Permit C 1TY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Ak i Iia DEVELOPMENT SERVICES PERMIT #: ELR2005 -00241
J — 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/23/2005
PARCEL: 2S 101 AD -03200
SITE ADDRESS: 12909 SW 68TH PKWY 450 ZONING: MUE
SUBDIVISION: TIGARD OFFICE BUILDING LOT: JURISDICTION: TIG
Project Description: Thermostat & wiring.
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: Phone: 503 233 - 6911
Reg #: ELE 26- 1063CRE
LIC 38868
FEES SUP 2613LEP
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 8/23/2005 $75.00
[TAX] 8% State Surchar€ 8/23/2005 $6.00
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 Taws. 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.
Issued By: '�� /LC�jL: Permittee Signature: I f ,dez.
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 Ap pp Eti, ■ ., iv FD FOR OFFICE USE ONLY
f City of Tigard Receive eceive
&C
eve d . Z � ' v S � Permit No: �., ) / J
J /)" -
13125 SW Hall Blvd., Tigard, OR 97223 !a; i. 6 2005 Plan Review Txuv `
Phone: 503.639.4171 Fax: 503.598.1960 /4 ti iii• -• Date/By: - Other Permit:
Inspection Line: 503.639.4175 ._a- c I� Date Ready /By: Juris ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGARD " ' ' Notified/Method: Supplemental information
f gg((���� L7J (� DIVISIO
O i1VORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply:
❑Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition 0 Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- 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 ❑Master builder 0 Other:
❑Occupant load over 99 persons ❑Manufactured structures or
. JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.:F7O Job site address: /290 7 &( (O /� $'74 ❑Health -care facility ❑Other:.
Submit 2 sets of plans with any of the above.
City /State /ZIP: /1
! + S/1,6 0A-e__ 9 7 ' The above are not applicable to temporary construction service.
•
Suite/bldg. /apt. no.: e / ^(�) Project name: FEE* SCHEDULE
+N �/ �/ ) Q A 14 Description l 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
i /� ,,, '� dwelling, service and /or feeder 90.90 2
te " " - n S� 4- "J tvi.if 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
Phone: ( ) Fax: ( ) relocation
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. 40I amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
Q. APPLICANT CONTACT PERSON A. Fee for branch circuits with
// service or feeder fee, each
Business name:p� � 45sOC.e-/ 6.65 2
/ branch circuit
D
B. Fee for branch circuits
Contact name: ,�p
v�� V(� tL1i..►`ilJe-,i without service or feeder fee, 46.85 2
Address: �y each branch circuit
? j �� � � V-t Each add'l branch circuit 6.65 2
City /State /ZIP: f�� �� a Me__ r5 i Miscellaneous (service or feeder not included)
Phone: ' v / "�+` y Pump or irrigation circle 53.40 2
(s�2 ) i t j C _C / 9 Fax: (6 &T ) 2 g' 921 Sign or outline lighting 53.40 2
E -mail: V -v Signal circuit(s) or limited -
CONTRACTOR - energy panel, alteration, or
extension. Describe: Page 2 , 2
Business name: $A,._( 45 1466(1--1
_(1..0
Address: ' � V � Each additional inspection over allowable in any of the above
• Per inspection _ 62.50
City /State /ZIP: Investigation per hour (1 hr nun) 62.50
Phone: Industrial plant per hour 73.75
( ) Fax: ( )
p ELECTRICAL I'ERMIT FEES*
CCB Lic &g6g Electrical Lic. /Q /TC Susrv Li yS
� fv/ Subtotal ' O 0
Suprv. Electrician signature, require . i / Plan review (25% of permit fee)
State surcharge (8% of permit fee) e , O (.o)
Print name: Date: ( `�
/fi # � p � Ja ` TOTAL PERMIT FEF Ql , !i"
•
Authorized signature:c_1/! �Z() This permit app a obtaine within 180 0 d
�� ✓\ C e~' ~ d[ � eJ
days plication after it ex bus ires been if accepted permit is not as co mplet e
Print name: /W •,...-- Date: ' —a5
• Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i\ Building \ Permits \ELC- PermitApp.doc 12/03 440.4615T(10/02 /COM/WEB
CITY-OF TIGARD . -..,
BUILDING DIVISION PERMIT #: LR2
E005 -00241
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: LR2 OO�a
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/26/2005 TIME: 7 :12AM PAGE: 66
SITE ADDRESS: CLASS OF WORK:
12909 SW 68TH PKWY 450
SUBDIVISION: TIGARD TRIANGLE CENTER LOT #: TYPE OF USE:
PROJECT NAME: TRINITY UNIVERSAL INSURANCE
DESCRIPTION: Thermostat & wiring.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: PROTEMP ASSOCIATES INC PHONE # : 503.233 -6911
Inspection Request Scheduled For: Date: 9/ 200F, Pour Time:
Code # Inspection Description Confirm # Contact # Message
191 Electrical final 016600 -02 503-519-6199 Y
Corrections /Comments/ Instructions:
I'�
L .__
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /, �-tei' Xc' Dater Z - 4--- Phone #: (503) 718 -