Permit 1111111 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t� COMMUNITY DEVELOPMENT Permit#: ELR2013 00187
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2013
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 350
Project: Williston Finacial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Low voltage for HVAC
Contractor: PROTEMP ASSOCIATES INC Owner: PACIFIC REALTY ASSOCIATES
9788 SE 17TH AVE ATTN: N PIVEN
PORTLAND, OR 97222 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-233-6911 PHONE:
FAX: 503-238-9767
FEES
Description Date Amount
—
Specifics: Restricted Energy Permit 08/05/2013 $75.00
12%State Surcharge-Electrical 08/05/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010th • •• OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued = �� �� ,, . 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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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 RECEIVE I FOR OFFICE USE ONLY
Received ' p J 7
City of Tigard Permit No.. G-K.o f 3-00/ /
13125 SW Hall Blvd.,Tigard,OR 97223 AUG 5 2013 DateB :
g Plan Review
' Phone: 503.718.2439 Fax: 503.598.1960
Date/B : Other Permit: iqEL )0/5-064 I/1
T I G A K D Inspection Line: 503.639.4175 CITY OF TIG' I Date Ready/By: ruris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDINGDIVISII \'otified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
Demolition Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ ❑ where the available fault current
❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ I-and 2-family dwelling ®CommerciaUindustrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A "E","I-2","1-3",
Job no.:3681 Job site address: 12909 SW 68th Pkwy 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard Or 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:#350 Project name:Williston Financial ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
I Qty. I Fee. i Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
Relocate Thermostat&wire residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits—new,alteration,or extension,per panel _
Owner signature: Date: A.Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Protemp Associates panel,alteration,or extension. I Page 2 2
Each additional inspection over allowable in any of the above
Address:9788 SE 17th Ave Additional inspection(I hr min) 66.25/hr
City/State/ZIP:Milwaukie Oregon 97222 Investigation(I hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)519-6199 Fax:(503)238-9767 Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
CCB Lic.: 38868 Electrical Lic.: 26-1063 Suprv.Lic.: 26131eb ELECTRICAL PERMIT FEES
Subtotal:
Suprv.Electrician signature,required: t"/N,,,-1'_"]- Plan review(25%of permit fee):
Print name: Monty Schroeder Date: 8/5/13 State surcharge(12%of permit fee):
��,rS __Af .. TOTAL PERMIT FEE: C (.�CJU
Authorized signature: I
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Bruce Butner Date: 8/5/13
• Number of inspections allowed per permit.
1:\Building\Permits'ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB