Permit 111 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELR2014 00115
T I i A R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/13/2014
Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 16575 SW 72ND AVE
Project: Routeware Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Data telecommunications system.
Contractor: PACIFIC NETWORKS INC Owner: PACIFIC REALTY ASSOCIATES LP
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:
FAX: 503-352-0202
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/13/2014 $75.00
12%State Surcharge-Electrical 05/13/2014 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 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 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 r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ite: . _ 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.
Electrical Permit Application ��``.-0 FOR OFFICE USE ONLY
City of Tigard Cl� Received Permit No.:
tY ' Date/By: 54 VIII ` Ac-O/4" " �)(t S'
-` 13125 SW Hall Blvd.,Tigard,OR 972* Plan Review
Phone: 503.718.2439 Fax: 503.598.1 O,Q Other Permit:
TIGARI> Inspection Line: 503.639.4175 A� y to Ready/By: Juris la See Page 2 for
Internet: www.tigard-or.gov M� 76 l'_N Oified/Method: j o Supplemental Information
TYPE OF WORK i411, �lOv,� _ rr PLAN REVIEW
❑New construction ®Addition/alteration/re� 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 ®Commercial/industrial ❑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 derived system.
❑Addition of new motor load of ❑"A","E","I-2","I-3",
Job no.: Job site address: 16 5 7S SL/-1,41 Ave 4i- I00HP or more. occupancy.
❑
❑Six or more residential units. Recreational vehicle parks.
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: QDU 4 e W a t e 1 0( ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
I 4h'• 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'l 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
D L C/ residential(with above sq.ft.) 75.00 2
a�Q �p ma �� Renewable Energy _ ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 I
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 168.54 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
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax::( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: PaG i.r,L N et t.., r kS Tel 6, Signal circuit(s)or limited-energy 1 See .�
8 panel,alteration,or extension. Page 2 b,00 2
Address: 16 2,4 ci S 1 65 +I+ A V(0 0-3 7 3 Each additional inspection over allowable in any of the above
t _ T' Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: l.Gt k g 05W eg o, Or 0703S Investigation(I hr min) 66.25/hr
Phone:(CO3 ) (OH S--!O 00 Fax:(SO ) 35).- o o dl Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: (,g l.+1 g Electrical Lic.: 6/45 ,). Suprv.Lie.: sj Q[.r$ specifically listed(V2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �tlK Subtotal: 4`]S, 6 0
' 11 �/ Plan review(25%of permit fee):
Print name: � q1H ��p�/� Date: 5— j 3 .r/ l
1 State surcharge(12%of permit fee): 9.00
Authorized signature' TOTAL PERMIT FEE: 44 48 4 0(2
This permit application expires if a permit is not obtained within 180
Print name: G4,0/v u p a Date: 5-- 122-) days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB
Location:
Record Type:
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Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16575 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
199 Electrical final
PASS - No C of O
May 19, 2014 at 8:37:19 AM
ELR2014-00115
Jeff Grove
Violation Summary:
Inspector Contractor