Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00021
" DATE ISSUED: 2/16/2007
TIGARDy 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S113AA -00100
SITE ADDRESS: 16350 SW 72ND AVE B4 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT: OOA JURISDICTION: TIG
PROJECT: POWER TELEPHONE
Project Description: POWER TELEPHONE HVAC stats.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROTEC INC
15350 SW SEQUOIA PKWY #300 -WMI 720 NE FLANDERS
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Contact #: PRI 503- 235 -4000
FAX 503- 235 -0363
FEES Reg #: ELE 215CLE
LIC 55414
Description Date Amount
[ELPRMT] ELR Permit 2/16/2007 $75.00
[TAX] 8% State Surcha 2/16/2007 $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 or 1.800.332.2344.
Issued By: joa,t t "/W 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.
Electri4al Permit Application FOR OFFICE USE ONLY
City of Tigard Received ,
13125 SW Hall Blvd., Tigard, OR 9 " Plan Revie
Phone: 503.639.4171 Fax: 503.59 60 ,..41J, i Date/B /
l Date/B : Other Permit:
2 20 Juris: ® See Page 2 for
Inspection Line: 503.639.4175 JAN Da te Ready /By: g
Internet: www.ci.tigard.or.us Notified /Method: Supplemental Information
:4, 3 PLAN REVIEW
El New construction EPAddiUon/altera �
oreepllacement Please check all that apply:
PP Y
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi family 0 Master builder 0 Other:
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION DE plan RV park
Job no.: 9088 Job site address: 16350 SW 72 ND AVE ❑ Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: TIGARD OREGON 97224 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: BLDG Project name: POWER & TELEPHONE FEE* SCHEDULE
Description 1 Qty. 1 Fee. I Total I **
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
CONTROLS FOR HVAC dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
® APPLICANT ® CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: PROTEMP ASSOCIATES branch circuit
B. Fee for branch circuits
Contact name: BRUCE BUTNER without service or feeder fee, 46.85 2
first branch circuit
Address: 8788 SE 17 AVE
Each add'l branch circuit 6.65 2
City/State /ZIP: PORTLAND OREGON 97222 Miscellaneous (service or feeder not included)
Phone: (503) 519 -6199 Fax: : (503 -) 238 -9767 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: SAME AS ABOVE THERMOSTAT &WIRING
Address: Each additional inspection over allowable in any of the above
City /State /ZIP: Per inspection 62.50
Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
CCB Lic.: 38868 Electrical Lic.: 261063CRE Suprv. Lic.: 2613LEB ELECTRICAL PERMIT FEES*
Subtotal
Suprv. Electrician signature, required: M y p�
• [*.) j—/ Plan review (25% of permit fee)
Print name: 440Nf/ Sci^2� e....L.) Date: 1/19/07 State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE D l , 00
This permit application expires if a permit is not obtained within 180
Print name: 'if`-"'V F� �/ /1
G iv / Date: 1/19/07 days after it has been accepted as complete
* Fee methodology set by Tri -County Building Industry Service Board
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COM/WEB
CITY_ OF TIGARD
BUILDING DIVISION PERMIT #: aR2007-00021
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 211612007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/20/2007 TIME: 7:09AM PAGE: 93
SITE ADDRESS: 16350 SW 72ND AVE 134 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK 1 LOT #: 00A TYPE OF USE:
PROJECT NAME: POWER TELEPHONE
DESCRIPTION: POWER TELEPHONE HVAC stats.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: PROTEC INC PHONE #: 3 - 3 5 - 4 0 0 0
Inspection Request Scheduled For: Date: 21200007 Pour Time:
Code # Inspection Description Contact # Message
199 Electrical finql 043M6-03 03-519-6199
Corrections /Comments/ Instructions:
i'\
)4fASS pi PARTIAL APPROVAL CANCEL 7 NO ACCESS
7 FAIL 1 CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: 1\b Date: 24:0 -b'\ Phone #: (503) 718-