Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
l DEVELOPMENT SERVICES PERMIT #: ELR2005 -00088
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/14/2005
PARCEL: 2S112AD -01000
SITE ADDRESS: 14945 SW SEQUOIA PKWY 170 ZONING: I -P
SUBDIVISION: PACIFIC CORP. CENTER LOT: JURISDICTION: TIG
Project Description: Limited energy for HVAC
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 9788 SE 17TH AVE.
PORTLAND, OR 97224 PORTLAND, OR 97222
Phone: Phone: 503 233 - 6911
Reg #: ELE 26- 1063CRE
LIC 38868
FEES SUP 2613LEP
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 4/14/2005 $75.00
[TAX] 8% State Surcharl 4/14/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started w ' • :0 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you ollow rules - 9 opt- - by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
thr. gh OAR 952 -001 d 10e. 'u may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Iss ed By: # . i, _ 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'N 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.
EleqZical Permit Application FOR OFFICE USE ONLY /
ity of Tigard Date /B �� �/ Permit No.: �` ,
_ III tl
I3125 SW Hall Blvd., Tigard, OR 97223 Plan Review ����
Phone: 503.639.4171 Fax: 503.598. III Date /By: Other Permit:
Inspection Line: 503.639.4175 ! e' _. Date Ready /By: / ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 1 Ma Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply:
OService over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑ Other:
OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling f Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, , 400 amps or more
❑ Multi- family Master builder ❑Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: I Job site address: < p ❑Health -care facility ['Other ) 9 y� J (4/ V f %r4 / k Submit 2 sets of plans with any of the above.
City/State /ZIP: i i S A,� 0 n.R__ The above are not applicable to temporary construction service.
p FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: V G I` eee01..ar Description I Qty. I Fee. I Total
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
J 1 dwelling, service and/or feeder 90.90 2
/ ` .4 S r '•' 00 (/V //t.,./ °:// Services or feeders installation, alteration, and /or relocation
J 200 amps or less 80.30 2
❑ PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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 600 amps 133.75 _ 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting • 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
/�
extens` , / Page 2 2
Business name: 5..„ � i9�se, (" " s n e:
9 g g S e_ / ) r Each additional inspection over allowable in any of the above
Address: Per inspection 62.50
City/State /ZIP: �0� �Art, _ -0 4—'e-- Investigation per hour (I hr min) 62.50
l Industrial plant per hour 73.75
Phone) 3 S 6 q S Fax: (�Q3) "....J S, b ELECTRICAL PERMIT FEES*
CCB Lic.: 3 gt'6 g- Electrical Lic.: 2/p4,34 Suprv. Lic.:a 2 'Q'4 Subtotal
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: Date:
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: it3� t-� av 7---(..,t_.... Date: ji.4 ,.......6S • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is Building 'Pemrits \ELC- PermitApp.doe 12103 440- 4615T(10,02/COM/WED
Electrical Permit Application - City of Tigard .•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ B urglar Alarm
❑ Garage Door Opener*
❑ H eating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
•
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ O ther
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
c BuildingTcmuts \ELC- PcmtitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005 -00088
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/2005
Phone: (503) 639 -4171 ud4�yihy�'�Ii
Inspection Requests (24 Hrs.): (503) 639 -4175 � , .
INSPECTION WORKSHEET FOR DATE: 5/4/2005 TIME: 7:15AM PAGE: 59
SITE ADDRESS: 14945 SW SEQUOIA PKWY 170 CLASS OF WORK:
SUBDIVISION: PACIFIC CORP. CENTER LOT #: TYPE OF USE:
PROJECT NAME: JC REEVES
DESCRIPTION: Limited energy for HVAC
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 503 -233 -6911
Inspection Request Scheduled For: Date: 5/4/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 006059-01 503-519 -6199 Y
C orrections /Comments /Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
oe / x/
Inspector: :.r `L� _ Date` (7 Phone #: (503) 718-