Permit • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00277
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/28/2009
Parcel: 2S113AA00300
Jurisdiction: Tigard
Site address: 16316 SW 72ND AVE B3
Subdivision: OREGON BUSINESS PARK I Lot: 0
Project: Spec space
Project Description: Low voltage for HVAC
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 08/28/2009 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 08/28/2009 $9.00
PHONE: 503 - 624 -6300
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222
PHONE: 503 - 233 -6911
FAX: 503- 238 -9767
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: y Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT • • :gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 e10 through OA' 952 -' • -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss ed By: Permittee Signature: A
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
CaII 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application 1:0lz c►rr•rcre- usl :- c/Nr., — — —
C i ty of Tig>aTa RC EI�IED ev
Dat �•ZIlLi' Permit No. Ea atoo9 -cr�a?
IS Plan
13125 SW Hall Blvd., Ti O & 97223 Revi
Phone: 503.639.4191 Fax: 503.598 /B , • Other - Permit:
InsperAionLine: 503.639.4175 � � 2 6 2 Date Ready/By: 81 See Page 2for
Internet: www.tivard- or.$ov CITY OF TIGARD Notified/Method: BM Supplemental Information
TYPE 9fl fiY9 'G DIVISION PLAN REVIEW
0 New construction 0 Addition/alteration/repiacement Please check all thatapply(submu 2.sets of plans w /items.checked blow)-.
Demolition Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available faun current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION • exceeds 10;000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
. CI 1- and 2-family dwelling El Commercial/industrial 9 Accessory building amps for all other installations. buildings.
Q Multi- family ❑ Master builder ❑ Other: • 'OFire pump. D Installation of 75 KVA or
rB Y " larger , " E", "1- derived system.
JOB SITE INFORMATION AND LOCATION
❑Addition of new motor load of ❑ "A ", "E ", "1 -2", "I -3"
Job no.: 9646 Job. site address: 16316 SW 72 A1 AVE 1001-IP or more. occupancy.
'(]Six or more residential units. (] Recreational vehicle parks. •
City/State/tIP: TIGARD OR 97224 ❑ Health raze facilities. ❑. Supply yoltage.for.mare than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: BLDG3 Project name: 0 Service or feeder 600 amps or more.
/�� FEE SCHEDULE
//�+
Cross street/directions to. job site: 1 (sp / `€, Description • I WY: I Fee 1 Toed 1
New residential single- or multi- family dwelling unit. •
• Includes attached - garage.
Subdivision: Lot no.: . 1,000 sq. ft. or less 145.15 . .4 .
Tax map /parcel no.: Ea..wki'1.00 sq. ft- or.portion -33.40 1
Limited energy, residential 75.00 2
. . • DESCRIPTION OF WORK (with above sq. R)
Limited energy, multi-family 75. 00 2
THERMOSTATS & WIRING
residential (with above sq. -ft.)
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 • 2
• 1. PROPERTY OWNER I Q 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
y /SZIP: 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 ampsto amps 133.75 2
Owner signature: • Branch olreults— new, alteration, or extension, per panel
A. Fee for branch circuits with
• El APPLICANT 1 fl CONTACT PERSON above service or feeder fee, 6.65 2 .
each"branch circuit
• . Business.name: PROTEMP ASSOCIATES B. Fee for branch circuits
Contact name: BRUCE BUTNER f i rs t service or feeder fee 46.85 2
first branch circuit
Address: 9788SE 17 AVE . . • Each add'1,branch.citrclut • .6.65 2 .
Miscellaneous (service or feeder not Included)
• City /State/ZIP: PORTLAND OR 97222 Each manufactured or modular 90,90 2 .
• • dwelling, service and/or feeder
Mlle.: (593) 519 -6199 Fax: :.(503 -) 238-9767 Reconnect only • - -66:85 • 2 •
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Signor outline lighting 53.40 2
Business name: SAME AS ABOVE Signal circuit(s) or limited -
energy panel, alteration, or CO
Address: extension. Describe: 1 Page 2 76 2
THERMOSTAT &WIRING
City /State /ZIP: Each additional Inspection over allowable.% ally of the above
Per inspection 62.50
Phone: ( ) Fad ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: 38868 Electrical Lic.: 261036CR Suprv. Lic.: 2613LEB Industrial Plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: (. Subtotal: -- 75� -'"'
Print name: MONTY SCHROEDER Date: 8/26/09 Plan review (25% of permit fee): -09
State surcharge (12% of permit fee): C', 40 l
Authorized simonize' {.L
TQTA� .P.1rRJ IT FP>~: � _
This permit applicadon expires if a permit is not obtained within 180
Print name: BRUCE BUTNER I Date: 8/26/69 days after it has been accepted as complete.