Permit C ITY OF TI GARD' ELECTRICAL RESTRICTED ENERGY PERMIT
ii� DEVELOPMENT SERVICES PERMIT #: ELR2005 - 00396
° -- - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
DATE ISSUED: 11/7/2005
PARCEL: 2S112DD -01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG
Project Description: Data/Telecommunication.
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:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES MATRIX COMMUNICATIONS
15350 SW SEQUOIA PKWY #300 -WMI 4243 SE INTERNATIONAL WY
PORTLAND, OR 97224 STE C
PORTLAND, OR 97214
Phone: 503- 624 -6300 Phone: 503 -513 -9152
Reg #: LIC 74332
ELE 26- 694CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/7/2005 $75.00
[TAX] 8% State Surcha 11/7/2005 $6.00
Total $81.00
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 within 180 days of
issuance; or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: [ Permittee Signature: so f 4ixP
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.
•
ctrical Permit Applica 1 FclR OFFI(:E u,tii•; il�Nt:1'
. �x o Tigard H �EI VE ► f l f
1
` ��, Dates i ��/ �J ,�/ Permit No.: 6l,/b�°�.� a3/16
13125 SW Hall Blvd., Tigard, OR 97223 plat Review
Phone: 503,639.4171 Fax: 503.598.1960 1 .
�,i �, ' i � �y Other Permit:
inspection Line: 503.639.4175 ®� ° ,,, ''''ii I: �
,...... _ _.. tAthc Re°dYBf'% 3 ' �I ® Sec Page Z Tor
Internet: www,ci,tigard.or.us Nntlf ed/Metbod; 1 V - Sopplemdttnl F
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❑ New construction ddition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comet ❑Hazardous location
�; s , ; ', f ' to-�.;� 1 \ r '
Li Semi= over 320 amps- rating ❑ Buildng over 10,000 sq. ft.,
F . R' �i} r • ? 'r I P. ,,:; r ; a .,t „ c . .a. , ,;1 �! ri;; ' , , r.:t:•,r amt d wellin 4 r
:. .1 �1� /f :`,'�r.i�:,,tr,:.a slt!IC „' , ; .: �,.�!,.,. • . - �, r,. ;',, . ,,,, , :, ,.., ,' i��i ? %' rir •,'r ^,l . . ” ": , 2- family � o more residential
1 ' ,, f ,31�;�11i4,, of 1- and 2•f rC new
❑ 1- and 2- family dwelling ( C ommercial /industrial ❑ Accessory building ❑Sys over 600 volts nominal units in one structure
[] Multi- fltimily ❑Master builder El Other ❑Building over three stories ❑Feeders, 400 amps or more
i M i i- f b r n r,ii;ii'!'iil; %° !I • :tY,:]',. , .;, a ❑Occupant load over 99 persons OManufactured structures or
' !1t ,p -':i i r a ' ; Ili iftf kZ'l 1'" lr t'l, `I r,: „.. If _Pgress/lighting plan park
,:.. ..,�..... , �,: � :.:.,... �i:; . ;.f'1�•G'I.i = •. � .. ❑ RV
Job no.: 1 Job site address;: / — $1 j - - • ^-al re facility ❑Other
� '� �`-� �_ ‘5 . '` ) ....nit 2 seta of plans with any of the above.
City/State/ZIP: J /� I ' b P jig The above arc not applicable to temporary construction service.
Suite/bldg. /apt. no.: /19 0 Protect name: 7:; • , //Q *� _ ”, I , F;;r• ;ri !:; � •
'l i y's )" ;1 `: ^;: ; 'r!:!s.::: ,;:'' , . •
, .0 - � " ' 1 / De ;' Qty. .. Rea Total e
•-
Cross street/directions toy t
job sift: New residential single- or multi- family dwelling uni
Includes attached garage.
_--, I 1,000 sq. R or Inas 1 145.15 4
Subdivision: I Lot no.: PAL add'I 500 sq. R or potion 33.40 1
Tax map /parcel no.: 1 Limited energy, residential 75.00 2
.�yyyry,��.Y�yy.,,:yyv ,,f�. y � Limited energy, non - residential 75,00 2
cn: „� uil%51 ., t : ;11 :"4'r'i^lii;r!:u.!:0.'i! ;',01:JWAiffttiti\�Jl"�' W O1� , i 1:•til:4 i:` :.... .. .
