Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
•
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00107
Date Issued: 05/29/2012
TFGAR. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S113A601201
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: Data Telecommunications
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 05/29/2012 $75.00
12% State Surcharge - Electrical 05/29/2012 $9.00
Type of Use:
Class of Work:
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N 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 52- 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.
Issued By: W! Permittee Signature: C/t 4 * [� Pue' 1 1 L�+�
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.
May 23 12 03:18p Shawn Giles 503- 727 -3397 p.2 5(
Electrical Permit Applicatio l % --. E I V ED FOR OFFICE
lIl City of Tigard MAY 2 4 2012 Y —
Permit No. L2 ,, v i 3 — oo /01
e ° 13125 SW Rail Blvd, Tigard, OR 97223 �
Permit
Plan
Phone: 503.718.2439 Fay 503.5 Review Other
TI'GAT.1 Inspection line: 503.639.4175 �1 "1 F f� , g /l � r�llppr �,y El See Page 2 far
a ' BUI ®F' "� Dl C IS ;o�y Ready/Br `� SuppkmeotallnformatSOn
Internet: wo w ti r ' D a t e dCt)md:
TkPE of WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement PIoase died- all that apply (submit2 sets ofplan w /items checked below):
❑ Demolition ❑ Other ❑ service or fender 400 amps or more ❑ Building over three stones_
_ where the available fault current ❑ Marines end boatyards.
CATEGORY' OF CONSTRUCTION exceeds 10,000 amps at 150 volts or Q Floating buildings
tem [] 1— and 2- family dwelling El Commercial/industrial ❑ Accessory building amps w ground, or exceeds ons 0 com
❑ Multi- family ❑ Master Commercial-use apficulnaal
aster builder foraucite ia�aaaSotts Installation ❑ Other_ ❑ Tae Pump. ❑ hrtstal(ntion of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ E1e hem. larger separately de rived system.
❑Additimt alum motorload ❑ "A ", E ", ° I - ". 1 -
Job no.: Job site address: 16260 SW UpperBoons Ferry Rd 10°lIP °rm°ra occupancy.
❑ six or more tesideetial units. e.7 Recreational vehicle parks,
City /State/ZIP: Porttand,OR Ellicanb -tee facilities. ❑ Supply voltage for more than
Cl Hazardous locations, 600 volts nominal
Suitefbldg. /apt no.: Project frame Game Day Media ❑ Service or fader 600 amps or more.
FEE MILE
Cross street /directions to job site:
Damps= l Qtr. I cep I raft' I •
New resideuttol Angie- or muld-fandly dwelling unit.
Includes attached garage.
Subdivision: , Lot no: 1,000 sq. ft or less 16854 4
Ea. add'( 500 sq. 0. or portion 33.92 1
Tax map/parel no.: _
DESCRIPTION OF WORK _ Limited residential 75.00 2
Limited energy, Inalti- family
Voice and Data ossidevtiai (with above sq. ft.) 75.00 2
2)4 /� 770 _ , e Services or feeders installation, aeration. and/or relocation
79' Tee ./y/7 tt /V f e 9 ,�1 200 amps or less 100.70 2
❑ PROPERTY _ I - ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amp 20034 2
601 amps to I,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/21P: won
Phone: ( ) Fax ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 440 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 1 to 599 amps 16854 2
Branch death -new, alteration, or extension, oer panel
Owner signature: Date: A. Foy for branch circuits with
above service or feeder beer;,
❑ APPLIt.ANa _ ®CONTACT PERSON
each brava alma 7.42 2
Business name: ProCnm
R Fee for brands circuits without
service or fender fee tint 56.18 2
Contact name: Shawn Giles branch circuit
Each add'! haatch circuit 7.42 2
Addre PO Box 22288 Miscellaneous (service or feeder not included)
City/State/ZIP: Portland,OR,97269 Each maimfactreed or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 727 - 3399 Fax : (503) 727 Reconoea Only 67.84 2
E shawn@proconmw.com Praop or irrigation circle " 67.84 2
CONTRACTOR Signal or outline fighting 6724 2
Signal sucait(s) or limited-cuergy 1 75.00
Business name: Same as above l + or =tension. Page 2 2
Each additional inspection over allowable In any of the above
Address: Additional inspection (1 hr mar) 66.25/ hr
City/State/ZIP: Investigation (I hr mm) 66.25/ hr
lndastrial plant (1 la aria) 78.18/ hr
Phone: ( ) Fax ( ) lnapaxiona for which no Bee is
specifically listed (X in mitt) 90.00/ specifically
CCB Lie.: 194272 Electrical Lie.: CLE282 �Su Lie,: 1172LEA • ELECTRICAL PERMIT FEES ' .
Suprv. Electrician signature, regluted• . ,/ Subtotal: 75.00
�' —.5r Pram review (25% of peril fee):
Print name: Shawn Giles Dam C - Z ' - (2. Slate surcharge (12% of permit fee): 9.00 /
Authorized siature gn � f/J� TOTAL PERMIT FEE: 84.00 10
�s� "��/ do , This permit application expires if a permit is not obtained within 180
Print name: Shawn Grles Dale: / Z I days after it has been accepted as complete.
Pi
5 - ?Ai - ` • Number or inspections allowed per permit.
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