Permit o
C ITY OF T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
Aet, DEVELOPMENT SERVICES PERMIT #: ELR2006 - 00182
■ II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/1/2006
PARCEL: 2S112AD-01000
SITE ADDRESS: 07007 SW CARDINAL LN 145 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG
Project'Description: Relocation of Telecommunication circuits.
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 ASHLAN COMMUNICATIONS INC.
15350 SW SEQUOIA PKWY #300 -WMI 7534 N ELMORE AVE
PORTLAND, OR 97224 PORTLAND, OR 97217
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Phone: 503- 624 -6300 Contact #: FAX 503- 286 -2158
PR! 503- 849 -9523
FEES Reg #: ELE CLE -33
LIC 169323
Description Date Amount SUP LEB3333
[ELPRMT] ELR Permit 8/1/2006 $75.00
[TAX] 8% State Surcha 8/1/2006 $6.00 REQUIRED ITEMS AND REPORTS
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: -1 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'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.
Electrical Permit Applicatio Receiv •
FOR OFFICIO USE ()NIX
City of Tigard C CEI VE® ' — CESIMMIIMEN
IIIII 13125 SW Hall Blvd., Tigard, OR 97223A r t Plan Review Other Permit:
C Phone: 503.639.4171 Fax: 503.598.19 1 2006 Date/B .
r rc n li I) Inspection Line: 503.639.4175 CI OF TIGARD Da /B d/ M ethoot /By. NM HI See Page 2 for
Internet: www.tigard- or.gov Supplemental Information
B UILDING n Tl i GA ON
TYPE OF WORK PLAN REVIEW
g.New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
1:1 Servi or feeder 400 amps or more ❑ Building over three stories.
El Demolition
❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
❑ 1- and 2- family dwelling ,g.Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: ///jjj��,��J /a Job site address: ( e lOOHP or more. occupancy.
/U 7�a 7 J t��s t 4 , 1) I�1 . ❑ Six or more residential units. ❑ Recreational vehide parks.
❑ Health -care facilities. ❑ Supply voltage for more than
City/Stat IP: 7 _�. ( O .2 y Z
� 00,)--- j 9 7 ❑H azardous locations. 600 volts nominal.
Suite/bldg. /apt no.: t Project name: Rjv /A ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Deseriptloa I R I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
XP - Ora th;o". o•V I -1- eleCO A Jwuo$ f ■ (k rCt+ :is • residential (with above sq. ft.)
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
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 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 599 amps _ 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel'
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
/ / , Signal circuit(s) or limited-
Business name:
/�l!'lci/t i�fiAt.N1C�A�e+ ^3(. energy panel, alteration, or
Address: 73-2,/ A. / maw Are extension. Describe: / Page 2 `— 2
City/ State/ZIP: /i i. f O F ax: , a i , Each additional inspection over allowable in any of the above
Phone: ( Q . y .'2 UV) ) ) 8 Per inspection 62.50
Cf 3 A 8G - .2 / )'8 Investigation per hour (I hr min) 62.50
v° CCB Lic.: /6 93 ,2.3 Electrical Lic.: t!I$ - 3 '3 Suprv. Lic.: LaQ3337 Industrial plant per hour 73.75
y ELECTRICAL PERMIT FEES
t Suprv. Electrician signature, required: � � ./) 1 "0 0 Subtotal: 7 j .00
Plan review (25% of permit fee):
Print name: ,",h_- �� i Date: 8//6 0
State surcharge (8% of permit fee):
ty Authorized signature: „� TOTAL PERMIT FEE:
� � /� This permit application expires if a permit is not obtained within 180
Print name: *- iv Date: VA I4 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Pamits\ELC- PamitApp.doc 0523 /06 440.4615T(I I /05 /COMM'FB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY: �1
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
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❑ Burglar Alarm
❑ Garage Door Opener* C.1- . 1 . ' ■. �,
❑ Heating, Ventilation and Air Conditioning System* - 'ti` % .c_\ i .
,,.,,
❑ Vacuum Systems*
❑ Other
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00 _ r .
C '
system '. ', - / ... .' .., :.:, /.•, :. "r ,� c1 .:,,• ;•`•
v•,,� f; :',
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
• D ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
N Calls ') • , • C. u •:}:_, f:.. .,I:• -Z) i i \'.... {'`j•,
0 < , U .
..'c. - 1--v,:,•, - ....:••:- . ::-:•, .%:•.. -,.•'
❑ Outdoor Landscape Lighting* A. .;, ,Z.• ..\
❑ Protective Signaling . ' - ':? • 5:-• ` . .`, ",'•? ••
El l .t. \ . , _ I. '; `•.'1.- `._.- -.\ -: ,
Other
o. -,. ''. - - . . ., .� •
• Total number of commercial systems:
*No licenses are required. Licenses are required ,
for all other installations
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