Permit ' ENERGY
,, Ay^ DEVELOPMENT SERVICES PERMIT #: ELR2003 -00260
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/28/03
SITE ADDRESS: 15115 SW SEQUOIA PKWY 150 PARCEL: 2S112DA -00800
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of 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-WM I 807 NE COUCH
PORTLAND, OR 97224 PORTLAND, OR 97232
Phone: Phone: 233 - 6911
Reg #: ELE 26- 1063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/28/03 $75.00 Elect'I Final
[TAX] 8% State Tax 8/28/03 $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 within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires -
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Issue by (�G'� Permittee Signature v a
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application ' FOR OFFICE USE ONLY
Received ,. Electrical
Date/By: p / '5 t 7 Permit No.: &4,006 —ma 't
City of Tigard Planning Approval Sign
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other , /
Tigard, Oregon 97223 Date/By: Permit No.: 81e--A05--,142 Sa S
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use
/ /�ll l r � "� Date/By: Case No.:
Internet: www.ci.tigard.or.us • kl I Contact ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 ' '' " Name/Method: h �E
6',p• Supplemental Information.
. - - Mt OF WORK . - PLAN REYIEW (Please check all that apply) - ' t.
❑ N w construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑
Addition/alteration /replacement El Other: Other: Hazardous Building location
Service over 320 amps -rating of ❑ Building over er 10 10,000 square feet,
`CATEGORY -OF CONSTRUCTION - ' • 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ,ommercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB" SITE INFORMATION and LOCATION • Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /17/5 wp / /4 e.m/ - FEt* SCHEDULE - • ..- . °: .
Suite #: / Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: /ehr .0214.4.1t/L7Z1J75 Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: New residential- single or multi - family per
dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
' - , a • DESCR IPTIM' OF WORK - service and/or feeder 90.90 2
r Services or feeders - installation,
7' 7' . sJ alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
❑ PROPERTY,OWNER • ` 1 ' Ill TENANT 601 amps to 1000 amps 240.60 2
Name: / 6 _ 1 C v S Reconnect nett amps or volts 454.65 2
econect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: G ' • 6.30 0 Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
El APPLICANT ; . ' 0 CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
Address: A . Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
CONTRACTOR . .. __ Each pump or-irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: Rter it/P Description:
Address: 970 sE /2
City/State/Zip: a °f ��� Each additional inspection over the allowable in any of the above:
Ci
p: PeXTLM, Per inspection per hour (min. 1 hour) 62.50
Phone: 233 -C // Fax: e't $
3- 1767 'G 67 Investigation fee: ,
CCB Lic. #: 3' ge4,25 Lic. #: ,ZG- /0 (.3 G/ICr. , Other: Electrica l'erinitFees*
Supervising electrician Subtotal $ ',S o0
signature required: Plan Review (25% of Permit Fee) $
Print Name: /Apt/ Sp9C^6G>�" J Lic. #: o�� 3 Lcn State Surcharge (8% of Permit Fee) $ , .0e9 < TOTAL PERMIT FEE $ 6/ , et'
Authorized . _ Notice: This permit application expires if a permit is not obtained within
Signature: -� _�_� Date: e , 180 days after it has been accepted as complete.
c�EG '� *Fee methodology set.by Tri -County Building Industry Service Board.
(Please t name) L
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application -.City of Tigard •
•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
❑ Burglar Alarm
• Garage Door Opener •
Heating, Ventilation and Air Conditioning System
•
❑ Vacuum Systems
Other
•
COMMERCIAL WORK ONLY:
. Fee for each 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
•
• ❑ Other � . .
Number of Systems
* No licenses are required. Licenses are required for all
' other installations
•
•
•
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03
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