Permit 1 u CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
� F '� COMMUNITY DEVELOPMENT Permit #: ELR2011 -00235
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/22/2011
T� Parcel: 2S 112 DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 350
Project: Cornett PC Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: HVAC system.
Contractor: PROTEMP ASSOCIATES INC Owner: PACIFIC REALTY ASSOCIATES
9788 SE 17TH AVE ATTN: N PIVEN
PORTLAND, OR 97222 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 233 -6911 PHONE: 503 - 624 -6300
FAX: 503 - 238 -9767
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/22/2011 $75.00
12% State Surcharge - Electrical 11/22/2011 $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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through 0 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: t) /�'0 ltlir�� - �"w
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application � ' - - - - - - FOR - OFFICE- USE -ONLY -• -- - • -
,q Received
City of Tigard ^ t � , " �� Date /B Permit • No.: � � ` t'
IN
"' ° 13125 SW Hall Blvd., Tigard, 7229 1 Plan Review
Phone: 503.718.2439 Fax: 5059$.- 1960 Other • Permit: , Date /B : •(- — CAS Z "5"
TIGARD Inspection Line: 503.639.4175 Q .` ®� Date Ready /By: See Page 2 for
Internet: www.tigard or.gov t \ Notified /Method: Supplemental Information
tl� c�0�
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'C� P1 REViEV4'
y
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I=1 New construction ® Addition /alterati n� placement 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.
" .
_� ,, ;� z_ CATEGORY.,ssOF� CONSTRUE �IQ• , ? ?,?/': ? ...: n ' - <r
exceeds 10,000 amps at 150 volts or Floating buildings.
a; "' " ""`' "' '' less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
. ❑ Multi- family ❑ Master builder El Other: ❑ Fire pump. ❑ Installation of 75 KVA or
J OBS Q .w . " " '' "' ' ❑ Emergency system. larger separately derived system.
%a.. - SIT INF = R A =A . Lizi TION P 4 : Add of new motor load of
100HP or more. occupancy.
Job no.: 3198 Job site address: 15350 SW Sequoia pkwy ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: #350 Project name: Cornett ❑ Service or feeder 600 amps or more.
job site: ry :IEEE SCHE v I �e ; o va
Cross street/directions to
J Description � \ �� , I Qtv. I � Fee. I 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
'
ti..:: =:-- ;1^ 75.00 2
: ? .. & ''," ` DESCRIPTION: 04 - vORK' ; ? i (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
® PR()PERTaY OWNER:s " TENAt t y amps to amps ��. ^'„ >' '` -Q 201 0 400 a 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
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
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
;, above service or feeder fee,
' °,•" " ;: rAPRLICAVf ;❑ ,GONiI'ACT PERSON° ,: 7.42 2
�_�u-.. ,:- ,...,.� : ., ., „ h �:. <, .. ; �.;. � -. � ,.�. ,� r- 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)
City/State /ZIP: Portland Oregon 97222 Each manufactured or modular 67.84 2
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 - mail: bruce @protmp.com
a , Tx , " Sign or outline lighting 67.84 2
1 " : C ONTR AG. .;.,
a� �s�'a. .wz - ;�=�� . - � �„ „„ -- �; ��� =: ° ; - . ` _- � -.... �- -, Signal circuit(s) or limited -enetgY !J
Business name: Same as above
panel, alteration, or extension. I Page 2 � i 5 . de. 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (/ hr min) 90.00 / hr
CCB Lie.: 38868 Electrical Lie.: 26 - 1068 Suprv. Lie.: 26131eb _ -- 'spa' ,E EUfti.CAL PERMTi'' FLES` —,=;..: ”'
Subtotal: •7S t'—
Suprv. Electrician signature, required:
Plan review (25% of permit fee): ^
Print name: Monty Schroeder M ate: 11/14/11 State surcharge (12% of pennit fee): c�-
TOTAL PERMIT FEE: ■ t '- 7
�
Authorized signature:
e e3- zeze _ e ___ A j_
,( -0,*( This permit application expires if a permit is not obtained within 180
Print name: Bruce Butner Date: 11/14/11 days after it has been accepted as complete.
* Number of inspections a llowed per permit.
1: \Building \Permits \ELC- PermitApp.doc 07/01/10 440- 4615T(I1/05 /COM/WEB q 2. G -o