Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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IN 2 COMMUNITY DEVELOPMENT Permit#: ELR2014-00056
T t Ci A R O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/26/2014
Parcel: 2S113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Project: Copytronix Subdivision: ROSEWOOD ACRE TRACTS Lot: D
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 SW SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-233-6911 PHONE: 503-624-6300
FAX: 503-238-9767
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/26/2014 $75.00
Type of Use: COM 12%State Surcharge-Electrical 03/26/2014 $9.00
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
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, 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
952-001-0010 2-001-00 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: / 7 Cr--tL1/d A_:, ,,,,,,
`-r Permittee Signature: . it. ......4
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 Applicat'on `,_., 11)11 I)I 1 1( I I .I O r%.1
City of Tigard 1, , `1v Received
Daze i Permit No.: s , �•
13125 SW Hall Blvd.,Tigard, 9'7223 ®Y —'— h
;� Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503. � b11 5 2 14 Date/B _�. 0,u. .� 03
I I t,a i,1 Inspection Line: 503.639.4175 Date Ready/ay:
Internet: www.tigard-or.gov Notified/Method:
CITY Of FIGARa
` ri nluiqnN PLAN REVIEW
New construction Please check all that apply(submit a sets of plans w/items checked below):
❑ ®Addition/ eration/replacement
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONDUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 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.:3780 Job site address: 16640 SW 72ad Ave I00HP or more. occupancy.
❑Six or more residential wits. ❑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.: Project name:Copytronix ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. I Total I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 st ft.or less 168.54 4
Ea.add'1 500 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
Thermostat And Wire residential(with above sq.ft.)
Renewable Energy _ (3 See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
' 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
742 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
branch circuit 56.18 2
Address: Each add'1 branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
Phone: dwelling,service and/or feeder 67.84 2
( ) Fax: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Protemp Associates Inc. Signal circuit(s)or limited-energy See
panel,alteration,or extension. I Page 2 75 CC 2
Address:9788 SE 17'h Ave Each additional inspection over allowable in any of the above
City/State/ZIP:Milwaukee Or 97222 Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(503-)519-6199 Fax:(503)238-9767 Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 38868 Electrical Lic.: 26-1063c R t. Suprv.Lic.: 2613Ieb specifically listed(Y2 hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: /11 Subtotal: -75.00
Print name: Monty Schroeder Date: 3/4/14 Plan review(25%of permit fee).
State surcharge(12%of permit fee): 9•co
Authorized signature: TOTAL PERMIT FEE: g4.00
This permit application expires if a permit is not obtained within 180
Print name: Bruce Butner Date: 3/4/14
days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(I1/05/COM/WE8
Location:
Record Type:
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Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16640 SW 72ND AVE B10, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
199 Electrical final
2014-04-16 (null)
ELR2014-00056
PASS - No C of O
Violation Summary:
Inspector Contractor