Permit CITY OF TIGA ��iy ELECTRICAL RESTRICTED ENERGY PERMIT
g�. n COMMUNITY DEVE LOPMENT Permit #: ELR2013 -00078
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2013
T1 GARD Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 105
Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (1) low voltage for cabling. 6/24/2013: REPRINTED to correct suite address.
Contractor: PAVELCOMM INC Owner: PORTLAND SW CENTER LLC
1640 NW 14TH AVE BY FELTON PROPERTIES INC
PORTLAND, OR 97209 ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: 503 - 223 -5008 PHONE:
FAX: 503 - 223 -0104
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/10/2013 $75.00
12% State Surcharge - Electrical 04/10/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Y Fire Alarm:
HVAC: Instrumentation:
Intercom/Paging: Landscape /Irrigation:
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other: 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 9 -001- . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. A/
Issued By: Permittee Signature: DA/ ff "�'/ t / C4} A
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 603.639.4176 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.
•
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2013 -00078
T E G ARO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2013
Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 100
Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (1) low voltage for cabling
Contractor: PAVELCOMM INC Owner: PORTLAND SW CENTER LLC
1640 NW 14TH AVE BY FELTON PROPERTIES INC
PORTLAND, OR 97209 ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: 503 - 223 -5008 PHONE:
FAX: 503 - 223 -0104
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/10/2013 $75.00
12% State Surcharge - Electrical 04/10/2013 $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: 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 503.232.1987 or 1.800.332.2344.
Issued By: �.. .� v " � J Permittee Signature: OM k CA n0 g
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.
04/09/2013 12:29 5032230104 PAVELCOMM PAGE 01
Electrical Permit A lies C EIVED FOR r1ri it I t ' l_ ONI l
City of Tigard Received `f I I Oil 3 Permit ten.: �uedo7 - 000 7�
p
■ 13125 SW I-Tall Blvd.. Tigard, OR 97 n 03 R 4 9 2013 Dateaty: Plan Review Other Permit: s 1 2 - °cap/
Phone: 503,718.2439 Fax: 503.598.1960 bate/B
Inspection Line: 503.639.4175 CITY OF TIGARD. Datc Rcady/13y, 7urie ! B See Page 2 for
I I i s 11 [ �
Nnt lMc
cd/thal 1p Supplemental Information
InternCl; «ww Ugard- nr,gnv
•
Iu g p I! I •" t... •roe • I (1. „,,,,,,,,,,,: , rl P t, _ % a 4 .4., 1� z , 4
ailkli y � lll � Ill y {Igyl lp' }E 1 j'PI N ,+ Illf , ,t1 1 4 a X I� 11 Iy� "Olt - + ,! , .f l
g llaN: u i . . . t a
DIN ,.9 ilk ”" I .I r IP � q "i''tl� r.. i ln u n'''''i '6..'"' ' " . i 611. � w• h : . .I"'�.''' i'11 f i iW'�SIf "Olt check all that apply (subunit 2 sots of plan, w/iteml checked below):
❑ New construction El Addition /alterati /replacement El Scicc et. feeder 4011 amps or mom ❑ Building over three stories.
Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
�� : �p%yO � :.014..' r I 1, mewed, 10160 amps at 150.ahs or 0 Floating buildings.
... �I�I� + � ►�t �w, , a.a•w� y �III p,41', l to ground. or exceeds 14.14.000 ❑ Commercial-use agricultural
414011111 rs
ID 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildino.
nr 75 KVA or
❑Multi ❑Master builder ❑ Other: Firc system. ❑ 1arger l ecpamtely derived system.
f ..k,3' 1 "r :Kill
r: ' � i ,..�� ' I '' ' t', '"p` f , l ❑A ter load of ❑ "A"..e. ..t-2• "1 -3
s'v,e,iis..,. -tiLis •e P. . ... .:r- r-rromr 'c•, ' :..,. . . _ ddiNaaofncwmo
1001•IP or more. occupancy.
