Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELR2009 -00174
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/06/2009
Parcel: 2S112DA00800
• Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 170
Subdivision: Lot: 0
Project: Spec Space
Project Description: Low voltage for data telecommunications
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
• ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 07/06/2009 $75.00
#300 12% State Surcharge - Electrical 07/06/2009 $9.00
PHONE:
Contractor:
TELEDIGIT INC
PO BOX 22287
PORTLAND, OR 97269
PHONE: 503 - 722 -8084
FAX: 503 - 722 -9914
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 Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. work will
be do ' -cco •an - 'th approved plans. This permit will expire if work is not started within 180 days of issu • -_, or if work is suspend d for ore ;•e 180
day.. ATTENTION: Oregon aw requires you to follow the rules adopted by the Oregon Utility Notificati• Ce er. Those le ar h in OAR
95 •- 001 -0010 thro gh OAR 952 -; 0 I +0. ou may obtain a copy of the rules or direct questions to OUNC by calling 50 .246.66 or 1.800.3 • • 3 4.
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1 _ ued By: k ! — o� _ -,1 _% �� Permittee Signature: A , �
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Electrical Permit ApplicatiogREC �+ tI ® FOR OFFICE USE ONLY
ili ° ceived s n �
City of Tigard JU L J
Date/By: 0 Permit No.: C , Jjo? �/ 7
13125 SW Hall Blvd., Tigard, OR 97223 U C 0 y
6 2009 Plan Review Other Permit:
II Phone: 503.639.4171 Fax: 503.598. .M60 2009 Date/By:
T I G R D Inspection Line: 503.639.4175 kiln/ OF Date Ready/By: ' ! RI See Page 2 for
Internet: www.tigard - or.gov BUILDIN TIG Notified/Method: /t�p Supplemental Information
TYPE OF WORK G DIVISIO PLAN REVIEW
❑ New construction ($• Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
r ❑ 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 at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 0, Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. •
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: /,�O S 5 .5 Se vc r� Pt w y Six or or more residential R occupancy. r
❑ Six or more residential units. ❑Recreation al vehicle parks.
City/State /ZIP: S 1 ° ❑ Healthcare facilities. ❑ Supply voltage for more than
.�, a ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: oy� �jq e— ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00
1 4:P V® II- 7 .t C c D �, .� )4'T/�" residential (with above sq. ft.)
S ervices or feeders installation, alteration, and/or relocation 2
200 amps or less 80.30 2
-•)'R ERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: ( ii /-- t`_1rL(,LC-, 7- 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits– new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
/ Signal circuit(s) or limited -
Business name:
�'4 47 i energy panel, alteration, or
Address: L` /Z $ ' � y , .,.„ ,_.e,/ 72 . s 6 , f" extension. Describg• it Page 2 2
City/State /ZIP: ® mac., e n e e .,/c/ O 7Z- 4,'7e</5--- Each additional inspection over allowable in any of the above
/ Per inspection . 62.50
Phone: 6 7 Z.Z. Ivey Fax: ( )
Q Investigation per hour (1 hr min) 62.50
CCB Lic.: r4 /81( Electrical 'c.:5^ Y /SAC = ry . Lic.: 192 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
• Suprv. Electrician signature, required: / ' '�: Subtotal: r76-pV
.............Q Print name „� _ f;-2 �\ \, c 0 ,5 ih Dater G Plan review (25% of p ermit fee):
State surcharge (12% of permit fee): y .00
II
Authorized signature: � 'M - —L TOTAL PERMIT FEE: c.r .
This permit application expires if a permit Is not obtained within 180
Print name•`.,,, , ( `) �. t \ v "S Date: 7 ( , days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building 'Permits\ELC- PermitApp.doc 05/23/06 440-4615T(11/05/COM/WEB
or .i
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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 Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
/4--
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ 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 are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06