Permit 114 a CITY O F TIGARD I G A R D ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2009 - 00041
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/30/2009
PARCEL: 2S 101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 430 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT: JURISDICTION: TIG
PROJECT: SPEC SPACE
Project Description: Low voltage for HVAC. Job No. 9548
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 PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 9788 SE 17TH AVE.
PORTLAND, OR 97224 PORTLAND, OR 97222
Phone: Contact #: PRI 503- 233 -6911
FAX 503- 238 -9767
FEES Reg #: ELE 26- 1063CRE
LIC 38868
Description Date Amount SUP 2613LEB
[ELPRMT] ELR Permit 1/30/2009 $75.00
[TAX] 12% State Surch 1/30/2009 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 • i'cation Center. Th.: - Niles are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules •r direct question o •• NC 41 5' - ,246.6699 or 1.800.332.2344.
Issu= . B 0 / jf 1/ 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.
Electrical Permit Application FOR OFFICE USE ONLY
d
RECEIVED Receive
City of Tigard Date/B : ► � G , WA Permit No.: / i i� ....400 a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
II
C . Phone: 503.639.4171 Fax: 503.598.1960 A 11 3 o 79 Date/B : Other Permit:
T I G A ii D Inspection Line: 503.639.4175 Date Ready /By: See Page 2 for
Internet: www.tigard CITY OF TIGARD Notified/Method: ffWill Supplemental Information
TYPE OF WAIEDING DIVISION PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit a 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 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 9548 Job site address: 12909 sw 68 pkwy 100HP or more. occupancy
❑ 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.: #430 Project name: Tigard Triangle Spec ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK • (with above sq. ft.)
THERMOSTAT &WIRE Limited energy, multi -family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 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: ( ) 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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
0 APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
• each branch circuit
Business name: B. Fee for branch circuits
•
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal panel, or limited -
Business name: PROTEMP ASSOCIATES
energy panel, alteration or e"�
Address: 9788 SE 17 AVE extension. Describe: 1 Page 2 73 ' 2
STAT &W IRE
City/ State/ZIP: PORTLAND OR 97222 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 519 -6199 Fax: (503) 238 - 9767 Investigation per hour (1 hr min) 62.50
CCB Lic.: 38868 Electrical Lic.: 26 - 1063 Suprv. Lic.: 2613 LE Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: M 9.1C rw J Subtotal: 75.
Print name: MONTY SCHROEDER Date: 1/30/09 Plan review (25% of permit fee): f}`
State surcharge (12% of permit fee): 00
Authorized signature : a�-.. TOTAL PERMIT FEE: g9`T ,C0
Print name: BRUCE BUTNER Date: 1/30/09 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
' . * Number of inspections allowed per permit.
1: 1Building \Pamits1ELC- PamitApp.doc 05/23/06 440-4615T(11/05/COM/WEB
• . . •
CITY OF TIGARD
BUILDING DIVISION
A PERMIT #: ELR2009-000
D ATE 13125 SW Hall Blvd., Tigard, OR 97223 E ISSUED: 1/30/2009
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 ---
INSPECTION WORKSHEET FOR DATE: 2110/2009 TIME: 7:01A.Ivi PAGE:
SITE ADDRESS: 12909 SW 60TH PKWY 430 • CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: SPEC SPACE
DESCRIPTION: LOW volta9e for HVAC, Job No. 954I
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 503233
Inspection Request Scheduled For: Date: 2/1012009 Pour Time:
Code # Inspection Description Confirm-#_ Contact # Message
• 199 Electrical final 080462-01 603-6196199 y
Corrections/Comments/Instructions:
. 0 PARTIAL APPROVAL 0 CANCEL E NO ACCESS
0 CALL FOR INSPECTION J ADDITIONAL FEES ASSESSED
Inspector: g Z Date: - 6 c f Phone #: (503) 718- viiit