IIJI•, t.?l.'�e a?j; ;;!;le f:. ! n . b :f'f. .WgilltWi;: ,,a! !} , ���r� + a: . >i';i; „t; }::
�,• Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
I 200 amps or Ic 80 .30 2
t :.' .•X4:1 . .I. . °
r!t C ,�$ iJ 'f�+!•r„ 4s, ' '' ' " 1. �� ?'r + " r;;,' : % }i:� '.i:di.:Y.k:;:;.. ":' =;` 201 amps to 400 arnpS 106.85 2
.. .. i '' � r FF� �'
t'i:, a• ...• ..r,• n'e, ... : ., ' r •r ":�t'. 1'flJ 4 . , . . 111:,1 rn, re e e , ::.'. 4 •4c ':. ' � .
401 amps to 600 amps 160.60 2
Name:
601 amps to 1,000 amps • 240.60 2
Address: I Over 1,000 amps or volts - 454.65 2
-- Reconncctonly 66,85 J 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and/o
Phone: ( ) I Fax: ( ) - relocation
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, tint, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 1 33.75 2
Owner signature: I Date:
Branch circuits- new, alteration, or extension, per panel
i ;p'1p!,el!ii ;,,a (:;i • . r .. ...- , r' . e ,„, ... : k .: {' rLL V y y r �, I� ' . ' "� 1' A, Fee for beetled circuits ea with
r. .ris .. . , .... ,
serv at feeder fee CACh
Business name: - branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fcc,
Address: each branch circuit 46.85 2
_ Each add'I branch circuit 6.65 _T
City /State/Z1P: Miscellaneous (service or feeder ant included) I `
Phone: ( ) Fax : ( ) Pump or irrigation circle 53.40 1 2
i
_ Sign or outline lighting 53,40 2
E -mail: Signal circuit(s) or limited
i! ;'d;:;:Rr :'( �:;'; ;rr;!:h! :: if:• = ''..: rr;i i : , ....J: i
' 1 a,� r •:.�: •`�::.• e!7 "i�Y��' � � Q �•a ?:r u;c.;,': �<' " r � '�i' " ° '; energy panel, alteration or
Business name: ��► , lion. Describe: ) Page 2 2 •
Address: „4:51, ' i � '„ Each additional inspection over allowable in an of the above
Pet inspection 62.50
City/State/ZIP: �, / . L :/
. I
0.— _ Investigation per hour (1 In min) 62.50
Phone i�� ] 5 ) A Fax: ADO �/ Z �, . + ,Industrial plant per hour 73.75
Electrical Lie • /� '�"' ✓✓ p ✓ : �J1 "a<111, I I , ,Yn {`i Ir, ' ';E l s !o a'•:,.::..;;.A; i:'ti.: :.!;
CCH Lit..
i / ' rv. )sits 1 y! iii:
. - Subtotal • Suprv. Electrician signature, required: / Plan review (25% of permit fee)
Print name: 4/j,ij i +ma State surcharge (8% of permit fee)
Authorized signature: v/ �-- I TOTAL PERMIT PEE .
Tula permit application expire. if a permit is not obtained within 180
days alter It has been netepted as complete
Print name: 1 Date: • Foe methodology set by Tn - County Building industry Service Board
" Number of inspections per permit allowed.
is lBuildmg WennlrARLGPerndtAtfp.doe 12/03 44o° O T,W1313
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00396
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/1/2005
Phone: (503) 639 -4171 .. i�ll�
Inspection Requests (24 Hrs.): (503) 639 -4175 _ °:_..
INSPECTION WORKSHEET FOR DATE: 12116/2005 TIME: 7 :06AM PAGE: 28
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONALS
DESCRIPTION: Data/Telecommunication.
OWNER: PACIF REALTY ASSOCIATES, PHONE #: 503.624 -6300
CONTRACTOR: MATRIX ■ • MMUNICATIONS PHONE #: 503.513-9152
Inspection Request Scheduled For: Date: 12/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 023624.04 503 - 888 -0214 N
Corrections /Comments/ Instructions:
•
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G Ni bB LE Date: IA( b, t\s' Phone #: (503) 718- ti44b