Permit :w
C ITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -00363
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10!20!2005
PARCEL: 2S112DD-01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 140 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG
Project Description: Security.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES T & L COMMUNICATIONS INC
15350 SW SEQUOIA PKWY #300 -WMI PO BOX 87387
PORTLAND, OR 97224 VANCOUVER, WA 98687 -7387
Phone: 503- 624 -6300 Phone: 360 - 737 -9725
Reg #: LIC 67787
ELE 37- 428CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 10/20/200: $75.00
[TAX] 8% State Surchart 10/20/200`. $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 ques,ons t/OUN .t 503- 246 -6699.
Issued By: �� 1> Permittee Signatur �Ar-
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.
I ' Electrical Permit Application FOR OFFICE : i si.: oNL.l
City of Tigard p � � �, Dom / _ Z) Permit No.: - - A •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 ®
" i ' Dates . Other Permit:
Inspection Line: 503.639.4175 r I -,a L I— 'I �� Date Ready/By. . See Page 2 for
Internet: www.ci.tigard.or.us �� /� 0 2U Notified/Method Supplemental Information
TYPH;IIY 1}QI I CARD PLAN REVIEW
❑ New construction Addi#91101MaidilniFtagMent Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ❑Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling CommerciaUindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION RV
❑Egress/lightingp
Job no.: Job site address: �5W ❑Health -care facility ❑der: park .
�1`r S t'a ) YJ . Submit 2 sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
1
if 114 -47 114 -47
FEE* SCHEDULE
Suite/bldg. /apt. no.: ( tf. 0 Project name:
Description Qty. I Fee. Total
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. R or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) 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, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) F ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
. CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: r.. V A.. `mow iLl S ) Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (I hr min) _
Phone: (34e 73 7 5 7 7 Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.:37 Electrical Lic.: Suprv. Lic.: Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: 2,� Date: l� /� State surcharge (8% of permit fee) ,
K-� TOTAL PERMIT FEE I vv
Authorized signs �lti'�y' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
• Fee Print name: Date: methodology set by Tri -County Building Industry Service Board
•' Number of inspections per permit allowed.
is\ Building \Pennits\ELC- PermitApp.doe 12/03 440-4615T(1W02/COM/w®
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT PEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
•
Check Type of Work Involved:
❑ Audio and Stereo Systems* • \ .
. ❑ Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
•
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
•
*No licenses are required. Licenses are required
for all other installations
is\ Building \Pennib\ELC- Pertnicpp.doe 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005.00363
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2005
Phone: (503) 639 - 4171 '.°1°v�,,j
Inspection Requests (24 Hrs.): (503) 639 -4175 _. _!i�
INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7:08AM PAGE: 30
SITE ADDRESS: 1 5 SW SEQUOIA PKWY 140 CLASS OF WORK:
SUBDIVISION: ACI IC CORPORATE CENTER LOT #: TYPE OF USE:
G i'
PROJECT NAME: t AIG
DESCRIPTION: Security.
OWNER: PACIFIC REALTY ASSOCIATES. PHONE #: 503 -624 -6300
CONTRACTOR: T & L COMMUNICATIONS INC PHONE #: 360 - 737 - 9725
Inspection Request Scheduled For: Date: 10/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 019010 -01 503 -888 -0214 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /41 Date: 10 Z' ° S Phone #: (503) 718-