Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I.'.• COMMUNITY DEVELOPMENT Permit#: ELR2013 00198
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/12/2013
Parcel: 2S113AA01000
Jurisdiction: Tigard
Site address: 16570 SW 72ND AVE B9
Project: Stay'N Power Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C
Project Description: Low voltage for data
Contractor: PACIFIC NETWORKS INC Owner: PACIFIC REALTY ASSOCIATES
16869 SW 65TH AVE, STE 373 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-645-4000 PHONE: 503-624-6300
FAX: 503-352-0202
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/12/2013 $75.00
12%State Surcharge-Electrical 08/12/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 .-.• •an. • 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. A ' NTION: Oregon =w requ' :. you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-J010 through OAR 952-0 c 1-••90. • ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue. By: / X-
/_ 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.
actrical Permit Applicatio EKED I:OR 011.1(1:. l'Sl:ONI.1.
City of Tigard Received g �� i3 �ss) PermitNo.: �eQ��3 GUl��
• 13125 SW Hall Blvd.,Tigard,OR 9722 - plan Review
g Phone: 503.718.2439 Fax: 503.598.1 )'i) 1 L 213 Date/By:
Other permit: poi 3—en`s 3
Inspection Line: 503.639.4175 Date Ready/By: tuns: Si See Page 2 for
Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method: Supplemental Information
TYPE oliiiiiiiING DIVISION PLAN REVIEW
Jew construction U Addition/alteration/replacement Please check all that apply(submit 2 sets of plans whtems checked below):
❑Service or feeder 400 amps or more ❑Building over three stones.
)emolition ❑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
-and 2-family dwelling ■Commercial/industrial ❑Accessory building amps for all other installations. buildings.
dulti-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
//- /l 1 / Addition of new motor load of ❑"A", E","1-2","1-3",
10.: Job site address: I W 5 70 S �/ 7 And d Ave.A 100HP or more. o +Pon
❑Six or more residential units. ❑Recreational vehicle parks.
/State/ZIP: T! 9 a��� o ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
:/bldg.-.`apt no.:13/415 q Project name: ANA ' IV ,gyp u3€112.- ❑Service or feeder 600 amps or more.
FEE SCHEDULE
:s street/directions to job site: Description I or,. I rec. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
iivision: Lot no.: 1,000 sq.ft.or less 168.54 4
no.: Ea.add'l 500 sq.ft.or portion 33.92 1
map/parcel
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
D Limited energy,multi-family a.fa Tele Corn mu,7Ga A a»r residential(with above sq.ft.) _ 75.00 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
1e. 601 amps to 1,000 amps 301.04 2
Tess: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
/State/ZIP: relocation
ne:( ) Fax:( ) 200 amps or less 59.36 1
ner installation:This installation is being made on property that I own which is not 201 amps to 000 amps 125.08 2
ided for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or ex_tension,per panel
ter signature: Date: A.Fee for branch circuits with
❑ APPLICANT r I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit. 7.42 2
iness name: P a,I.,t T i G Me#liar is Inc. B.Fee for branch circuits without
service or feeder fee,first 56.18 2
tact name: u o el Such branch circuit
�4 /'Ti�if! Mis eddn brunch eircuit 7.) 2
Tress: !6 ( -( S V s Y 73 Miscellaneous(service or feeder not included)
Each manufactured or modular
/State/ZIP: 67.84 2
e S�✓e�go, �R q70- 'S' dwelling,service and/or feeder
ne:(5d) �p yy'_I/000 Fax: :( ) 35 .-Ott(U Reconnect only 67.84 2
tail: nu on c1eachofw6rksaGorr7 Signor irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
//'' ^� Signal circuit(s)or limited-energy
iness name: pa L 11'1 E We i-works J,,,.rx G. panel,alteration,or extension. Page 2 75 00 2
G r(n s� c 4 k 4 ve 3 73
Each additional al p inspection inspection over allowable i. any of the above
tress: dV `7 Additional inspection(1 hr min) 66.25/hr
/State/ZIP:
Lake Os vP d ®/2 q-''70 ' Investigation(1 hr min) 66.25/hr
ne:( j ) t9s— V000 /( ) 3c�
Industrial s plant r w(1 hich hr min) 78.18/hr
Fax: �et('� Inspections for which no fee is 90.00/hr
/� specifically listed(%hr min)
3 Lic.: ` cs(,lq'b/i Electrical . G 115-2_ Suprv.Lic.:5-00Z ELECTRICAL PERMIT FEES
Subtotal: g 75 00
rv.Electrician signature,require Plan review(25%of permit fee):
it name: Ni /1 r As elrO Date: — Lo._/3 State surcharge(12%of permit fee): j q.00
TOTAL PERMIT FEE: s giz Qd
horized signatur;• ',1
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
It name: ((y,4447 , Date: g ' `I,/3 • Number of inspections allowed permit.
l sPecti per P�
ing\PermitsiELC-PermitApp.doc 07/01/10 440-4615TI1 v05/COM/WEB