Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• f' COMMUNITY DEVELOPMENT Permit #: ELR2010 00165
T I G,'1R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/24/2010
Parcel: 2S112DD01601
Jurisdiction: Tigard
Site address: 15755 SW SEQUOIA PKWY 100
Subdivision: Lot: 0
Project: Bridgeport MRI
Project Description: Thermostats.
•
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 08/24/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 08/24/2010 $9.00
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: Y Instrumentation: N Total $84.00
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 0 952- 001 -0100. You may obtai • py irect questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By ___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.
Electrical Permit Application FOR OFFICE. (SI ONLY
City Of Tigard ,mi h Received
• -, Permit No.:
S" `+ DateB 1., ► j Q `' , _
13125 SW Hall Blvd., Tigard, OR 97 3, Plan Review
'. a Phone: 503.639.4171 Fax: 503.598.4460 , '( Other Permit:
TIGAI:U
Ins Line: 503.639.4175 y�� ti {.. L. DateB : Date Ready/By: fil Page 2 for
'S\
Internet: www.tigard-or.gov �� y �, �� Ct �✓ � Notified/Method: UM Supplemental Information
TYPE OF WORK rA"c �` �G�- PLAN REVIEW
❑ New construction ® Addition/alteratio C ement Please check all that apply (submit 2 sets of plans wlitems 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 al 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 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor Toad of ❑ "A ", "E ", "1 -2 °, "1 -3 ",
Job no.: 9869 Job site address: 15755 SW SEQUOIA PKWY 10011P or more. occupancy.
1 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: TIGARD OREGON 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: t 00 Project name: BRIDGEPORT MRI ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 see. 1 Total 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
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy, multi- family
67.84 2
Thermostat & Wire 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
Name: 401 amps to 600 amps 200.34 2
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
intended 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 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
56.18 2
Contact name: BRUCE BUTNER branch circuit
Each add'1 branch circuit 7.42 2
Address: 9788 SE 1 '7 AVE Miscellaneous (service or feeder not inchided)
Each ing service and/or or r modular 67.84 2
City/State/ZIP: PORTLAND OREGON 97222
tug, serviceand /or feeder
Phone: (503) 519 - 6199 Fax: : (503) 238 -9767 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: bruce @protmp
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy 1
rxJ
pane alteration, or extension. Page 2 � °�
Business name: SAME AS ABOVE 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/ State/ZIP: Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (V2 hr min) 90.00! hr
CCB Lie.: 38868 Electrical Lic.: 261036 Suprv. Lie.: 2613LEB ELECTRICAL PERMIT' FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: MONTY SCHROEDER Date: 8/23/10 State surcharge (12% of permit fee):
TOTAL PERMIT FEE: pi (/U
Authorized signature: _ f\ ( C 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: 8/23/10
• Number of insnectinns allnwed ner nermit.