Permit A's ENERGY
�� ;� DEVELOPMENT SERVICES PERMIT #: ELR2004 -00306
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/4/2004
SITE ADDRESS: 15865 SW 72ND AVE BLDG -C PARCEL: 2S112DC -00201
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: 003 JURISDICTION: TIG
Proiect Description: Relocate (2) thermostats.
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 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233 -6911
Reg #: ELE 26- 1063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/4/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 10/4/2004 $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 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 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 ___ p-� e Permittee Signature 24..c.c.,
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: /Q Li
LICENSE NO: 26 / 0 a --
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received ! /j/ /y �
`J g DateB : < LS..�I� - 'W b l.•
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Da a 6x ' r1 M ti (`! `\ Da teBy: Other Permit:
Inspection Line: 503.639.4175 • �' 'I 1' Date ReadyBy: iwis ® See Page 2 for
Internet www.ci.tigard.or.us Notified/Method: 6�. Supplemental Information
u �x s r : y . tf YP i WO , a 4 - ��a ' x* L�r`L a-x aA s } ; i t 0, '' •- r - 6
i li -a ., -4 , f k-f;pro, >' ` k F 't �3' r ,r�.,s.: w, x'' t`.xC 3 � 5 e: . a4a a 4 t` Y : RE,YE'�
❑ New construction Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other ['Service over 225 amps, comm'l ['Hazardous location
, • r u_ , 1 ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
y .- ': y 7 '�C uT1 G "O. R t , , O S R IUI �. 0 f. , ' � ti _ of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling .RYCommerciallindustrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
'4 ' 1 t' 1' SOB ,PIYO Tf )1 LOGATIO 4. 7 g Vi n' _ Egress/lighting lan RV park
❑ P
.._ :'�.T, .., : a.� -,...k _ .• .� �t . ?�;. �; ❑Other:
r � /5 S&i 7 2 • 0 ❑Health -care facility
Job no.: Job site address: U Fo G_G,+
Submit 2 sets of plans with any of the above.
City/State /ZIP: 7 ' ` The above are not applicable to temporary construction service.
C Project name: ,. cL ' I f a ` +F a a'��.". FF. :tSiG)E > k.- -
Suite/bldg./apt. no.:
e.. / tN�i.S , „ Description I Qty. I Fee. I Total I
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
,tom. 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no Limited energy, residential 75.00 2
d �, a, u �s Limited energy, non - residential 75.00 2
-; y'1 ";:..4?„ *' 4 D 'S ' I(1PI 0 'p J; ( tr: rCr . l " " ; . t' ` # Each manufactured or modular
/'t e'ta C-03 -- _ f k S i7nly /Gt trot -Am p t %.s / 2 S erv ic es service and/or feeder 90.90 2
,� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
-
-_ P.> vr.P IT'O 'OWNER' • -. r' , ^ r E N/ANT. ? , e 201 amps to 400 amps 106.85 2
F , _ t • r a a' 401 amps to 600 amps 160.60 2
Name: CA CIA') " Cu/ e c % 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
S ia'`"'c.- 14 -4 Adz' ° - Reconnect only 66.85 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel • `' 4 AL ICeYN'f.. s'-^`;''',!.1. f . QNf 7 T 1P ELI 't A. Fee for branch circuits with
,.r 4 fir*` ,:
^ 'A t .... 'J° -''. _, ... service or feeder fee, each
Business name: Av / f .� g c � .�, N G , branch circuit 6.65 2
P� ��
B. Fee for branch circuits
Contact name: SR ae__, Q ,, q, e_ �� without service or feeder fee, 46.85 2
p' each branch circuit
Address: a
gO sr , 7) / � 15 Each add'l branch circuit 6.65 2
City/State /ZIP: / -L�24.44.- CY 9 Z 2_2- Miscellaneous (service or feeder not included)
Phone: �ai ) �'j ,6 / S Fax: : (gyp ) Pump or irrigation circle 53.40 2
9 Fax: c9 so 5 Sign or outline lighting 53.40 2
E -mail: h }� , 7� a Signal circuit(s) or limited-
s : ¢ ,t i1 �: . . , ",,,:eV! t *" ,c : I s 7 i s epy2,, . g r, energy panel, alteration, or
s . , x A x. a , .,t _ !s ,` extension. Describe: Page 2 2
Business name: £Ai4 t° As 46e 1 v�
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax ( ) Industrial plant y f per hour 73.75
p � 'a ," . :b �r-1 1,'44.'P I ITt ''% , '
Te a''
CCB Lic. L2ggt60 Electrical Lic.2 f Q ca ota Suprv. Lic.:3 5 b ff ie,d Subtotal
Suprv. Electrician signature, required Plan review (25% of permit fee)
Print name: /e State surcharge (8% of permit fee)
��h N^4 �`k... f/00-.0... Date :_t_i.`11) TOTAL PERMIT FEE /5 O
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: 84,,,_, /2„ ,j e , Date: // t-j y • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PermitApp.doc 12/03 440 .46I5T(10 /02/COM/WEB •
Electrical Permit Application - City of Tigard
Page"2 = Supplemental Information
LIMITED ENERGY PERMIT FEES:
M �Jy�7
ID ' S, U % \
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
� + 6 v vY' 10,14,16,-A
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
V HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 2.
*No licenses are required. Licenses are required
for all other installations
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