Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 q COMMUNITY DEVELOPMENT Permit #: ELR2013 00065
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/19/2013
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 100
Project: Language Line Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: (1) low voltage for access control and (1) low voltage for CCTV system
Contractor: ACTION TECHNOLOGY SYSTEMS LLC Owner: PACIFIC REALTY ASSOCIATES LP
835 SE 17TH AVE ATTN: N PIVEN
PORTLAND, OR 97214 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 231 -1992 PHONE:
FAX: 503 - 231 -1402
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/19/2013 $150.00
12% State Surcharge - Electrical 03/19/2013 $18.00
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: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
Security Alarm: N Other: N Total $168.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 9 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
(.eil.�� nib p,( A- PPLrc4 - 70q
Issued By: / Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
Mar 19 2013 3:37PM HP LASERJET FAX p. 2
Electrical Permit Application 1Yflt of hit l•: t.!,1•; +'.1iVi.5
City of Tigard Received Ferm Ne
h' 6'� oats /By: Z.. Sg-490 1 .3 - g00
13125 SW Hat/ Blvd., Tigard, OR 97273 Plan Review � /
.„----
f OtlrarPorro ?1 - ,sl
Phone, 503.639.4/71 fez: 503.5g8,lyG(1 uate/[3y;
TI :,1 V. a inspection Line: 503.639.41 Deta Reatlytty: 1uej - 1 71 gee Puy: for
111tcrnet: www,tigard- or,gov Notifed/Methud: ( i Supplemental Information
'?�,'A {r'4 .,;i.' 1 _j - ;.' '!- {. • e � :,• ,u 1 i:, ;J P �'''' *!�!
''. 0,.' a l l ";i �i iy, VI',.1. ��bIllii. :4511 °;K`, r •'r•, �` '""',.,;'t'!',.
�.; ';ai.4 9 i '.i . .. a. 1' +$ 49.1' n - Ni+ ; ', ,:; " .. 1!�11t ,l ,p a,::�!t: . ' 1 r1 F� '' c.; �; 1,
ttr.. . •.. .,._ .�. ; ,.",,P61 . ! - � . , �, a " '�S � IP S:,- 1 ° ! °�r11i5� L• a� � s ti�tp'E . i'.e . '- •..
P Now construction 1 :4 Addition/alteration/replacement Plana alook all that apply (submit], sets of plans vetems eheeined below /:
p Servioo or fei,dcr 400 etnpe or more ❑ Aeildine emu throe aeries.
D Demolition ❑ Other: wham the available Iantlt cstnent
❑ Mtvittea and bwtytarda,
k
"r''' ;7'lr.'.t� ;F :r ff'. ;:ni � T l,yy.e, • . '''' - _ a �1 F , ; .r.. t . n; j;. ._'
, ' r; . . '-ta. ` 1 :I oxewd e10,000am sat 150 ❑floati buitdiu ..
:4 . �'' ''t i ■- . J ,s • . ' , , n ,hr.'f -' ,= 5' „ . , ,' ∎' • '5, >r•R a :s,rt : -L,. P 6 g
Wee to around, orsa,seeds 14,000 ❑ C.ommeroial -use agricultta•al
❑ 1- and 2- family dwelling ca'Commercial/industrial ❑ Accessory building amps for all other Ioatsllatinet. buildings.
❑ Multi - family ❑ Master builder 0 Other: In Fire pump. ❑ Inatallatior, 01'751.VA
.� ?` ' '; :, ,u�u�r,ca.., t . r o �.: rv; �, ;' ° " r.'' 0 rileolly9YUCm largo: serialistolyderived systt.
•, ' P,. r t rrl t! o f . ,. t o y d . A : i
.p•,..- .:r " n h G " . �`- .... , �. ., ,. ; _. -k � j., a i ❑ Add of new motor load al i I "A'' "IL", ., -Z . ., I.i
. ai � r r rL Diu, a ;Val ti .� 7i'�: ':,�
Job no..2jj�j `T - Job site address: 1 is i Si or o rrora occupancy, ❑ Six or more rotidential units. ❑ Karoalicnnl vehicle parks.
' City /Statc/ZIP: ' CO e0. 9-7 as 4 - ❑ 1f ar
oalttrue lb ditties, 03%1144y vottsge tbrr mole then
El 1•tnrardoua Locations. 4UU vulla nominal
Suite /bldg, /apt. no.: Prglect name: , - - ❑ Service or fader 600 ant, or more.
Cross strt t/directians to job site; Dnerlpltne • 11.1MIEMUMME •
---"• New residential single- or m ulti- family dwelling unit.
_Includes attached ge.
