Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 . 11 111 '
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00095
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/14/2012
Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 16260 SW UPPER BOONES FERRY RD
Project: Game Day Media Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: Voice and Data
Contractor: PROCOM TECHNOLOGIES LLC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 22288 ATTN: N PIVEN
PORTLAND, OR 97269 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 797 -0000 PHONE:
FAX: 503 - 233 -8052
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/14/2012 $75.00
•
12% State Surcharge - Electrical 05/14/2012 $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 OA 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2322.1987 or 1.800.332.2344. 1 I
Issued By: kkatt Permittee Signature: iJ 4-Pk
OWNER INSTALLATION 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.
May 13 12 06:58a Shawn Giles 503- 727 -3397 p.2
Electrical Permit Application
RECEIVE ��. FOR OFFICE l SE ONLY
r s 1 SW Hall a� rgand,OR 97223 MAY 1 4 2012 � ( l 4 ' / ii Pernik No.: EZ- 4ta— 0009
Plan Review Otber Permit: J0 0/ . 000w
Phone: 503.T1R.2439 Fax 503.598.1960 DatdBv:
T I G n K L) Inspection Line: 503.639.4175 CITY OF TIGARD pate nead emir El See P, 2 for
Internet www.tigprd- or.gov
BUILDING DIVISION
Notlfied/Method: I Supplemental Information
TYPE OF WORK �1 !` U PLAN REVIEW
❑ New contraction ® AdditioWattetation/r+eplaoement Please check all that apply (sabmitg sets of plans w/ttcm, checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps atIS0 volts or 0 Floating buildings.
less 1:3 1- and 2- family dwelling ® Comm cial/mdust>ial ❑ Accessory building amps ground, er r res eels 14,000 ❑ Commercial-use agricultural
amps for all other irtstallaims. buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fore pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergmry system. larger separately derived system.
❑ Addition of new motor load of ❑ - A ". "E `1 -2 ", - 1.3 ",
Job no.: Job site address: 16260 SW Upper Boons Ferry Rd. 10011P or mom occupancy.
❑ Six or more residential emits. ❑ Recreational vehicle parks.
City/StatelZIP: Portland,OR,97224 ❑ Health-eaee facilities ❑ Supply voltage for more than
• - ❑ Hazardous locations. 6)0 volts nominal.
I Suitclbldg. /apL no_: Project name: Game Day Media El Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ftesenptien I Qtr. I For 1 Teat I •
New reddendal e- or multi - family dwclhng unit_
. Iuctudes attached garage.
SUbdnision: Lot no.: 1,000 sq. it or teas 1 168.54 4
Es. add, 500 sq. f. or portion 33.92 1
Tax map/parcel no.: Limited awn residential
tei>b above s . A ) 75.00 2
DESCRIPTION OF WORK (
Limited energy, multi-family _
residential (with above sq. ft.)
75.00 2
Voice and Data
Services or feeders hsstallalon, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 15356 2
1 Name: 401 amps to 600 amps 20034 2
60] amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
I City/State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
f Phone: ( ) l Fate ( ) 200 swam less 59.36 , 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 auger 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch thralls — new, alteration, or extension, per panel
Owner signature: Date A. Fee far branch circuits with
❑ APPLICANT
above service or feeder fee,
El CONTACT PERSON each hraneL circuit 7.42 2
Business name: ProCom 13. Fee for branch circuits without •
service or feeder foe, fast 56.18 2
w
Contact name: Shawn Giles branch it
Each addl branch circuit ` I 7.42 2
Address: PO Box 22288 Miscellaneous (service or feeder not Included)
Each manufactured or module
City/State/ZIP: Portland,OR,97269 dwelling, service armor fislder 67.84 2
Phone: (503) 727 - 3399 I Fax:: (503) 7273397 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: shawn®prucomnw_com Saga, or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) 75.00
Business name: Same as above
panel, alteration, or extension. 1 Page 2
Each additional Inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
lnviceligation (1 in min) 66.25/ In
City/State/ZIP: -
1 Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) \ Fax: ( I N y' r At 1"r ` Inspections for wbiwhich nn fee is 90.00/
c ^ ` speci6oally listed (SS hr min)
f CB Lic.: 194272 l l Electrical Lic.: CLE282 ` Suprv. Lie.: 1172LEA ELECTRICAL PERMIT FEES
-
Suprv. Electrician signature, required:
' �� 4 I � /
Subtotal: 75.00
Cyr Plea review (25% of permit fee):
Print name: Shawn Giles Date: 5/14/2012 State surcharge (12% of permit fee): 9.00
Authorized signature: ` f / /1. .a TOTAL PE FEE: 84.00
tills permit application expires Ira permit b not obtained within 180
Print name: Shawn Giles Date: 5f14l2012 days after it has been accepted as complete.
• Number of inspections allowed per permit.
LWHuildiii 1'eemib1ELC-Pertmt tppdoc 07101110 440- 1615T(11i05/COMIWED