Permit •
Es� ar r NAM, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t n
• i' COMMUNITY DEVELOPMENT Permit #: ELR2009 -00322
Date Issued: 10/06/2009
tTIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101AD03200
Jurisdiction: Tigard •
Site address: 12909 SW 68TH PKWY 150
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Shuller Financial
Project Description: Install restricted energy for relocating thermostat.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 10/06/2009 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 10/06/2009 $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: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 '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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: C CtIJ'Le — �F A) 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 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.
r L' • - 00 52
.- EI&trical Permit Application - ' -- =1 o�z Or l�ic E 1�� O l 5 �,
mm ` ECEVE Perm No.: Tigard, OR 97 r ' ' t C ���(. �' Z
Plan Review
` C 4 - Phone: 503.639.4171 Fax 503.598.1960 DateB . Other Permit. to 02 • • : • • o
"J' l,rA t u In Line: 503.639.4175 OCT 0 6 2009 Date ReadyBy: tans: El See Page 2'for
." Internet www.iagard-or.gov r /� Q NotifedlMethod: `�'�' Supplement 1 Inf ormation
.n '' ',A ; :-1 5K .. .> _ t -t" Yt -,,rrpp TtGf'11 t� .-?,: v ;.° `d-' '+ ?` ' a 's ." -
,.- AT ,
YPEfiOF W(RtI . { o v i n ;: ,.. , .. - e , a� - — PLAN REVIEW
❑ New constructio ® Addition /alteri� tf1'�dt 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 boalyards.
r fug.
a--- r ° -t CATEGORY QF CONSTRUCTION - �� - ��� - exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to; round, or exceeds 14,000
g ❑Commercial -use agncultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE IPIFORAIATION AND L � " . ❑ Emergency system. larger separately derived system.
o f �` t - i._ . .. .1• � . , ❑ Addition of new motor load of ❑ "A "E "1.2 "1.3
Job no.: 9673 Job site address: 12909 SW 68Th.PKWY 100HP or more. occupancy.
❑Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: TIGARD OREGON 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg /apt, no.: Project name: SCHELLER FINANCIAL ❑ Service or feeder 600 amps or mote.
F.- . - „ FE E SCHEDULE x'�_ 1 4 .
Cross street/directions to job site: Desc•iptiup I Qt3' I Fee I T°tilt 1 •
New residential single - or. multi -family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.:tt. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
. FQ r DESCRIPTION Cik- WORK -rat ' - s -j Lf "- Limited energy, residential 75.00 2
Tax map/parcel no
2a ", F (with above sq. ft)
RELOCATE THERMOSTAT Limited energy, multifamily 75.00 2
residential (with above sq. ft.)
Services feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
'•' ' ® `PROPERTY.-OWNER 4 — 2 le
-- - r „ , r4, , TENANT , NF - 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for -branch circuits with
' 41- ' 1:4 " .=-4 e' ®-r APPLICANT' -" -- - - above service or feeder fee,
,_. 4 I r CONT -A ACT PERSON 6.65 2
each branch circuit
Business name: PROTEMP ASSOCIATES 13. Fee for branch circuits
Contact name: BRUCE BUTNER
without lt branch circuit
or feeder fee 46.85 2
first branch circuit
Address: 9788 SE 17 AVE Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: PORTLAND OREGON 97222 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503 —) 519 -6199 Fax: : (503) 238 -9767 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
'= Y r - " mot. 'CONTRACTOR _ = , g ; _ Sign or outline lighting 53.40 2
Business name: SAME AS ABOVE Signal circuits) or limited-
energy panel, alteration, or
Address: extension. Describe: 1 Page 2 2
THERMOSTAT& WIRING
City/State /ZIP: Each additional inspection over allowable m any of the above
Per inspection 62.50
Phone: ( ) I Fax: ( ) • Investigation per hour (1 hr min) 62.50
CCB Lic.: 38868 I Electrical Lic.: 261063 C I Suprv. Lic.: 2613LEB Industrial plant per hour 73.75
= i ELECTRICAL;,PERM1'r FEES t - ' - ,
Suprv. Electrician signature, required: Subtotal: ( , i,e.1,
Print name: MONTY SCHROEDER Date: 10/5/09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): . IL(
Authorized signature: M 014 TOTAL PERMIT FEE: 7 5 , q 8
Print name: BRUCE BUTNER I Date: 10/5/09 This permit application expires if a permit is not obtained within 180
days after it has been accented as complete.