- gai Subdivision: _ 1 Lot no.; 1.0005q. fl. or leas 145.15 _ 4
Tax map /parcel no,; Ea sdd'I 500 sq. tt. or portion 33.40 I
Limited energy, resi At1a1 75.00 2
; ;. �: _;:4 Y = .i •` :.rii: T7 :g. d U �•','' 1', il` .;,::2111: lul l! +iii1 :i :{! q'cipa.! t "�:`!il :with above . tt-
' M �.. . ,... . ,,vs .. : . : ,..1
, ,. ,, r,4� .,i•i;tra,t: Av., !,.. ( )
' - ��n,:. �F, irc4l '.. : 7` ye_ r ..• � I[k 4 ]f:�:: , .��,r�. .,,,. r � -7
_ /� �f/S} l.imitr d energy, multi- ihmi 75.00 2
a 4' 414 ' Q . • -:,. ewe- +' residerttial (with above so. H.)
I ` • C e Services or feeder, lnataliation .andior relocation
�,���.�-._�^}, Jt•� r : n M1 200 amps or loss _ 80.30 2
? ;. ::=;t: li( �I yy a ° - P. i La .. ;. ! i r n l r '., 1 6,5: - 5;:.,,( 2
`F 01 amps to 4�
'it, ..': - rt� a�lkt °i " ":'r:T ;IF:Y:a�iv�' t i�s i ¢;4 '';:;, ia, , :.:;.. s p 400 amps _ 106. &5 2
Name; 401 amps to 600 amps _ 160.60 2
- -- - 601 amps to 1,000 amps _ 240.60 2
Address: Over 1,000 snips or volts 454.65 2
City/State/ZIP: Temporary services or fenders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less - 66.85 .. I
Owner installation: This installation is being made on property 'hat I own which is not 201 amps to 400 coops 100.30 2
intended for sale, lease, rent, or exchange; according to ORS 447, 449, 670, and 701. 401 amps to 59 amps 133.75 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fcc for branch circuits with
rr ' 4 to a' r r' n •A rhY4: +.1!:11 T
:i. :: , : ;rj y ,,d' , ,' -. lafi 151a>,r ,.) x 2 ;t ,gin, Iu a�a : ' l ' ° +c,• t•r•, f, a se rv ic e ur ch a d or Pee,
a ... c 5;149 µ: ,:a is,._. °_ ; /';.;. ).:,,;,e 6.65 2
each brooch circuit
Business name; B. Foe for branch circuits -
without service or feeder fee
Contact name: first branch circuit 46.85 2
Address: Each add'I branch cir uit 1 6.65 2 -'1
- Miscellaneous (service or feeder not Included)
City/State/ZIP'; Each ntanutbctured or modular 90.90 2 111
" dwelling. scrvloc and/or feeder
Phone: ( ) Fax' : ( - ) Reconnect only 66.85 2
E -mail: : Q Pump or irrigation circle 53.40 _ 2
;.,,, : - 7!
,,,•,„ , ,N : ; •. tea 0; ,: ,. 4 U gwar a 91 „�t:i !
,,.•.,�,, < a� � i .. 4 : . • _ ; . ry` ..,,.,
>'� - -.... ...,SFr'+ 111...11¢ ids'`' �.. ;��?i1us,?tir.,•a ":k ,h; {'iV.: ,?Ii ,c,,;;ri,va , i ,�'": :jl'a�z,i Sign or outline lighting 53.40 2
I Business name; Signal circuits) or limited - �
Action Technology Systems LLC ., energy panel. alteration, or 2, - Id- (5p,°
Addle ; 835 Sr 1 7th Ave . T cxtcnslon. Describe: Pugs 2 2
City /Mate /ZIP; Portland, OR 97214 1 a--• .. Each additional Inspection over allowable In an of for above
Per I pcction 62.50 I
Phone; ( 503) 231 -1992 W rue (503-231-19W 1: I 1 1 investigation per hour (1 hr min) 62.50 •
CCB Lic.:157630 Electrical Lie.: 26- 775CLE Suprv, I.ic, 52 , EA Industrial plant per /our 73.75
I Suprv. Electrician signature, required; .r ) . ..• ,, r t , . . / , . da:•. _ Subtotal: I D -
,re • PIER review (25% of permit fee)'
Print Lawrence , C r itz Date: 3/''19/13 - ststesurcharge (tz'�onfpumitfee): je CO
Authorized signature; /�'! � � X41. TOTAL PERMIT FEE: j , nc0
! 3/19/13 This permit application explreslf a permit is not obtained within Igo
Print name: Rena Kirkland Date:
dell, titter It has boa accepted ne complete.
• Number of impactions allowed per permit,
I,VIUt1rrne\oerm;tal2LC- leash /Lop.dae 05a71o6 44046157;1 I A05/COMN4REI
Mar 19 2013 3:37PM HP LRSERJET FAX p.3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a ll residential systems combined . .. 575.00
Check 'Type of Work Involved:
❑ Audio and Stereo Systems*
L Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
•
.1 Other: _
Tr:i'Y�A� ►�� ?tlF��i��:.l�1y + i:,`i'•r iT:'v �:7,� -���y i.
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
❑ Data Telecommunication Installation
❑ Pire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
NI Other acry
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
LIBuuei*Wcs.hu ELca«ri+app as mnJioe