Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2011 -00113
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/20/2011
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: PACIFIC CORPORATE CENTER Lot:
Project Description: HVAC system.
Contractor: PROTEMP ASSOCIATES INC Owner: PACIFIC REALTY ASSOCIATES LP
9788 SE 17TH AVE ATTN: N PIVEN
PORTLAND, OR 97222 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 233 -6911 PHONE:
FAX: 503 - 238 -9767
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/20/2011 $75.00
12% State Surcharge - Electrical 05/20/2011 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OA' - 001 -0090. You may obtain a cosy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By • Permittee Signature: � 6a •
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.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 \K FOR OFFICE USE ONLY
City of Tigard \ Received • / // 71 Permit No.: '
° 13125 SW Hall Blvd., Tigard, OR 972 �- `',� �' —
Plan Review
Phone: 503.639.4171 Fax: 503.598.1 y 'A 1Date /B : Other Permit. itB . /I — U� r
TIGARD Inspection Line: 503.639.4175 � P ` r � i (Iaa� Ready /By ® See Page 2 for
Internet: www.tigard - or.gov .�I o � �` V ` ` q \ \ j\N /Method: ' Supplemental Information
,,., �, T , � 1° . RK " : � , . �5 "F �,�:,, PLAN '�ItEYIEWw; ::
h;• A. ; �,:��, ,..�'Q..��u�.P ..� = �x'� � �pe's3� -rte. �'H'� � ,g _ :`lL
❑ New construction ® Addition /alteration /replahve)lient Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
`I" `'' � " -ireb" R exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
:. , . G
'- AT§§EGU OF ' --, ' RUGT ' Y',' ; ' , • " , ; : °' H l_
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1 - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ['Other: ❑ Fire pump. ❑ Installation of 75 KVA or
„ v F ' ❑ Emergency system. larger separately derived system.
�JOB :SI
. " TE ' =: = -
.,;. a ,. ,•:.::<;•��� ' - . - - . ❑Addition of new motor load of ., .. .. ..
Job no.: 3023 Job site address: 15862 SW 72 AVE 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD OREGON 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: IMMUNOLOGY ❑ Service or feeder 600 amps or more.
:;, - ;, FESC = ,
Cross street/directions to job site: =% i ~ =: E AED IJLE ` Total 4
J Description l Qty. I Fee. 1 Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: residential
' , DESCRIPTION R -OF W WORK , - v 67.84 2
y am. _'-" ;"" en
URK ,��:,=. (with above sq. ft.)
Limited energy, multi- family 67.84 2
THERMOSTAT & WIRE residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
� ",;',"01; _ [] Two-WY oW11-g# ' f:(0. : .TEN 1 201 am s to 400 am s 133.56 2
�?, P P
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. • _® APPE-KANT o ®GUN. -- SO ''
above service or feeder fee,
TACT N
_ each branch circuit 7.42 2
Business name: PROTEMP ASSOCIATES B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: BRUCE BUTNER branch circuit
Each add'l branch circuit 7.42 2
Address: 9788 SE 17 AVE Miscellaneous (service or feeder not included)
City/State/ZIP: PORTLAND OREGON 97222 Each manufactured or modular 67.84 2
y dwelling, service and/or feeder
Phone: (503) 519 - 6199 Fax: : (503) 238 - 9767 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E bruce protmp 67 84
, Sign or outline lighting 7
t , r • NTRA •:..,n... -
��s,<...� ., . .... y 9 . - :: �' c ,rr N , CTt3R,: �',�,I�, _ r`;�s Signal circuit(s) or limited- energy 1
Business name: SAME AS ABOVE panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (/ hr min)
CCB Lie.: 38868 Electrical Llc,: 261036 uprv, Llc,: 2613LEB y . E tMIT ,0.08; yx. al l
Subtotal: 7s--,, u'
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Print name: MONTY SCHROEDER Date: 5/20/11 State surcharge (12% of permit fee): ,
see TOTAL PERMIT FEE: °�
Authorized signature: ����� This pe rmit application expires if a permit is not tained within 180
days after it has been accepted as co plete.
Print name: BRUCE BUTNER Date: 5/20/11
* Number of inspections allowed per permit.
1:\ Building \Permits \ELC- PermitApp.doc 10/01/09 440- 4615T(II /05 /COM /WEB