Permit ,�' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
L
' �' ' -1 COMMUNITY DEVELOPMENT Permit #: ELR2011 00248
TIG 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/20/2011
Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 105
Project: Cognex Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: Low voltage for HVAC
Contractor: PROTEMP ASSOCIATES INC Owner: JDS LLC
9788 SE 17TH AVE CRITERION CREEKVIEW LLC
PORTLAND, OR 97222 ATTN JAMES A MEYER
PO BOX 6525
BEAVERTON, OR 97007
PHONE: 503 - 233 -6911 PHONE:
FAX: 503 - 238 -9767
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/20/2011 $75.00
12% State Surcharge - Electrical 12/20/2011 $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. ATT ION: Orego aw re•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 through OAR 952 -06 .09k. • may obtain a copy of the rules or direct questions to OUNC by callin• • . .1987 or 1.800.332.2344.
Issue By: �' _
• Li ■' _1 /� Permittee Sign ure: . % /
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 RECEIVE.
.,.....,
...
FOR OFFICE USE ONLY
EIVE.
City of Tigard Received
Date/B : MAEFAMII Permit No.: 6,12// — 640,,,Itle
° Hall Blvd., SW H
13125 Savd., Tigard, OR 97223
i
. Plan Review
' theot4X2ii—eb567
Phone: 503.718.2439 Fax: 503.598.1960 DEC 1 3 2011 Date/B : Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: Juris• 0 See Page 2 for
TIGARD
Internet: www.tigard CITY OF TIGARD Notified/Method: Supplemental Information
WilltAntiltkilittiEMCfik#gi:'' .'blNaifiltfgityipkk Cf1
O New construction [X] Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
El Service or feeder 400 amps or more El Building over three stories.
O Demolition 0 Other: where the available fault current 1:1 Marinas and boatyards.
f .: " Q ° 1 - 1:41J 7 f.*: 4.11Fil ', --''
,,r,:, exceeds 10,000 amps at 150 volts or El Floating buildings.
less to ground, or exceeds 14.000 El Commercial-use agricultural
El I- and 2-family dwelling E Commercial/industrial 0 Accessory building amps for all other installations. buildings.
El Multi-family 0 Master builder 0 Other: El Fire pump. 0 Installation of 75 KVA or
0 Emergency system, larger separately derived system.
- ' ' ! '";44 VV.r : i7 " ,N.=1~, l ifSTO 1 1*.figN.th.:0**0.Kiiii,i1111111Wi, 0 Addition of new motor load of 0 "A", "E", "1-2". "1-3",
Job no.: 3211 Job site address: 15865 SW 74- Ave 100HP or more. occupancy.
CI Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard OR 97224 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: #105 Project name: Cognex 0 Service or feeder 600 amps or more.
- NRCZECtikt.1:50:06-Lkit'ilik„,:'''''
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
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
t -lrfifiAAii ' W ORK - " ' r - ' '''':" ' ' - ' ' --'- -"- ' - ' - 75.00 2
„., :--24,14,,,,—__0,,.,,,, , ,, ,,,- „,,,,,,,,, (with above sq. ft.)
Limited energy, multi-family
75.00 2
thermostat & wire residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
EMS 0 : .: 4,,i1401110 if: 201 amps to 400 amps 133.56 2
401 dmps 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 I
201 amps to 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 to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
UNVC : ...:::...igagkie Ai Z1 PAM El000: ;,PERSON l :;:- : - .:: 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'I 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) 519-6199 Fax: : (503-) 238-9767 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E bruce@protmp.com
Sign or outline lighting 67.84 2
Wi-i'..: SAW --,:. i.i:M COIV:MCIAltidairrSerAlitigl:`4r
, Signal circuit(s) or limited-energy I
panel, alteration, or extension. Page 2 75 :11° 2
Business name: Same as above
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr mm) 66.25/ hr
Investigation (I hr mm) 66.25/ hr
City/State/ZIP: .
Industrial plant (I hr mm) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
90.00/ hr
specifically listed (1/4 hr mm)
CCB Lie.: 38868 Electrical Lie.: 26-1068 Suprv. Lie.: 2613leb tIII' -; 7I0 4WeIgtOKOPAEINttfrg:$ ITF
Subtotal: -7
Suprv. Electrician signature, required: /\,- ..3,,,,..,.._.‘„,., Plan review (25% of permit fee): ----
Print name: Monty Schroeder Date: 12/9/11 State surcharge (12% of permit fee): 9. 00
TOTAL PERMIT FEE: g c cc)
Authorized signature: zqze4r_e_de_ee--- This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Bruce Butner 7 Date: 12/9/11 * Number of inspections allowed per permit.
I: \BuildingTermits \ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB .