Permit y n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
E, COMMUNITY DEVELOPMENT Permit #: ELR2012 -00246
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/30/2012
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 310
Project: Cascade Management Subdivision: VARNS ACRES Lot: 9
Project Description: (1) low voltage for Data/Telecommunications and voice cable installation
Contractor: PC ELECTRIC Owner: GK TRIANGLE CORPORATE PARK III L
PO BOX 517 BY THOMSON REUTERS INC
NEWBERG, OR 97132 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 - 538 -6033 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/30/2012 $75.00
12% State Surcharge - Electrical 10/30/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: Y 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 OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 or 1. m ' /l
Issued By: _ iL..k _ Permittee Signature: Oki �` • V/ / / 9L
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 Ina 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.
RECEIVE 0 ,
Electrical Permit Application I.01: t 01 1.(('1, I..tir trNt.1
City of Tigard 0 C T 3 0 2012 n /ere d to 3o/ a- ci- Permit No,:
• 13125 SW Hall Blvd„ Tigard, OR 97223 M: f � - " r
Phone: 303.718.2439 Fax: 503.598.196001 I ur nu' " 1 , D : 01 Parc 4 • . i 1) ... 0,1g -
I I t ;:11: I) p c 1 t : w r BU DING DNISI 1'i� od; TI X , Su Inf o ormation
'11�.. III .'- I��di ei: YNI :, .I, I. ,o `%with Ji'.,Tr'aliJ` r.u�'dsl� IL*i ?Pd. It _ fGf I.Y ,l.1 �l_ i iI` .. 0 1 { I II,I �; �I. iimia
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2, eels of plane wincing checked below):
0 Service or ceder 400 amps or mare ❑ Bulldiog over three atones.
❑ Demolition ❑ Other;
whore the avaiible fteat current ❑ Marinas and boatyards.
flu ?� /fju n1TrlTVs,r u , , W c0 , n T ' ilk ' 1-1
�,� , �. �, l i m�' °,. i..J , t1h },,, ` t 1� I T; yy EI:1)r. ii, r.r, r l+ , FF I e exceeds t reads 10.000 amps at ISO volts or ❑ Floating buildings.
I:; �1nu,.n 1ai�M _ :.... rrF�,r , -,QtarM�Tf,lf
1:1 1- and 2 family dwelling ® Commercial/industrial Accessory meat so ground, or exceeds
nstall t ons. ❑ C buildings
ayticulq+rat
❑ sexy building amps fat all other installations. boildiogt
❑ Multi ❑ Master builder ❑ Other: . Fire pumP• CI Installation ef75 KVA or
I r 1 1.� { t•- gllSi�'1 °l :zu- J' 7 Zn u4 - I[I , :1 tF,a 0 Ernerg ncy system. larger Ie arftely derived ayatem_
!� �t 4 >{ Ft r t a r; uF ,.i� 1 t t'n ri4i a ,' �]j t�, 1 r f
.i :IflfRF�.11ltll_I. n�;IFx.�e��,l� :sell r dw, y., u3ti�l� .��tlmilnr�ilHi1,3II.IV,i I "111 0 Additon of n motor lo of 0'A ", "E", "1.1 ","I.3"
Job no.: Job site address: 13221 SW 68 Ave. 100[[r or more. occupancy.
In six or more residential unite. Recreadooal vehicle parka,
City/State/ZIP: Tigard, Or 97223 Health -care nullities. ❑ Supply voltage for more than
0 Hamardoua locations, 600 wits nominal
Suite/bldg./apt, no.: Project name: Cascade management TI CI Service or tbeder 600 s or more.
I` TIN 11 'bill,x,i,p'f.� '.i7.7 a' l.Ra` fail =
Cross street/directions to job site: DeteAptIon eta. Foe, Total •
Now residential single. or multi- family dwelling unit.
Includes attached garage,
Subdivision: Lot no.: ^ 1,000 sq. ft, or leas _168.54 4
Tax map/parcel n0.' Ea. add'/ 500 sq. ft. or portion 33.92 1
p Limited energy, rcsidendal 500 2
I � , i 14 t , T_ �I 1 r. �r,.• �IS 1-1?� :;k �a. i ..,, 1i � t ly ri tll with abotro w. a' - ,
7
,lie � 0. I CI. I� q; tl" 'F, �,I, j.�l;..;;fl � ( )
Limi ted energy, muhi- ihmlly 75.00 2
DATA and Voice cable Installation residential (with above eq. ft.)
