Permit CITY OF T�G�1FZ® ELECTRICAL RESTRICTED ENERGY PERMIT
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2* COMMUNITY DEVELOPMENT Permit #: ELR2010 00106
T t CARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/09/2010
Parcel: 2S 112 DA00700
Jurisdiction: Tigard
Site address: 15333 SW SEQUOIA PKWY, STE# 150
Subdivision: PACIFIC CORP CENTER Lot: 0
Project: OnOne Software
Project Description: Low voltage for HVAC
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 06/09/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 06/09/2010 $8.14
PHONE: 503 - 624 -6300
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222
PHONE: 503 - 233 -6911
FAX: 503 - 238 -9767
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 acco • - - • 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. ATT ION: Oregon w r' • • es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 % 10 through OAR 952 -• -0100 Y• • ay obtain a copy of the rules or direct questions to OUNC by calling 50 or 1.800.332.2344.
Is- ued By: _ // , `IL mot[ Permittee Signature: /C �iCL�'�L[J
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.
Cali 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.
Electrical Permit Application _ -- ---- rc)lt_oi..Fic :G_ tlst ONl_a`-- - -- - -- - - -_.
ipl . City of Tigard Dates
Lo _ Permit No.: f(�/p -� l d
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I ` Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
I 1 t "; A It t) Inspection Line: 503.639.4175 Date Ready/By: Juris: Ea See Page 2 for
Internet; www.tigard- or.gov Notified/Method: Supplemental Information
YPE OF WORK 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 eurreat ❑ Marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
I- and 2- family dwelling cs Conmlercial/indiistrial I] Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
doll SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ",
Job no.: 9832 Job site address: 15333 SW SEQUOIA PKWY 1OOHPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: TIGARD OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: #150 Project name: ON ONE SOFTWARE ❑ Service or feeder 600 amps Of tuore,
FEE SCHEDULE
Cross street/directions to job site: Desertprion 1 oty. 1 Fee. 1 Taal 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'l 500 sq. ft or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
-.— — - - - -- Limited energy, multi- family 67.84 2
RELOCATE THERMOSTAT residential (with above sq. ft,) _
Services or feeders installation, alteration, and/or relocation _
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133,56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended-for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: PROTEMP ASSOCIATES B. Fee for branch circuits without
_ -- _ _ - - -_,_ - . - - service or feeder fee, first
Contact name: BRUCE BUTNER — branch circuit 56.18 2
Each add'l branch circuit 7.42 2
Address: 9788 SE 17 AVE Miscellaneous (service or feeder not included)
City /State/ZIP: PORTLAND OR 97222 limanufactured or modular 2
dwelling, service and/or feeder
Phone: (503) 519 -6199 Fax: : (503) 238-9767 Reconnect only _ -- -_ - 67-84._ 2
Pump or irrigation circle 67.84 2
E -mail: Sign Of outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy A /_ c �
Business name: SAME AS ABOVE
panel, alteration, or extension. r Page 2 (17 a 7 2
Each additional Inspection over allowable in any of the above
Address: Additional inspection (1 la' thin) 66.25/ lir
City /State / ZIP: Investigation (1 hr min) 66.25/ hr
Jndustrial plant (1 lir min) 78.18/ hr
Phpne: ( ) Fax: ( ) Inspections for which no fee is
90.00/ hr
specifically listed (V: hr min)
CCB Lic.: 38868 Electrical Lic.: 261063CR Suprv. Lic.: 2613LEB ELECTRICAL PERMIT FEES
Subtotal: 6 k
Suprv. Electrician signature, required;
Plan review (25% of perrrtit fee):
Print name: MONTY SCHROEDER Date: 6/9/10 State surcharge (12% of permit fee): q . /V
TOTAL PERMIT FEE: 7s, 9g
Authorized signature: rm, `t 9 -' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: BRUCE BUTNER I Date: 6/9/10
,6Z(1/6(-- l �� G � '% ""'Y ' N of in sr>�tinns allowed reel tre_rmit