Permit 111 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00283
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/26/2012
Parcel: 1 S 134AA01800
£ �" t Jurisdiction: Tigard
Site address: 10120 SW NIMBUS AVE C4 ' a 'a/3
Project: In Focus ... on: IKOLL BUSINESS CENTER, TIGARD Lot: 2
Project Description: (1) low voltage cabling. 1/2/2013: REPRINT permit to change site address.
Contractor: PAVELCOMM INC Owner: PACIFIC NW PROPERTIES LIMITED PA
1640 NW 14TH AVE STERN FAMILY LIMITED PARTNERSHIP
PORTLAND, OR 97209 STERN, HELEN R REVOCABLE TRUST
6600 SW 105TH AVE #175
BEAVERTON, OR 97008
PHONE: 503 - 223 -5008 PHONE:
FAX: 503 - 223 -0104
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/26/2012 $75.00
12% State Surcharge - Electrical 12/26/2012 $9.00
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: N 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: Y 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- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: ,� a—�_ Permittee Signature: OX/ 1��L /C� , 9/7ON
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 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.
v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00283
T f GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/26/2012
Parcel: 25101 DA00101
Jurisdiction: TIGARD
Site address: 13190 SW 68TH PKWY 200
Project: 2nd Floor Subdivision: VARNS ACRES Lot: 9
Project Description: (1) low voltage cabling 2nd floor
Contractor: PAVELCOMM INC Owner: PACIFIC NW PROPERTIES LIMITED PA
1640 NW 14TH AVE STERN FAMILY LIMITED PARTNERSHIP
PORTLAND, OR 97209 STERN, HELEN R REVOCABLE TRUST
6600 SW 105TH AVE #175
BEAVERTON, OR 97008
PHONE: 503 - 223 -5008 PHONE:
FAX: 503 - 223 -0104
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 12/26/2012 $75.00
12% State Surcharge - Electrical 12/26/2012 $9.00
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: N 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: Y 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 -000090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 or 1.800.332.2344.
Issued By: )-- lL,id1 iLe.iik Permittee Signature: O N A-PPc -r C 4-r10�
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 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.
12/26/2012 1 0: 09 5032230104 PAVELCOMM PAGE 02
,
Electrical Permit Application RECEIVE
Rcccivea
City of Tigard DEC Datc/By: / / ? - C ( ( ? ( 'r Permit No.: G LSE ( - 00 3
13125 SW I1aII Blvd.. Tigard. OR 97223 DE 2 6 2014 Plan Rcvicw
■• • Phone: 503.718.2439 Fax: 503.598.1960 Datc/By: Other Permit:
1 I r; A P 1 i inspection i.inc: 503.639.4175 CITY OF TIGARD Tate Ready/By: hrtjr ® t n en 2 far
• o g � '� BUILDING c - �.;', N � Ct�:;±"- � l ( � Slop pkmentnllnfarmaHgn
Internet: www ti and or ov
t a ` m r r , *k � . ✓i 91;'.
Plcnse check all that apply (submit 2 sees of nos wfir6ms checked below):
121 New construction ® Addition /alteration /replacement
❑ scrsicc or feeder 400 amps or more Q Building over (I11TC 3t0rIC¢.
❑ Demol ❑ Other: where the available fault current ❑ Marinas and bonlynrda,
� ..; . I � u + l i wrt e" , exceeds l0.eno amps at 150 volts or 0 Floating buildings.
IAN
t '� n . J r �
191141E � ;111'110 1 r °''�' .���. .-:''^• � ". . ..;��` } '+c' , ' ;' 4 " �. "'. { -�' " - t ` 7e less to ground, or exceeds 14,000 ❑ Commercial agricultural •
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations, hullchngs.
❑ Multi - family ❑ Master builder ❑ Other: ❑ I7irc pump. ❑ TnsialImion of 75 KVA or
❑ Emergency system. larger separately derived system.
, . • 4 'I.. a :-rjJ` .' E• 1 n. €:ts M i ': ;,_t . i -'- t I . t ?. ❑ Addition of new motor load of ❑ r. ,. 1 -7 ..1.3
Job no.: Job site address: 13190 SW 68`" Parkway 100[{P or mart. occupancy.