Services or feeders instillation alteration, and/o relocation
200 amps or leas 100.70 2
I� 1 t .. N l rd t� � 1�° ",1'11 T „ I n �" I . r + I Vi I It ; � t u I ! . l L� _201 amps in 400 amps/ 133.36 2
• Name. 401 amps to 600 amps - 200.34 2
601 amps to 1,000 amps _ 301.04 2
Address: Over 1,000 amps or volts 352.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1
Owner installation: This installation is being made on property that I own which is not 201 amps in 400 amps 1 23.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits. new, alteration. or extendon, per pawl
Owner signature: Date: A. Fee for branch circuits with
] r n,a , uR; I ,.^ , I l it�41 n I I J ' I T aboix a fee der ilea ' 7.42 2
011 mill.,' ,4sk, l E :Illllcll J tl�t'.` . I1!I M'-i L 01 1 oGl ll
each ve breech cery olrouik r
Business name: B, Poe for branch circuits witherr
service or t•eder Re, first 56.18 2
Contact name; breach circuit
Each add' I branch circuit 7.42 2
Adder: Miscellaneous (service or feeder not included)
City /State/ZIP: Each manuetctured or modular 67.84 2
dwelling service and/or Seceder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation clrole 67.84 2
it It r � .7.. 11�"{�'ntlo 3 7� l •''' 1 i r ' - I ' nmiam t Sig,... line li hmi 67,84 2
�,.1 , I , J. �. ;i :.l.i�, ',. u 1 ,.�'r i . �� I , r tG'..�� gnu ircutk(s) ar timind<rtet�y
Business name: PC Electric mod. alteration. or exteo"ion. Paget X .
75.00 2
Each additional Inspection over allowable in any of the above
Address: PO Box 517 Additional inspection (1 hr min) j 6625/ hr
City/State/ZIP: Newberg, Or 97132 Investigation (I hr min) 66,251 hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (5113) 538-6033 Fax: (503) 5.18-6461 Inspections which fen
CCB Lie.: 1W7490 Electrical Lie.: 36 -11 9 i ' Beall it cted i hr no mi is 90.00 / hr
� "R'} 1 r
� Uprv. Lie.: 5012S � �II��I I��i�, ;�tlL,u:�,�. T.EJMatt_,i.:ir,gilM, ..?t.a
Subtotal: 75.00
Suprv. Electrician signature, required: �/, M -
Plan review (25'36 of permit foe):
Print name; Steve Peppmeier Date: 10/30/12 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized eigttature: This permit application expire, If • permit b not obtained within 180
Pont name: Date: • days star It has been accepted a complete.
Number of laepootione allowed per permit.
1. 16u11diasTerniitd6LC- NratAPp.doe 07/01/10 44046157it1/O000MwwnB
2•d XEIJ 13Ca3SFi1 dH Wd62:6 2102 oe 100
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
APSWISIMISONWORM1416104111,70
Fee fot 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:
t °!lift,ffip, I IV Eh;� T'bl , !ill ■ ®Il��lllu:�
a ill&
Fee for szch 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
❑ Fire Alarm Installation
❑ MAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
LI Medical
0 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: laugdingWeraths113LC.hrmhAypdoe 07 /01/10
E • d XEid 13C213Sd1 dH Wd62 6 2102 OE 2,00
PC Electric
PO Box $17
Newberg, Or. 97132
503.538.6033 office
503.538.6461 fax
ccb#187490
peat even@ fro nt le r, co m
Date: 10/30/12
Attn: Electrical Permits
From: Steve Peppmeier
#of Pages: 4
Please see the attached electrical permit application and credit card authorization form for 13221 SW
68 . This is for a limited energy TI project. If possible, could we please get an email copy of the
processed form sent to ocsteve2oefrontler.corrt once processed? If you have any questions or
concerns, please feel free to contact me at 503 - 9I9 - 2200. I thank you In advance, have a great
afternoon.
Steve Peppmeier
t
• d XIJJ 13Ca3S1:11 dH Wd62 t 6 2102 OC 1.00