Permit 7,- i1
CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
6 DEVELOPMENT SERVICES PERMIT #: ELR2005 -00439
` 11 ' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/27/2005
PARCEL: 2S113AA-00600
SITE ADDRESS: 16126 SW 72ND AVE B1 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT: OOB JURISDICTION: TIG
Project Description: Limited energy for HVAC. Job No. 8792
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: 503- 624 -6300 Contact #: PRI 503- 233 -6911
FAX 503- 238 -9767
FEES Reg #: ELE 26- 1063CRE
LIC 38868
Description Date Amount
[ELPRMT] ELR Permit 12/27/200E $75.00
[TAX] 8% State Surchar€ 12/27/200E $6.00 REQUIRED ITEMS AND REPORTS
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 Signature: A
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 am required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received
: 4 i; ac 1 Permit No.: - 1
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ! a'y�•i� 11 "' l * Date /By: Other Permit:
ai� J
Inspection Line: 503.639.4175 - ,a,, . el I Date Ready /By: aura' ' ® See Page 2 for
Internet: www.ci.tigard.or.us 3 Notified/Method: ..07 ( f� Supplemental Information
TYPE OF WORT C 1 J 2_05 PLAN REVIEW
❑ New construction ® Addition /alterat�on/replace�neARD Please check all that apply:
❑ Demolition ❑Other: ll�� y 1 �j ['Service
-ratio Service over 225 amps, comm'l ['Hazardous location
BUILD1BUILDING D J IS O Service over 320 amps g ❑Bulldog 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
❑ Multi- family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: 8792 Job site address: 16126 SW 72ND ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: TIGARD OREGON 97224 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: BLDG 1 Project name: CONNECT AIR FEE* SCHEDULE
Description I Qty. I Fee. I Total 1 °•
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
THERMOSTAT AND WIREING FOR NEW A/C UNIT dwelling, service and /or feeder 90.90 2
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
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
® APPLICANT ® CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: PROTEMP ASSOCIATES branch circuit
B. Fee for branch circuits
Contact name: BRUCE BUTNER without service or feeder fee,
first branch circuit 46.85 2
Address: 9788 SE 17 AVE
Each add'I branch circuit 6.65 _ 2
City /State /ZIP: PORTLAND OREGON 97222 Miscellaneous (service or feeder not included)
Phone: (503) 519 -6199 Fax: : (503) 238 -9767 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or ��
extension. Describe:
Business name: SAME AS ABOVE THERMOSTAT Page 2 2
Address: Each additional inspection over allowable in any of the above
City /State /ZIP: Per inspection • 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
Industrial plant per hour 73.75
CCB Lic.: 38868 Electrical Lic.: 261063 CRE Suprv. Lic.: 3948LEB ELECTRICAL PERMIT FEES*
Suprv. Electrician signature, require //e Subtotal 75"
/ ��' Plan review (25% of permit fee)
Print name: r � 6 1,14A fret Date: 12 -13 -05 State surcharge (8% of permit fee) • ‘°'° Authorized sign & La...4 d t TOTAL PERMIT FEE . Oel
This permit application expires if a permit is not obtained within 180
Print name: Bn v GG �1. 1 !� e ^ _ Date: 12 -13 -05 days after it has been accepted as complete
(�! • Fee methodology set by Tri- County Building Industry Service Board
is \ Building \Permits \ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM /WEB
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Et.R2005 00439
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12J2717006
Phone: (503) 639 -4171 1 4 ,I
Inspection Requests (24 Hrs.): (503) 639 -4175 t,
INSPECTION WORKSHEET FOR DATE: 1/26/2006 TIME: 7:03AM PAGE: !
SITE ADDRESS: 16126 SW 72ND AVE t31 — • CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK! LOT #: 008 TYPE OF USE:
PROJECT NAME: CONNECT - AIR
DESCRIPTION: Limited energy for HVAC. Job No. 8792
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 603 - 62461300
CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 503 - 233.6911
Inspection Request Scheduled For: Date: 1/26/2006 Pour Time:
Code # Inspection Description onfirm # Contact # Message
199 Electrical final 025721 -01 503 - 519.6199 Y
Corrections /Comments /Instructions:
- 2iQt.kl • Goo a.-
Act f; ��.
����PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �7 • 1\16 � Date: I Z6 c1 6
p I Phone #: (503) 718 -
! r= ,..
CITY OFTIGARD
/ BUILDING DIVISION PERMIT #: EI..R2006_O0439
•
i l 13125 SW Hall Blvd Tigard, OR 97223 DATE ISSUED: 12/27/200
Phone: (503) 639- 4171 Nlloi i i t
Inspection Requests (24 Hrs.): (503) 639 -4175 A I..
INSPECTION WORKSHEET FOR DATE: 1/9/2006 TIME: 7:01AM PAGE: 46
SITE ADDRESS: 16126 SW 72ND AVE 81 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK i LOT #: 008 TYPE OF USE:
PROJECT NAME: CONNECT
DESCRIPTION: Limited energy for HVAC. Job No. 8792
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 - 524.6300
CONTRACTOR: PROTEMP ASSOCIATES INC • PHONE #: 503.733.691 i
Inspection Request Scheduled For: Date: 119/ 2006 Pour Time:
Code # - • -c ion 1 _ ' • ion Confirm # Contact # Message
135 Low voltage 024559-05 503-519 -6199 Y
Corrections /Com - - 1 tions:
•
2I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C L FOR I • • ECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / Date: J-9 • V v Phone #: (503) 718- .2-4%