Permit ELECTRICAL RESTRICTED ENERGY PERMIT
CITY OF TIGARD
•
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00352
T t o 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/10/2009
Parcel: 2S 113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK I Lot: 9
Project: Veris
Project Description: Low voltage for HVAC.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 12/10/2009 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 12/10/2009 $8.14
PHONE: 503 - 624 -6300
Contractor:
PROTEMP ASSOCIATES INC
9788 SE 17TH AVE
PORTLAND, OR 97222
PHONE: 503 - 233 -6911
FAX: 503 -238 -9767
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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. �A E ION: Oreg n-Jaw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 01 -0010 through OAR 952 -.: -01i0. • may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Is ed By: � / � , I . . � -' 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 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 FOR OFFICE [SF O\ ed
R ECEIVED Received
City of Tigard Receiv : ! ir Permit No.: h --o035
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review •
II Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
Inspection Line: 503.639.4175 DEC 0 8 2009 Date Ready/By: furls: D furls: M See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF t OF TIGAuw PLAN REVIEW
❑ New construction ® Addition/alt 1onP6PegtlitJ Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 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
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ 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 "1-2", "1 -3"
Job no.: 9700 Job site address: 16640 SW 72 AVE 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.: Project name: VERIS NORTH ANNEX ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: nesaiption 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi -family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
THERMOSTATS & WIRING residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
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 599 amps 133.75 2
Owner signature: Date: Branch circuits – new, alteration, or extension, Per panel
A. Fee for branch circuits with
® APPLICANT I ® CONTACT PERSON above service or feeder fee,
6.65 2
each branch circuit
Business name: PROTEMP ASSOCIATES B. Fee for branch circuits
Contact name: BRUCE BUTNER witlrarru service or feeder fee
first branch circuit 46.85 2
Address: 9788 SE 17 AVE Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included) _
City /State/ZIP: PORTLAND OR 97222 Each manufactured or modular 9090 2
dwelling, service and/or feeder
Phone: (503) 519 -6199 Fax: : (503 -) 238 -9767 Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: SAME AS ABOVE Signal circuits) or limited -
energy panel, alteration, or 1
ry
Address: extension. Describe: Page 2 , D e( 2
THERMOSTAT &WIRING;
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: 38868 Electrical Lic.: 261036CR Suprv. Lic.: 2613LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Nr1 Subtotal: '7, &'q
Print name: MONTY SCHROEDER Date: 12/8/09 Plan review (25% of permit fee): A/li
State surcharge (12% of permit fee):
Authorized signature
. /1 TOTAL PERMIT FEE: '7
This permit application expires if a permit is not obtained within 180
Print name: BRUCE BUTNER I Date: 12/8/09 days after it has been accented 713 camnlet .