Permit , CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00229
13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 11/02/2011
T t' _ 9 Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 300
Project: Williston Financial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: HVAC system
Contractor: PROTEMP ASSOCIATES INC Owner: PACIFIC REALTY ASSOCIATES
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 11/02/2011 $75.00
12% State Surcharge - Electrical 11/02/2011 $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 OAR 952 -001 -0090 Y•u ma • • • - • • o s.nr direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
I.
Issued By: Permittee Signature: .
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 <,, •
FOR OFFICE USE ONLY
City of Tigard ‘a,44,- Received i i
Date/B I t illtill Permit No • ) /I—(y digt
, g 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
r l . Phone 503.718.2439 Fax: 503 5981 Date/B Other Permit -
Inspection Line 503 639.4175 jic"
96°
1, (\\;\
...., Date Ready/By 10 See Page 2 for
Internet' www tigard-or.gov
TIGARD
% Ci.-I
, c.t.,V op fo . tified/Method MI Supplemental Information
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Re:::-2 ci i:i wo k iz i,,-, k ,4 44 -.-crwo „ ::::Ipt:;!, „ 4-..,..„ „,-7 :nwki: REviiwt
0 New construction 0 Addition/alteration/rOaCerneiV' Please check all that apply (submit 2 sets of plans w/items checked below)
r; N, Nflt t'." 12 Service or feeder 400 amps or more 0 Building over three stories
El Demolition I=1 Other: ‘... ‘14\‘' -'. where the available fault current 0 Mannas and boatyards.
. -,-- .t..-.,-....K. . ut; , ' , „.,,,, \ '-, .:,
... NON, A Ilik tA440:‘' agC , :'W AN : - exceeds 10.000 amps at 150 volts or 0 Floating buildings
less to ground, or exceeds 14,000 0 Commercial-use agricultural
D i- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations buildings
0 Multi-family El Master builder 0 Other: 0 Fire pump 0 Installation of 75 KVA or
0 Emergency system larger separately derived system
Ill -It ii:0!miteNkpir*f1oN: AND ; :i10.001-*1'11i, 'W . - 0 Addition of new motor load of
Job no.: 3197 Job site address: 12909 SW 68 PKWY 100HP or more occupancy
0 Six or more residential units 0 Reuvational vehicle parks
City/State/ZIP: Tigard OR 97223 El Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations 600 volts nominal
Suite/bldg./apt. no.: #350 Project name: Williston Financial 12 Service or feeder 600 amps or more
NMELli- - -11 Rial -- Ottf$0 1 -E 1 * - 0,- ' '
Cross street/directions to job site: Description I Qty. I Ere. I Total I 't
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'l 500 sq. ft. or portion 33 92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
'M , ?w - JP ,? (with above sq. ft.)
Limited energy, multi-family
75 00 2
Relocate thermostat & wire residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
;e- °W411;? ' ''' MI ILIE3; TRIANJ liti -, : 201 amps to 400 amps 133.56 2
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 10 400 amps 125 08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
tg.! ? '1110i8ribe• ' ' I 0 X
-V 1 ;:(07:4 4 : 6 1*#0i 4 : " .:Vgiik ,: above service or feeder fee,
7.42 • 2
each branch circuit
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)
Each manufactured or modular
City/State/ZIP: Portland Oregon 97222 67 84 2
dwelling, service and/or feeder ,
Phone: (503) 519 Fax: : (503 238 Reconnect only 67 84 2
Pump or irrigation circle 67.84 2
E bruce@protmp.com
, Sign or outline lighting 67.84 2
A rif , i ' , '-' < 65* Signal circuit(s) or limited-energy --v----0--' -
Business name: Same as above panel, alteration, or extension. Pa ge 2 /.5 . -- 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr mm) 66 25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP:
lndustnal plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
90.00/ hr
specifically listed (1/4 hr min) .
CCB Lic.: 38868 Electrical Lic.: 26-1068 Suprv. Lic.: 26131eb Ntt: Witlik4:BaCIRI,CALI*E01\41T4BESi:
Subtotal '7c.; -
Suprv. Electrician signature, required: iv . 0, r „....4...1*
"<--1 .ft, Plan review (25% of pennit fee): —
cX
Print name: Monty Schroeder Date: 11/2/11 State surcharge (12% of permit fee) crl,
TOTAL PERMIT FEE.
Authorized signature:
r 2- 4 - - • --- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Bruce Butner Date: 11/2/11 * Number of inspections allowed per permit
1 \ Budding \ PermIts \ ELC-PemutApp doc 07/01/10 440-4615T(1 I /05/COM/WEB