Job no.; Job site address: 7632 SW Durham Road ❑ Six cc more residential units, p Recreational vehicle mks.
❑Htchh.care facilities. ❑ Supply voltage for more than
City/State/ZIP Tigard, OR 97224 ❑Haardonn locations. 600 volts nominal.
Suite/bldg./apt. ID Service or feeder 600 Suite/bldg./apt. no.: 130 Project name t :P 1��p t it Ii , - ,•
— _ I,,i Y , r ; F� 1., t �.� ' tom. e swz;
Cross street/directions 1.0 job site: Deieei ' ` ® �0
New residential single- or mniti- family dwelling unit.
incindtit attached garage. _
Subdivision; ! Lot no.: 1.000 se. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33,92 1
Tax map /parcel no.: Limited energy. residential 7500 2
�� 1 r. ''''''--74111°' A 1 'ri"lE rt a �, '1 I 61 ?')1, ^'.l�? with above .. ft.
r •Limited energy, multi - family 75.00 2
Low voltage cabling residential (with above so, ft.)
Services or feeders installation alteration, and /or relocation
r� 21X7 amps or teas 100.70 2
_, . 'IF� I , i Y f� , . . .4 a 1 T'r 20 amps to 4400 a
a •� � tntp
Ir ., X I s 133,56 2
..p h a 1'+ i �.; • c! {" i.p F s r ., l .. Y' '�i'.' ` + 4 . .t r I i � [a�:
.
401 amps to 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 servicc,s nr feeders Installation, alteration, and/or
City /State /ZIP: relocation
Phone: ( ) Fax: ( )
200 amps or lass 59.36 1
-
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that T own which is not 401 amps to 599 amps 168.54 2
intended for sale. 1 ease, rent or exchange, according to ORS 447. 449, 670, and 701.
Branch circuits — new, alteration, or extension. p r panel
Owner signahue: Date: A. Fee for branch circuits with
...., , ., ` a Ig o . Y . ` r feeder fey 2
a t each service or fee
�; �.'•��es�11t,.i�Gh ' .. ,. , ..: � ,_ .,a 7,42
each branch c
B. Fcc for branch circuits without
Business name: service or feeder fee, first
branch circuit 56.18 2
Contact name:
Each add'l bra nch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
Each manufactured or modular 67 R4 2
City /State /ZIP: dwellin: service and /or feeder
Reconnect only 67.84 2
Phone; ( ) Pttx :: ( ) 67.84 2
Pump or irrigat circle
E -mail; Sign or outline lighting, 67.84
04.1,M.IN1;AIIV,PWWWWTt‘'1$s'" � i Signal circuit (S)Orlimitod- energy l i 75.
Business name: Pavelcomm, Inc panel, alteration, or extension. Pa
Each additional inspection over allowable in a of the abov
Address: 1640 NW 14 Ave Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Portland, OR 97209 — .
industrial plant (I he min) 78.18/hr
Phone: (503) 223 - 5008 Fax; (503) 223 - 0104 inspections for which no fee Is
90.00/hr
specifically listed (h hr min) _
CC ' 7 j 13 Lie.: 63963 Electrical Lie.: 26559CEP Suprv. Lie.: 699 -LEA ! i I ''�'��
Subtotal: 75.00
Suprv. Electrician signature, required: Plan review (25% of permit foe): _
Prini name: Date: lit 11(3 State surcharge (12% of permit fee): 9.00
'— TOTAL PERMIT FEE: 84.[X1
Authorized signets . --An.- This permit 'application expire% if a permit is net obtained within JIM
days after it has been accented IS complete.
Print name: . Date: " Number of ingpedions allowed per permit
I\ DuildingPenniu \ECC•PmnitApp,Anc t17101JID 4104515T(11/05 /COMrW5.I
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7632 SW DURHAM RD 100, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
199 Electrical final
05/17/2013 00:00
ELR2013-00078
PASS - No C of O
Violation Summary:
Inspector Contractor