Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 • COMMUNITY DEVELOPMENT Permit#: ELR2014-00009
TIGARD 13125 SW Hall Blvd.. Tigard OR 97223 503 718 2439 Date Issued: 01116/2014
Parcel: 1 S135DD01800
Jurisdiction: TIGARD
Site address: 11565 SW HALL BLVD 180
Project: Bella Institute Subdivision: METZGER ACRE TRACTS Lot: 32
Project Description: Low voltage for HVAC.
Contractor: PROTEMP ASSOCIATES INC Owner: BKB PROPERTIES LLC
9788 SE 17TH AVE 11255 SW DAVIES RD,APT 1014
PORTLAND, OR 97222 BEAVERTON, OR 97007
PHONE: 503-233-6911 PHONE:
FAX: 503-238-9767
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/16/2014 $75.00
12%State Surcharge-Electrical 01/16/2014 $9.00
Type of Use: SF
Class of Work: ALT
Total Number of Systems: 1
Audio& Stereo: 0 Boiler Controls
CCTV: 0 Clock Systems 0
Data&Telecommunications: 0 Fire Alarm. 0
HVAC: 1 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, Stale 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
952-001-0010 through OAR 952-001-0090 You may obtain a of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By LT �T T Pcrmittee 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' 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 vV-D l ; ,t I i, 1 I 1 1.1
City of Tigard &V ON Received r�,�
1111 '• g V DateiB : ; Permit No.: G ' At.y 4-00_ c
i * 13125 SW hall Blvd.,Tigard,OR Plan Review
g Phone: 503.718.2439 Fax: 503.598.1960 414 Date/B :
Other Permit: �t r — ,i .�
is 1, Inspection Line: 503.639.4175 ,P� Q 9 Date Ready/By: See Page 2 for
Internet: www.tigard-or.gov A�ot Notified/Method: �� Supplemental tnformrlioe
TYPE OF Lit ��}�.t"�'ffr't� tgt4 PLAN REVD W
❑New construction ®Add ition/alteratjpp(rgj ni check all that apply(submit j sets of plans w/items checked below):
❑Demolition 'oU l" ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Other; where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating building.
❑ I-and 2-family dwelling ®Commercial/industrial El Accessory building less s for eda r exceeds one, ❑Canmac>d.uae agricultural
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 ition of new motor load of ❑"A""E" "I.2","I-3"
Job no.:3746 I Job site address: 11565 SW Hall Blvd IDDHP or more. occupancy.
['six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard Or 97223 ❑licalth'care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: Bella -f ta`1t ❑Service or feeder 600 amps or more.
' FEE SCHEDULE
Cross street/directions to job site: Description I Q17. 1 Fee. 1 Total 7
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: l Lot no.: 1,000 sq ft or less 168.54 4
Tax maplpan el no.: Ea.add'I 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
• Limited energy,multi-family 75.4() 2
Thermostat&wire residential Iwith above sq.ft.)
Services or feeders installation,alteration,ard/or relocation
200 amps or less 100.70 2
Q mammy of NER I 0 radArer 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps - 204.34 2
-
601 amps to 1,000 amps 301.44 2
Address: Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) I Fax:( ) 200 amps or less 59.36 I
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. 401 amps
cirettlits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
0 APPLICANT I Q 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 ineladed)
City/Stale/ZIP: Each manufactured or modular 67.84 2
dwellin&service and/or feeder
Phone:( ) I Fax::( ) Recooncet only 67 84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuits)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 17m Ave Additional inspection(1 hr min) 66.251 hr
Investigation(1 hr min) 66.25/hr
City/State/ZIP:Milwaukie Oregon 97222 industrial plant 11 hr min? 78.18/hr
Phone:(503)519-6199 I Fax:(503)238-9767 Inspections for which no fee is
specifically listed('72 hr min) _
CCB Lic.: 38868 I Electrical Lic.: 26-1063 1 Suprv. Lic.: 26131eb ELECTRICAL PERMIT MKS
Suprv.Electrician signature,required:
oftc----- Subtotal:
Plan review(25%of permit fee):
Print name: Monty Schroeder Date: 1/9/14 State surcharge(12°1,of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Ibis permit application eapitee if•permit is not obtained wlthia 1811
days after it has been accepted as complete.
Print name: Bruce Butner Date: 1/9/14 • Number of inspections allowed per permit.
1.5nuildirn\Pnmils1ELC•PermitApp doe 071'01/10 440461 ST(t 1/05/CONS/WED
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11565 SW HALL BLVD 180, TIGARD, OR, 97223
Commercial - Electricial Limited Energy
199 Electrical final
2014-02-21 (null)
ELR2014-00009
PASS - No C of O
Violation Summary:
Inspector Contractor