Permit CITY OF TIGARD ELECTRICAL PERMIT
�`1 2 COMMUNITY DEVELOPMENT Permit #: ELC201300353
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/26/2013
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15575 SW SEQUOIA PKWY 180
Project: Safeguard Business Systems Subdivision: PACIFIC CORPORATE CENTER Lot: 4
Project Description: (10) branch circuits for TI
Contractor: JOHANSEN ELECTRIC INC Owner: PACIFIC REALTY ASSOCIATES
10948 SE VALLEY VIEW TERR ATTN: N PIVEN
HAPPY VALLEY, OR 97086 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE 503 - 698 -3417 PHONE' 503 - 624 -6300
FAX 503 - 698 -2486
FEES
Quantity Description Date Amount
10 al Branch Circuits wo /Purchase 06/26/2013 $122 96
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/26/2013 $14 76
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $137 72
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes 'nd all other applicable law All work will
be done i ordance h approved plans This permit will expire if work is not started within 180 days of issuan ', or if work is suspended for more the 180
days TENTION Oregon law = • _ ires you to follow the rules adopted by the Oregon Utility Notification • er Those rules are set forth in OAR
952- 1 -0010 through OAR 952 -r • -0090 ••u may obtain a copy of the rules or direct questions to OUNC by calling 503.234 . •10 332 2344.
/ /
Is ued 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:
11111 CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' A tka Date: t.:: 3
LICENSE NO. ' 5 37 /
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.
Electrical Permit Applicativ � � FOR of t lcl USE ONLY
51,1 Received L. o f�,e,Ro�3 - 60 City of Tigard DateB . �� Permit No..
1 3125 SW Hall Blvd., Tigard, OR 9721 , n Plan Review
C Phone: 503.718.2439 Fax. 503.598.4960 '/ 6 . ) Date/By Other Permit P�o p /la
I'. I G n P. a Inspection Line: 503.639.4175 Date ReadyBy Juris ® See Page 2 for
Internet: www.tigard - or.gov R� CITYOFTIGARD Notified/Method• Supplemental Information
6r✓
TYPE NG'DIVISION PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below).
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 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 ,CommercialIindustrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑Fire pump ❑ Installation of 150 KVA or
JOB SITE 'INFORMATION AND LOCATION ❑ Emergency system larger separately denved system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: (55 p QLA.DI 101.°KW'7 100HP or more occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: _ I I C 04 e 7 2 2, , ❑ Health-care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.:t g'D Project name: ❑ Service or feeder 600 amps or more
^ i'•eE 4c.i. A / LD 76ee _ Sr�l fs, s � •,-e FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 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 168 54 4
Tax map /parcel no.: Ea add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi - family
K fA rO+g� Wu e+
�IS TO GCc91r 1 e.. rv' "' ok 1 n A c v - i ` ` ' residential (with above sq ft.) 75.00 2
(� -
Renewable Energy ❑ See Page 2
El. i S \ v"3 0 -t-C k S Pac e- Services or feeders installation, alteration, and/or relocation
ig PROPERTY OWNER ❑ TENANT 200 amps or less 100 70 2
L 9. 2 0.,1 } A S So S l 0_4 es 2
201 amps to 400 amps 00 34 2
Name: O i ; 401 amps [0 600 amps 200 34 2
Address: 1 5 3 5 0 SE Sei 00 10- P ov k wc ii - 300 601 amps to 1,000 amps 30104 2
Over 1,000 amps or volts 552 26 2
City/State /ZIP: Pd f V 10,6 0 t e O-- 91 2.2A Temporary services or feeders installation, alteration, and /or
S
( 3) �oZ� G 300 ( ) relocation
Phone: � Fa x:
200 amps or less 59 36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 sa 2
Owner signature: Date: Branch circuits— new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with
above service or feeder fee, 7 42 2
Business name: each branch circuit
B Fee for branch circuits without /
Contact name: service or feeder fee, first 1 56.18 56. (g 2
branch circuit
Address: Each add'l branch circuit 1 7 42 &ep. ?$ 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67 84 2
E - mail: Pump or irrigation circle 67 84 2
CONTRACTOR Sign or outline lighting 67 84 2
Business name: J Q h ' s I etii t rL Signal circuit(s) or limited- energy See
panel, alteration, or extension Page 2 2
Address: (CR 2, SE V u- ILA \ e+ Tef f rCe Each additional inspection over allowable in any of the above
Di. 2 Additional inspection (I hr mm) 66.25/ hr
City/State /ZIP:
N P(� Vf c _1l 1 0 Q . t h. q 70 8G Investigation (I hr min) 66 25/ hr
Phone: (S 6 - 3 i 11 Fax: (5'e. ) C,1 t - 245“, Industrial plant (1 hr min) 78.18/ hr
Inspections for which no fee is 90.00 / hr
CCB Lie.: 5/ 5 7 Electrical Lie.: . "2,3L( Suprv. Lic.: 537 g 5 specifically listed (% hr min) _
Suprv. Electrician signature, required: : ��: /D lt 3 • ELECTRICAL 'PERMIT FEES
Subtotal: / a 9,.9(0
Print name: .JdIna0i.in00.\ C. ,p V\ays0, Date: 1 GI 2G I2.013 Plan review %of permitfee)
.� State surcharge (12% of permit fee). ('( . 7 <0
Authorized signature: ;•, - TOTAL PERMIT FEE. i 3 7 ,, '72.,
�! This permit application expires if a permit is not obtained within 180
Print name: jD�j,,i- n C, .v\S tin Date: G12_61 2p (3 days after it has been accepted as complete.
" Number of inspections allowed per permit
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Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100 70 2
5.01 to 15 kva 133 56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200 34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552 26 2
El Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva— no additional charge 0 0 3
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly (1 hr min) 66 25/ hr 1
Inspections for which no fee Is 90.00 / hr
specifically listed (% hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other •
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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