Permit 4 " �v ELECTRICAL RESTRICTED ENERGY PERMIT
=1 s t ° ;.. COMMUNITY DEVELOPMENT Permit #: ELR2010-00043
r yr Date Issued: 03/10/2010
T I GWRL7 13125 SW Hall Blvd. Tigard OR 97223 503.639.4171
_ Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 210
Subdivision: Pacific Corporate Center Lot: 0
Project: NuScale
Project Description: Low voltage for HVAC
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 03/10/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 03/10/2010 $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 Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 • • • : ith 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 NTION: Orego la. :.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 0010 through OAR 95 001- 01'0•ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344.
Issu By: _ _ _ /A /. / / LA — 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 USE ONLY
City of Tigard �-`t Date /B : �/ l� ��
lig
n 13125 SW Hall Blv Tigard, OR 97223 DECEIVED Plan Recei Review ved
Phone: 503.639.4171 Fax: 503.598.19�(� Date /B : � Permit No.: � L,Q • Other Permit:
TIGARD
Inspection Line: 503.639.4175 m hus .r 0 t Date Ready /By: Juris: ® See e Page 2 for
Internet: d - or. ov www.ti an Notified /Method: Supplemental Information
g g CITY OF TIC 4 ' t°
TYPE OFpygfggING DIVISION PLAN REVIEW
❑ New construction ® Addition /alteration /replacement 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', t - 2 ", "I - ",
Job no.: 9752 Job site address: 6650 SW REDWOOD LN. 10OHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD OREGON ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: #210 Project name: NU SCALE ❑ Service or feeder 600 amps or snore.
FEE SCHEDULE
Cross street/directions to job site: Description 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
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
THERMOSTATS & WIRING Limited energy, residential (with above sq. multi-family
th aboe sq. 0.) 75.00 2
Services or feeders installation alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER 0 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 1
Owner installation: This installation is being made on property that 1 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: PROTEMP ASSOCIATES B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: BRUCE BUTNER first branch circuit
Address: 9788 SE 17 AVE Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: PORTLAND OREGON 97222 Each manufactured or modular 90.90 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
Signal panel, or limited-
Business name: SAME AS ABOVE
energy panel, alteration, or
Address: extension. Describe: 1 Page 2 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 (1 hr min) 62.50
CCB Lic.: 38868 Electrical Lic.: 261063 C Suprv. Lic.: 2613LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: M ��� Subtotal: 617.54/
,
Print name: MONTY SCHROEDER Date: 3/10/10 Plan review (25% of permit fee): , t
State surcharge (12% of permit fee): s .�`I
Authorized signature: l S ) �►Llv TOTAL PERMIT FEE: 7g .qq
This permit application expires if a permit is not obtained within 180
Print name: BRUCE BUTNER Date: 3/10/10 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COWWEB