Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
'ol, DEVELOPMENT SERVICES PERMIT #: ELR2005 -00049
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/11/2005
SITE ADDRESS: 12909 SW 68TH PKWY 450 PARCEL: 2S101AD -03200
SUBDIVISION: TIGARD OFFICE BUILDING ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
Project Description: 3 stats
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: STATS X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 -WMI 9788 SE 17TH AVE.
PORTLAND, OR 97224 PORTLAND, OR 97222
Phone: Phone: 503 233 - 6911
Reg #: ELE 26- 1063CRE
LIC 38868
FEES SUP 2613LEP
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 3/11/2005 $75.00
[TAX] 8% State Surchar€ 3/11/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952A 11 - 0100. You may o • = in copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by +rte _ - _ 41 Permittee Signature Z,.ur
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'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next 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 A lication FOR OFFICIO USE ONLY
t r
City Ot Tigard E E I V E ri Received Date/B : � / t I 0 Permit No.:4 l „SO / 5— if I 0
13125 SW Hall Blvd., Tigard, OR 9722 Plan Review
Phone: 503.09.4171 Fax: 503.598.1960 mN , ' Date/By: Other Permit:
Inspection Line: 503.639.4175 MAR 11 200 = ! I I' Date Ready/By: Jurh• ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 7 , 4 Supplemental Information
Irig5147CTICARD PLAN REVIEW
❑ New construction .:,: i ggf{�lt�at{t�p Please check all that apply:
wii 1J11� V it v 1 ' ['Service over 225 amps, comm'l ['Hazardous location
❑ Demolition • It er:
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling IR Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: ❑Buildin over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
QP/
Job no.: t7,7 g Job site address: /27o? Se.) 6944 A J ❑Health -care facility ['Other: :
t Submit 2 sets of plans with any of the above.
City/State /ZIP: C 7722a The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: 771.44///),. /Airs0„ Description I Qty. I Fn. 1 Total I **
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 2::: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
/� Lo Limited energy, non - residential 75.00 2
DE CRIPTION OF WORK Each manufactured or modular
R e.00�.14 _ 3 1x IS / //^)( 7!r 1�r 0,1,441... S erv ic es serviceand/or alteration, and/or relocation
■
feeder 90.90 2
A J p Services or feeders installation,
w 0 / 4 � ; ,c „ L 200 amps or less 80.30 2,.
�ROPERTY OWNER /�� ' TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
•
Name ..i4I.0 10.1 Ad e 4,4-- 601 amps to 1,000 amps 240.60 '2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 --1 -
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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
["APPLICANT I "'CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: fig 0 �J /�s-r D c49-, Te..S branch circuit
Contact name: � I'�/ B. Fee for branch circuits
/Z,v�— Q.1 ii■Pe.—"/ without service or feeder fee, 46.85 2
Address: 7 p �y each branch circuit
7 J e. t / Each add'l branch circuit 6.65 2
City/State /ZIP: /90A�(^1,r1.X..._ .0 P 2 L2, L_ Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: (co ) S/ T _4/ 7 i I Fax:: (6 & ) 2 Q3 - ,247 Sign or outline lighting 53.40 2 ;
E -mail: Signal circuit(s) or limited- I
CONTRACTOR energy panel, alteration, or
extension. Describe: 3 Page 2 -•2 °-
Business name: ._
Address: Each additional inspection over allowable in any of the above_.
Per inspection 62.50
City/State /ZIP: Investigation per hour (1 hr min) 62.50 ; -- ,
Phone: ( ) I Fax: ( ) Industrial plant per hour 73.75 - —
ELECTRICAL PERMIT FEES*
CCB Lic.:3M11 I Electrical Lic.2 i 0 3 I Suprv. Lic.: yg Subtotal - 745
Suprv. Electrician signature, required. �) �— Plan review (25% of permit fee)
/,/ Date: State surcharge (8% of permit fee) i� , 0 ,
Print name:
o ' l�/�fFvc'� 3 _/6— b � TOTAL PERMIT FEE %-j 0o
Authorized signature: erc.'.t" This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: `s'r 1 f , SVi i Date:S/6 - $ • Fee methodology set by Tri- County Building Industry Service Board
`s'�" •• Number of inspections per permit allowed.
i:\Building \Permits \ELC- PermitApp.doc 12/03 440- 4615T(10 /02/COIWWEB
CITY OF TIGARD • •
BUILDING DIVISION PERMIT #: ELR2005`00049
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/11/2005
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/21/2005 TIME: 7 :10AM PAGE: 55
SITE ADDRESS: 12909 SW 613TH PKWY 450 CLASS OF WORK:
SUBDIVISION: TIGARD OFFICE BUILDING LOT #: TYPE OF USE:
PROJECT NAME: TRINITY UNIVERSAL INSURANCE
DESCRIPTION: 3 state
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 503-233-6911
Inspection Request Scheduled For: Date: 3/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Loan voltage r 002297 -04 503 - 519 -6199 Y
•
Corrections/Comments/Instructions:
•
V
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/' C Date: Phone #: (503) 718-
Ins L
� ✓ — � / � � ( ) � !f 17-Z