Permit C ITY .OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a * 4 'kel DEVELOPMENT SERVICES PERMIT #: ELR2005 -00438
� l DATE ISSUED: 12/27/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
.PARCEL: 2S112DD -00701
SITE ADDRESS: 15800 SW UPPER BOONES FERRY RD A -300 ZONING: I -P
SUBDIVISION: OREGON BUSINESS PARK II LOT: JURISDICTION: TIG
Project Description: Limited energy for HVAC. Job No. 8790
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: Contact #: PRI 503
FAX 503- 238 -9767
FEES Reg #: ELE 26- 1063CRE
LIC 38868 •
Description Date Amount
[ELPRMT] ELR Permit 12/27/200` $75.00
[TAX] 8% State Surchari 12/27/200E. $6.00 REQUIRED ITEMS AND REPORTS
• 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 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: sj, Permittee Signature: , ,e
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.
•
;,-.Electrical Permit Application / /3 FOR OFFICE USE ONLY
City of Tigard
Date/By. / ,9- /3 65...- Permit No J '«3 q
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax 503.598 1960 A
Date/By Other Perm Inspection Line: 503.639 4175 Date Ready /By. Jam' el See Page 2 for
Internet: www.ci.tigard onus r 11 p // E f�1 Notified/Method. / / Supplemental Information
TYPE I' ll O 5 \,v(/ l PLAN REVIEW
❑ New construction ® Addition /alteration /replace a Please check all that apply:
❑ Demolition ❑ Other: DEC 1 6 � -
['Service over 225 amps, comm'I ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CCOS1RI WCT16J�R of 1- and 2- family dwellings 4 or more new residential
❑ I- and 2- family dwelling ® Commeil J1bUUgl1GI DIEl &ss building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ['Building over three stories DFccdcrs, 400 amps or more
[Occupant load over 99 persons ['Manufactured structures or •
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
❑Health -care facility ❑Other:
Job no.: 8790 I Job site address: 15800 SW UPPER BOONES FERRY RD Submit 2 sets of plans with any of the above.
City /State /ZIP: TIGARD OREGON 97224 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: #300 I Project name: MATTHEWS GALLERY FEE* SCHEDULE
Description I Qty. I Fee. I Total I ..
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 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORT' Each manufactured or modular
THERMOSTAT AND WIREING FOR NEW A/C UNIT dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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
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
® APPLICANT ® CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each G 65 2
Business name: PROTEMP ASSOCIATES branch circuit
B. Fee for branch circuits
Contact name: BRUCE BUTNER without service or feeder fee, 46.85 2
first branch circuit
Address: 9788 SE 17 AVE Each,add'I branch circuit 6.65 2
City /State /ZIP: PORTLAND OREGON 97222 Miscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone: (503) 519 -6199 I Fax: : (503) 238 -9767 Sign or outline lighting 53.40 2
E-mail: S •• •ted-
CONTRACTOR ener: . • i - alteration, o
B extension. Desc be l Page 2 2
Business name: SAME AS ABOVE
THERMOSTA
Address:
. • t addir t , • ction over allowable in any of the above
City /State /ZIP: Per inspection 62.50 _
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
Industrial plant per hour 73.75
CCB Lie.: 38868 Electrical Lie.: 261063 CRE Suprv. Lie.: 3948LEB ELECTRICAL PERMIT FEES*
Suprv. Electrician /nature required: Subtotal S
/ Plan review (25% of permit fee)
Print name: J Date: 12 -13 -05 a OCT
/ - State surcharg (8% /o of perm fee)
Authorized signature: TOTAL PERMIT FEE i , O v
/ This permit application expires if a permit is not obtained within 180
Print name: ag J4. , e___ Ad!' �-e..A-, Date: 12 -13 -05 days after it has been accepted as complete •
• Fee methodology set by Tri County Building Industry Service Board
I \ Building \ Permits \ELC- PermaApp doc 12/03 440- 4615T(10/02JCOM /WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: LLR2005 00430
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/21/2005
Phone: (503) 639 -4171
Inspection Request (24 Hrs.): (503) 639 -4175 °7 I I..
INSPECTION WORKSH.ET FOR DATE: 1 /24/2006 TIME: 6:50AM PAGE: t31
SITE ADDRESS: 15000 ',W UPPER BOONES FERRY RD A -300 CLASS OF WORK:
SUBDIVISION: OREGO BUSINESS PARK II LOT #: TYPE OF USE:
PROJECT NAME: MATTHE11d GALLERY
DESCRIPTION: Limited ener for HVAC. Job No. 0790
OWNER: PACIFIC REAL \ ASSOCIATES, PHONE #:
CONTRACTOR: PROTEMP ASSOIATES INC PHONE #: 503-233-6911
Inspection Request Scheduled For: • Date: 1/24/2006 Pour Time:
,\
Code # Inspection Description C•-•' • Contact # Message
199 Electrical final )25513 -01 503-519-6199 N
Corrections /Comments /Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: . / Date: I 2 0 Phone #: (503) 718- 204