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Permit CITY T ELECTRICAL RESTRICTED ENERGY PERMIT DEVELOPMENT SERVICES PERMIT #: ELR2005 -00295 III 1 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/4/2005 PARCEL: 2 S 112 D D -00400 SITE ADDRESS:' 15912 SW 72ND AVE B17 ZONING: I -L SUBDIVISION: OREGON BUSINESS PARK I LOT: 017 JURISDICTION: TIG Project Description: Limited energy for HVAC. 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 9788 SE 17TH AVE. PORTLAND, OR 97224 PORTLAND, OR 97222 Phone: 503- 624 -6300 Phone: 503- 233 -6911 Reg #: ELE 26- 1063CRE LIC 38868 FEES Description Date Amount REQUIRED ITEMS AND REPORTS [ELPRMT] ELR Permit 10/3/2005 $75.00 [TAX] 8% State Sat 10/3/2005 $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 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: Permittee Signaturek 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. • nivC1 V CLJ O a 4,A Electrical Permit Application SEP 2 0 1005 q/ 103 es � .' n � , (l i - / 4,t n , Oregon, Bureau of Development Services, 1900 SW 4th Avenue, Suite 5000, Portland, OR 97201 A r6 or- r Phone: 503- 823 -7363, Fax: 503- 823 -3018, r , • , ` , . _ •c,a .portlandonlineconilbds TYPE OF WORK PLAN REVIEW • ❑ New construction Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ❑Service or feeder, 400 amps ❑Service or feeder over 601 amps or more ❑ Buildng over three stories CATEGORY OF CONSTRUCTION ❑Fire pump ['Marinas and boatyards ❑Emergency system ❑Floating buildings ❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building ❑Addition of new motor load ['Commercial use agricultural ❑ Multi- family Master builder ❑ Other: of 100 HP or more buildings JOB SITE INFORMATION AND LOCATION ❑Six or more residential units ❑Installation of 75 KVA or larger ❑Health care facilities separately derived system Job no.: Job address: t� ❑Hazardous locations ❑A, E, 1 -2, 1 -3 occupancy 2., `-� / � recreational vehicle parks City/State /ZIP: / fi� Otte_ 9'722-y Submit 2 sets of plans with any of the above. J The above are not a. • livable to tem . . ra construction service. Suite/bldg. /apt. no.:fi / az9 / 7 1 Project name:ce704i1� � FEE' SCHEDULE Cross street/directions to job site: Description Qty. Fee Total Residential sin2lc- or multi - tastil■ d.vcllin2 unit. Subdivision: Lot no. Tax map /parcel no. Includes attached (4:1r :12c. DESCRIPTION OF WORK 1,000 s.. ft. or less - $180 —IIM Each added 500 s.. ft. or .ortion - $ 38 -- ` f TH-!� S IA✓ G✓l #t ✓ i —© f • Limited ener3 residential 1.11 $ 38 • Limited ener3 , multi -famil - $ 38 —© ❑ Reference RS /Combination Permit no. s cr%ices (11 teeth.' s installation, alteration, and/or relocation PROPERTY OWNER TENANT 200 am.s\5kvaorless -$ 92 —© 201 to 400 am .A5.01 to 15 kva - $131 —© Name: 401 to 600 am.s \15.01 to 25 kva - $175 — Address: 601 am.s to 1 000 a .s 1.111 $263 _© Over 1,000 am.s or volts - $480 —© City/State / ZIP: 1 emporaQ services or 'ceders installation. alteration, and /or Fax: relocation Phone: ( ) I ( ) 200 am.s or less - $ 76 — Owner installation: This installation is being made on property that I own, which is not intended for 201 am.s to 400 am.s - $122 — © sale, lease, rent, or exchange. 401 a .s to 600 am.s - $152 — © Owner signature: Date: Branch circuits - new, alteration, or e.tension, per panel A. Fee for branch circuits with r CONTRACTOR u; SUBCONTRACTOR . © service or feeder fee, each Business name: �� y w !, f branch circuit $ 8 B. Fee for branch circuits Address: 9 7 3 Se_ / / 77 , without service or feeder fee, first branch circuit $ 77 il City/State /ZIP: Ruiz:, 4.14) Gik.e_ 9 ZZ Each additional branch circuit - $ 8 -- Phone: (Ye?) s'/ ' �‘T l cj Fax: (6 eu ) .24 8 . 4 2ti :\iisceIl: (serv ur 'eeder not included) Elec. lic. no.: 24/O G 2 : r Each manufactured a or r fed modular CCB lic. no. ■ _© ��6 r dwellin_, service and/or feeder $103 Metro or City lic no: l,7 — Date: Reconnect onl $ 78 —ME Supervising electricia Punt. or irritation circle MI $ 65 —© eie - Si: or outline li: tin: $ 65 signature, required: /,` — Signal circuit(s) or limited - Sup. elect. name (pnnt): S 4 )1A, 1 -----4 4f•� ✓ z , License no. �'yg -L. energy panel, alteration, or extension. Describe: 1 65_ ( 1 Authorized signature : Hourl rate: — $ 110 — Print name: i c • U - L t „ 1/4... _ Date: Each additional in spection uvcr allu.v: llie in tun 01 the: m%e APPLICANT • CONTACT PERSON Perins.ection - $ 75 -- ` Business name: s'..54"€--- AS' /9-4,,,,c___ �(..o (7 LET? Investiration fee ME MI Other -_ -- Contact name: ELECTRICAL PERMIT FEES* Address: Subtotal g City/State /ZIP: Plan review (25% of permit fee) Phone: ( ) Fax: ( ) State surcharge (8% of permit fee) & E - mail: TOTAL PERMIT FE '' S , oU • Fee methodology set by Tri-County Building Industry Service Board Credit Card ❑ Trust ❑ RS Permit/No Fees Due ❑ •• Number of inspections allowed per pennit. This permit application expires if a permit is not obtained within 180 days after it has been accepted pennitapp_electrical 06/30/05 as complete. CITY OFTIGARD . - BUILDING DIVISION PERMIT #: ELR2405 -04295 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2005 Phone: (503) 639 -4171 {� Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 10/5/2005 / TIME: 7:OOAM PAGE: 85 SITE ADDRESS: 15912 SW 72ND AVE 617 CLASS OF WORK: SUBDIVISION: OREGON BUSINESS PARK I LOT #: 017 TYPE OF USE: PROJECT NAME: COOKIE LEE DESCRIPTION: Limited energy for HVAC. OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503-624 -6300 CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 503-233-6911 Inspection Request Scheduled For: Date: 101512005 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Y Low voltage 017456.01 503 - 519.6199 N t 11 4 1 W q1-- Corrections /Comments / Instructions: ). I M PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 'L 2 Date: /0 /1 Phone #: (503) 718- /