Permit r 1
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN, 9
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00164
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/24/2009
Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11555 SW DURHAM RD A -4
Subdivision: Lot: 0
Project: Oregon Music Academy
Project Description: Install restricted energy for HVAC.
Owner: FEES
HIP WILLOWBROOK LLC Description Date Amount
BY TAX DEPARTMENT, PO BOX 2708 Restricted Energy Permit 06/24/2009 $75.00
PORTLAND, OR 97208 12% State Surcharge - Electrical 06/24/2009 $9.00
PHONE:
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 Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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. 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 throug OAR 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.
Issued By: C Qt C V.1 Permittee Signature: ).J
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 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 - - -,_ - - -- FOR OFFICE USE' ONLY— . _ n
Received 0 �Q •'' '
III City of Tigard Date/13 . t Pe e
r 13 125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C • Phone: 503.639.4171 Fax 503.598.1960 Date/By: Other Permit: 0 Ii , ik
•
-1' I G A it 0 Inspection Line: 503.639.4175 Date Ready/By: Jmis: El See Page 2 for
Internet: www.tigard- or.gov Notified/Method: 114 Supplemental Information
_ - - _ ` '
' TYPE _OF; WORK - . __ _ _ _ , - - : - _ PL REVIEW , _ - - i ' -
❑ New construction ® Addition /alteration/replacement Please check all that apply (,..1,,,, it 2 sets o£yl.,tii, w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
- CATEGORY OF CONSTRUCTION` exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
El 1 -and 2-family dwelling Commercial/industrial less to ground, or exceeds 14,000 ❑ commercial -use agricultural
y g ® ❑ Ac cessory building amps for all other installations. buildings.
Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
3QB =S ITE TNEO .. .. .. . .. 0 Emergency system. larger separately derived system.
- `
. _ . __ SITE R119A1'ION AND- LOCATION _ _ - - - . , - , • ❑ Addition of new motor load of ❑ "A> "E> , `I.2 ' 1 3 ",
' .. .fob no.: 9610 Job site address: 11555 SW DURHAM RD 10011P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
" City / State/ZIP: TIGARD OREGON 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
▪ Suite/bldg. /apt. no.: Project name: OREGON MUSIC SCHOOL ❑ Service or feeder 600 amps or more.
- : , FEE SCHEDULE. '
Cross street/directions to job site: Description
Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
• Includes attached garage.
' Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
75.00 2
• -` - - - .._ _ D ESCRIPFION.'OF WORK (with above sq. ft.)
THERMOSTAT &WIRE _ Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
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
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
City / State/ZIP: Temporary services or feeders installation, alteration, andfor
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 599 amps 133.75 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
- CI APPI:ICANT " - . ® CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: PROTEMP ASSOCIATES B. Fee for branch circuits
Contact name: BRUCE BUTNER without service or feeder fee 46.85 2
first branch circuit
' Address: 9788 SE t 7 AVE Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City / State/ZIP: PORTLAND OR 97222 Each manufactured or modular 2
• dwelling,
ectvme ct
. Phone: (503) 519 -6199 Fax: : (503) 238 - 9767 Reconnect and/or feeder only 66.85 2
'-E -mail: Pump or irrigation circle 53.40 2
_ - - - - = CONTRACTOR' _' - __ ,' = : . - . _ Sign or outline fighting 53.40 2
Business name: SAME AS ABOVE
Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: 1 Page 2 2
STAT & WIRE
City/State/ZIP: Each additional inspection over allowable in any of the above
Phone: Per inspection 62.50
( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: 38868 Electrical Lic.: 26 -1036 Suprv. Lic.: 2613LEB Industrial plant per hour 73.75
- ' - . = - - - ELECTRICAL PERMIT FEES' - , -
Suprv. Electrician signature required:M Subtotal:
' Print name: MONTY SCHItOEDER Date: 6/24/09
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized sigtattir /�f _ a TOTAL PERMIT FEE: 8 & cy 1
Print name: BRUCE BUTNER I Date: 6/24/09
This permit application expires if a permit is not obtained within 180
Jars after it has been accepted as complete.