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Permit
y � CITY OF T I GA R D ELECTRICAL PERMIT - RESTRICTED ENERGY 4 1 DEVELOPMENT SERVICES PERMIT #: ELR2004 -00005 c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/21/04 SITE ADDRESS: 15822 SW UPPER BOONES FERRYRD BLD.0 PARCEL: 2S112DD -00701 SUBDIVISION: OREGON BUS. PARK II ZONING: I -P BLOCK: LOT: JURISDICTION: TIG Project Description: Limited energy for HVAC controls. 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 807 NE COUCH PORTLAND, OR 97224 PORTLAND, OR 97232 Phone: Phone: 233 - 691 I Reg #: ELE 26- I063CRE LIC 38868 SUP 2613LEP FEES Required Inspections Description Date Amount Low Voltage Inspection [ELPRMT] ELR Permit 1/21/04 $75.00 Elect'I Final [TAX] 8% State Surchart 1/21/04 $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 I sued by 2 i a 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day Electrical Per FOR OFFICE USE O NLY CI '''Of Tigard D R eceB • 1/ �m Permit No.: 13125 SW Hall Blvd., Tigard, OR Plan Review Phone: 503.639.4171 Fax: 503. 6 t� 1 2004 "kivOil Date/B • Other Permit Inspection Line: 503.639.4175 �' Date Ready/By ® See Page 2 for ' Internet: www.ci.tigard.or.us CITY OF TIGARD Notified/Method. Mill ' Supplemental Information - . .. , , ® i1 UICDI I . ',- t'• ' ,, PLAN REVIEW • ' A ,',, ti ❑ New construction ❑ Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑ Other: ['Service over 225 amps, comm'l ❑Hazardous location ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft , ' ' CAT OF CONSTRUCTION ,, - of I- 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 ❑ Multi - family CI Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more ['Occupant load over 99 persons ['Manufactured structures or ` ' JOB SITE'INFORMATION -AND LOCATION - RV park ' .. , _ ❑Egress /lrghungplan P ❑Health -care facility ['Other: Job no.: Job site address: z (/P etOkeS liaftiky Submit 2 sets of plans with any of the above. City/State /ZIP: 7- ceA rt 0 The above are not applicable to temporary construction service FEE* SCHEDULE `;` r Suite/bldg. /apt. no.: Project name: ^� • " ' ' " G �PC AC -E' Description I Qty I Fee. I Total ,' •* Cross street/directions to job site: I 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 dwelling, service and /or feeder 90.90 2 /'' 5 15 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ' • , - , E IROPERTY OWNER . , , , - 201 amps to 400 amps 106.85 2 ❑ TENANT - ' ' 401 amps to 600 amps 160.60 2 Name: ,/A C_ 7 U 5 1 601 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 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 , ' I "' .❑ 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, each branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 _ 2 City/ State/ZIP: Miscellaneous (service or feeder not included) Pump or imgation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- :'.....r-, ; - -i_:;.;',,,,,'; . , -' , ; ;CONTRACTOR ' " ';;- energy panel, alteration, or ' extensiok f n, le �{- t!: / Page 2 2 Business name: eq -Emip �J Address: 9�g 8 SC ]Tj��C Each additional inspection over allowable in any of the above Per inspection 62.50 City /State/ZIP: poor -re4N0, Investigation per hour (1 hr min) 62.50 Phone: (spa) a3 3 v 7jJ Fax: (c4, ) .236.974, 7 Industrial plant per hour .73.75 . _ ELECTRICAL .PERMIT FEES* CCB Lic.: 3 Electrical Lic.-6, lot C � Suprv. Lic.: o ff ` 3 1 �'" Subtotal ° Suprv. Electrician signature, required: Plan review (25% of permit fee) 6.00 State surcharge (8% of permit fee) Print name: // ow) SG+tte `/aec., Date / UO TOTAL PERMIT FE L Authorized signature: T his permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: J,= k � _Z Date: / © y • Fee methodology set by Tri- County Building Industry Service Board • • Number of inspections per permit allowed. i \Building\Permits\ELC- PemtitApp doe 12/03 440- 4615T(10 /02/COM/WEB Electrical Permit Application - City of Tigard 0 :3V 2 O 'R ,. Page 2 - Supplemental Information 4 C LINIITED ENERGY PERMIT FEES: :RESIDENTAL`WORK ONLY _ 3'' t,., `''�`' vtO VICE ;7Jil� �ILKI Fee for all residential systems combined ... $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: COININERCIAI . 01- 0C.CON: 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 V • • . ❑ Nurse Calls V V ❑ Outdoor Landscape Lighting* - • ❑ Protective Signaling ❑ Other Total number of commercial systems: V • *No licenses are required. Licenses are required - V for all other installations ' ' - V • i \Buildmg\Peri=\ELC- PmnitApp doc 04/03