 125,08 2 Owner installation: This installation is being made on property that I own which is not 401 8.5 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. .. T Branch circuits new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with i i ❑' AEt'LI0A1V'1r; 1 t ' ' , r r� ' C 1+ 'c above service or feeder fcc, ;.;., 1 i " ' :; lL�C1]TA� k I'�u1i5Q1V each branch circuit 7 2 Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each. add'l branch circuit _ 7,42 2 Address: Miscellaneous (service or feeder not included) Etch 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 . ;::.;...., i.,y, ,,.1ST ".r. ^ „ hr „- .: .v- r.'r:;rq - I T'i - "'C'r\ :1:X1 - 2 , C` NT"ftAi;G'1' j1k Sign or outlin lighting 67 84 . i t ;., -...M' S c or limite - energy Business name: IES COMMERCIAL, INC panel, alteration, or extension. / Page 2 �6 2 Each additional inspection over allowable in any of the above Address: 16135 SW 74 AVE Additional inspection (i hr min) 66.25/ hr Investigation (1 hr min) 66.25/ hr City /Sta.te /ZIP: 3IGA.IZD, OR 97224 Industrial plant (1 hr min) _ 78,18. In — Phone: (.503) 64$ - 1,9Q0 Fax: (503) 670 -9572 Inspections for which no fcc is In u specifically listed h h min CCBLie.: 182452 Electri Lie.; C4.4.$ Suprv. Lie,: 331 -�8 i;.l[+]f;EZ'I1i1CCAI1Isk ]ff Suprv, Electrician signature, required: Subtotal: _75.--, a Plan review (25% of permit fcc): Print name: Date: / / .1-..... State surcharge (12% of permit fee): 9 p'O TOTALPERMiTFEE: t f F el 6 Authorized signature: This permit appticntinn expires if a permit is not obtained within 180 dnye after it has been accepted as complete. • Print ntime. - _ ,Date. • Number of inspecti allowed per permit. I:1'Quiltliag \Permits \ELC•PermitApp.doo 07/01/10 44e- 4r70T(1 /a5 /co7 / r1 Ii 01/17/2012 14:22 5036709572 IES COMMERCIAL INC PAGE 02/03 Electrical Permit Application -- City of Tigard Page 2 - Supplemental Information. LIMITED ENERGY PERMIT FEES: 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* ❑ Vacuum Systeins* ❑ Other; ,015I14IMtCIAL:i (:), Fee for ec commercial $75.00 system (SEE OAR 918 -309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler. Controls ❑ Clock Systems W . Data Telecommunication Installation ❑ Fire Alarm Installation ❑ I-IVAC ❑ Instrurn.entation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* • ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses arc required for all other. installations 1: 113uilding ?emiltalAl-C- Penn11App,000 07 /01/10