❑ Sir or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP Tigard, OR 97223 El rtealth• care Ctcililics ❑ Supply voltage for more than
❑ Hm.srdrncc Irtenhnnc. 640 volts nominal,
Suite /bldg. /apt. no.: 2 " floo Project name: lI Service or feeder 604 amps or more.
i''). 1 u 1 r ^:''i l' 1I I : F + 0 II ! ! 7: 0q 1e
Cross street /directions to job site: j ( ten Qty. I rec. Total
New residential sinak or multi family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1 sq I or lens 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: r�s7ya ,. Limited energy, residential
3. , `,7v 1[ [Irtt�, u . • -, • � r ; r•. d ' 'r (with above sq, ft )
• 75.00 2
low voltage ,, .,,,,.. ,.a ,._. , . . .• .' "!s, '' `k�'' Limited energy. multi family
a
75.00 2
tage cabling residential (with above sq, R,)
Services or feeders installation, alteration, and /or relocation
200 amps or Tess 100 70 2
( i t : i r '. 3 ir'tf' ' Ir• "it . -"'i 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts ; 552 26 2
Temporary services or feeders installation, alteration, and /or
City/State /7.1P: relocation
Phone: ( ) I East: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for salt, lease. rent, or exchange. according to ORS 447, 449. 670, and 701. 401 amps to 599 amps 168.5a 2
Branch circuits - new, alteration. or extension, per panel
Owner signature: Date: A. Fee for branch circuits OM
i :,!:';!;b1+! W feeder
o
u li9H,? �I 'F toIDi 4 • e 's e ` ° r ? iF ' � v 4 ` I ' ; a ' B " S ' r , agave service feeder fcc. 7.42 2
' each branch C
Business name: B. Fee for branch circuits without
service or feeder fee, first 56 18 t 2
Contact name: branch circuit I
Each add'1 branch circuit 7.42 2
A ddress: Miscellaneous (service or feeder not included)
C it y / S tale / 7.1P: dwellinRnsrn ce and /or fa tier 67.84 2
R only 67.84 2
Phone: ( ) Fax::( ) i
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67,84 2
1 .
l i •A It ti -
Business rtp y� 1 . iri : P . r rt is - " 5C1
- ` �1�� Nhvu I : �'r2F�. *• - ��- � ., � -�; ttalcircuit(s)orlimited energy
name: PAVC1comm, Inc. „ Sia panel, alteration, nr extension. 1 Page 2 ; 2
Each additional inspection over allowahle in any of the above
Address: 1640 NW 14`” Ave Additional inspection (1 hr min) 66,25/ hr
City /State /ZIP: Portland, OR 97209 Investigation (1 hr min) 66 / hr
industrial plant (1 hr min) 78.18/ hr
Phone: (503) 223 - 5008 Fax: (503) 223 - 0104 lnspcctions for which no fcc is 90.00 / hr
— specifically listed ('h hr min)
CCB Lic.: 63963 electrical Lie.: 2( i55 Suprv. Lic.: 699 -LEA ,1 1 kl ! "wf ,ai t J' 7 'Knvo tt W A ?':";li,1
Subtotal: 75.00 1
Suprv. Electrician signature, require ��,...-- ._....A.. Plan review (25% of permit fee):
Print name: :: , Stale surcharge (12% of permit fcc): 9.00
TOTAL PERMIT FEE: 84.00
AUlbofi7.Cd signature. This permit application expires if a permit is not obtained within 180
days after It tins been accepted as complete.
Print name: Date:
Nnrnhcr of inerr:etitms allowed per permit.
I1 fauiidingIPermitalELC- PcrmitApp.doc 07/01/10 440.461ST(II /05 /COM(iVHT3
12/26/2012 10:09 5032230104 PAVELCOMM PAGE 01
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Fax (503) 223-0104 Business (503) 223 -5008 pav��comm Inc.
1640 NW 14 Ave, Portland, OR 97209
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To: / ; � , , From: / / 5 . I/
RIM 5O3 __5 - fqe,e7 Pages
Phone: • Date: /V li Z
Re: AtAle...42 CC:
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