Permit i
C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
*elk DEVELOPMENT SERVICES PERMIT #: ELR2005 -00217
��J I 13 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/16/2005
PARCEL: 2S112DD -01600
SITE ADDRESS: 15575 SW SEQUOIA PKWY 130 ZONING: I -P
SUBDIVISION: PACIFIC CORP. CENTER LOT: JURISDICTION: TIG
Project Description: L.V. T -stats and wiring. Job No. 8694
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: 503- 624 -6300 Phone: 503- 233 -6911
Reg #: ELE 26- 1063CRE
LIC 38868
FEES SUP 2613LEP
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 8/16/2005 $75.00
[TAX] 8% State Surcharl 8/16/2005 $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 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
through OAR 95 01 -0100. You m obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: 1,1.S Permittee Signaturg• 1 tg2c
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.
ilik �ctrical Permit Applic4tion� FOR OFFICE USE ONLY
City of Tigard '� R eceived
Date/B • a " p S % Permit No. � .0, ,e 1
')
13125 SW Hall Blvd., Tigard, OR 97223 'l � ' Plan Revie
� ��++00dd``CC�A J 5 is � .,
Phone: 503.639.4171 Fax: 503.598.1960 L Other Permit
+�t'�I D ate /B y:
Inspection Line: 503.639.4175 e' W Date Ready /By: luris: ® See Page 2 for
Internet: www.ci.tigard.or.us t - • -). • Notified/Method: 7T` Supplemental Information
:' :.L .1YPE' 'Ot . • WORK . - . PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply:
❑ Demolition they: ❑Service over 225 amps, comm'l DHazardous location
['Service over 320 amps – rating ❑ Buildng over 10,000 sq. ft.,
CA GORY OF CONSTRUCTION ` ' of 1 - and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling [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
9 (� J Job site address:��` S r DHealth facility ❑Other:.
Job no.: ca
J e mit 2 sets of plans with any of the above.
City/State /ZIP: ��� �� �1Pa�BY� z The above a re not applicable to temporary construction service.
Suite/bldg. /apt. no.: 30 Project name: v FEE* SCHEDULE ' "
�� �l •
�" ��`• Description 1 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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK . Each manufactured or modular
', � r dwelling, service and /or feeder 90.90 2
77744,410 0 411/Q zee." ��' L r it,,,. ..e or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
• ❑ PROPERTY OWNER' ❑ TENANT . . 201 amps to 400 amps 106.85 2
Name:
401 amps to 600 amps 160.60 2
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
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
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
"PLICANT eCONTACT PERSON A. Fee for branch circuits with T
tom' service or feeder fee, each
Business name �� Ki /��'S S, branch circuit 6.65 2
Contact name: /� _• Y/ �`t► B. Fee for branch circuits
14,a /({� without service or feeder fee, 46.85 2
Address: 9 ' s -,,, /2 74 A. �� each branch circuit
6 ` Each add'I branch circuit 6.65 2
City /State /ZIP:
�� / 64.z.,4, OAG�40"...) 5)72_ zi.._ Miscellaneous (service or feeder not included)
Phone: ( ( ) 7-6( F � Fax: : (9 a) 2L 7 �7 Pump or irrigation circle I 53.40 I I 2
tl / Sign or outline lighting 53.40 2
E -mail. Signal circuit(s) or limited-
- - . CONTRACTOR • ; , . . energy panel, alteration, or
extension. Describe: / Page 2 2
Business name: ..e
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB LicgeG Electrical lLLie / ®` T�� Suprv. Lic.j 7 l '
e Subtotal
—
Suprv. Electrician signature, rcquired0 ?� Plan review (25% of permit fee)
Print name: A6 ,,.0? Date: Z�S State surchar (8 %of fee)
.e.Z---- 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: `� n U1 �- t ' � Date: -2 • Fee methodology set by Tri- County Building Industry Service Board
�1
•• Number of inspections per permit allowed.
440 46 15T(10 /02 /COM/WEB
i:\ Building \Permits\ELC- PemmitApp.doc 12/03
CITy OFTIGARD .
BUILDING DIVISION • PERMIT #: ELR2005 -00217
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/16/2005
Phone: (503) 639 -4171 N , ,� i Ix
Inspection Requests (24 Hrs.): (503) 639 -4175 "'I L.
1 INSPECTION WORKSHEET FOR DATE: 8/29/2005 TIME: 7 :13AM PAGE: 33
SITE ADDRES . 15575 SW SEQUOIA PKWY 130 CLASS OF WORK:
SUBDIVISION: - , CIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: M -C INC
DESCRIPTION: L slats and wiring. Job No. 8694
OWNER: PACIFIC • . LTY ASSOCIATES, PHONE #: 503. 624 -6300
CONTRACTOR: PROTEMP • .SOCIATES INC PHONE #: 503-233-6911
Inspection Request Scheduled For: Date: 8/2005 Pour Time:
Code # Inspection Description C. # Contact # Message
- Volta • 01•'`01 503 -619 -6199 Y
• - ection / • II Wts7ln uctions:
.o u t � Lk
o�C� N41 cm�� %,
10Q kA4kv E pk A.IL cE' t,U NI chi u'tk.
-- r - sTO s Iactx' A6p.p ‘ii.,
10Q N - Nopao a . , csa\
foQ. ELL 6423 aER .E
C_E 1 L i n C _.z , v 6
PASS ❑ PARTIAL APPROVAL 111 CANCEL ❑ NO ACCESS
❑ AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G i\CS Date: _ Phone #: (503) 718-