Permit III q CITY OF TIGARD
COMMUNITY DEVELOPMENT ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2007 - 00422
7
: 11/1a/2oo
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED:
2S 14/200 00300
SITE ADDRESS: 15230 SW SEQUOIA PKWY 100 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG
PROJECT: A COMMON THREAD
Project Description: Low voltage for (2) systems, data and alarm.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: ALARM X
TOTAL # OF SYSTEMS: 2
Owner: Contractor:
PACIFIC REALTY ASSOCIATES BLUE SHIELD SECURITY
15350 SW SEQUOIA PKWY #300 -WMI PO BOX 14344
PORTLAND, OR 97224 PORTLAND, OR 97293
Phone: Contact #: PRI 503- 228 -5433
FAX 503- 228 -2881
FEES Reg #: ELE 26- 935CLE
LIC 81272
Description Date Amount
[ELPRMT] ELR Permit 11/14/2007 $150.00
[TAX] 8% State SurcharE 11/14/2007 $12.00 REQUIRED ITEMS AND REPORTS
Total $162.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started with . - • - s of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by e Oregon ity Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of - lip or direct q estions to OUNC at
503.246. or 1.800332.2
I
Jo,.
ssued ir...414-44 i Permittee Signature:
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'N: 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 Application FOR OFFICE USE ONLY
C o f T Received
i gard Date/By: // / b 7 L•� Permit No.: &JAZ ?—e C /
�i .
II 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
` C ' Phone: 503.639.4171 Fax: 503.598.1960 • Date/By: Other Permit: •
T I G A I1 D Inspection Line: 501639.4175 Date Ready/By: i› //�� ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: /e (it Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items 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 at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
. ❑ 1 - and 2 family dwelling › /industrial ❑ Accessory building amps for all other installations. buildings.
• ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. . ❑ installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
/S„3a0 ) ❑ Addition of new motor load of ❑ "A ", "E ", "I - 2 ", "1 - 3 ",
Job no.: Job site address: i I�OHP ore. occupancy.
❑ Six rtts trr ts. ❑ Recreational vehicle parks.
City/State /ZIP: 77� �� ❑ Health-care a Hazardous cities.
❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: /O Q I Project name at,,t,e, v 7-- e , 4 p ❑ 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
Ea. add'I 500 sq. ft. or portion, 33.40 1
Tax map /parcel no.: , Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2,
) Limited energy, multi - family 75.00 2
/T_ �� Zj S /s / 0.e 7�l - f . yv � residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
•
200 amps or less 80.30 2
. ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 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: ( ) I 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
Branch circuits — new, alteration, or ex tension, per panel
Owner signature: Date: • A. Fee for branch circuits with ,
g APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
_ each branch circuit
Business name: �� B. Fee for branch circuits
1 - >
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
Business name: / Signal circuit(s) or limited -
_ . �/�/ / c� _ 1 i� energy panel, alteration, or eC
l !_F � SG1 e
Address: extension. Describe:
Page 2 l 2
P �o� — 0,¢T» ' 41-
City/State /ZIP: p , Z2/2 9 7;2 9. Each additional inspection over allowable in any of the above
/ ( Per inspection 62.50
\0 Phone: (,5;3) ‘ 2,1-6 — Z./.3 3 I Fax: (6'�) S d-gy / Investigation per hour (1 hr min) 62.50
\• CCB Lie.: g v, - 7OZ I Electrical Lie.• / .... 3s— uprv. Lic.: f?f9r7 Industrial plant per hour 73.75
� z ELECTRICAL PERMIT FEES
Suprv. Electrician signature, requ - a' " , 7 / / /Q g /
t.-
.,/ S 5� 00
Print name:. / // . Al---A--g Date: Plan review (25% of permit fee): / a
/'�/ ://_744_,e;,•7 State surcharge (8% of permit fee):
Authorized signature: . TOTAL PERMIT FEE: EP A ,60
- ' Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \Building\Permits\ELC- PermitApp.doc 05/23/06 • ' 440- 4615T(11/05 /COM/WEB
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
`jam D ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
V , 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
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00422
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2007
Phone: (503) 639- 4171w ill,
Inspection Requests (24 Hrs.): (503) 639 -4175 ___.
INSPECTION WORKSHEET FOR DATE: 114/2008 TIME: 7 :01AM PAGE: 62
SITE ADDRESS: 15230 SW SEOUOIA PKWY 100 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: A COMMON THREAD
DESCRIPTION: Low voltage for (2) systems, data and alarm.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: BLUE SHIELD SECURITY , PHONE #: 503. 228-5433
Inspection Request Scheduled For: Date: 1/4/2008 Pour Time:
Code # Inspection Description ( Cori firm # Contact # Message
135 Low voltage 062518 -01 503.228 -5433 V
RR CiINAL
Corrections /Comments /Instructions:
•
I - f 1
Di,
_.
PASD ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �'f1 6(6 L >v Date: 1 Os Phone #: (503) 718- M 'b'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007- 00422
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2007
Phone: (503) 639 -4171 ill
Inspection Requests (24 Hrs.): (503) 639 -4175 "_
INSPECTION WORKSHEET FOR DATE: 11/151200 TIME: 7 :01AM PAGE: 26
SITE ADDRESS: 15 SW SEQUOIA PKWY 100 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
, PROJECT NAME: A COMMON THREAD
DESCRIPTION: Low voltage for (2) systems, data and alarm.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: (JLUE SHIELD SECURITY 1\I\\1L PHONE #: 503-220.5433
Inspection Request Scheduled For: Date: - 11/15,2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage / 1::724-01 503-228-5433 "N Y
Corrections /Comments /Instructions:
•
2,
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c'r N G e Lg Date: 1513 Phone #: (503) 71814/g