Permit II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
0 COMMUNITY DEVELOPMENT Permit #: ELR2010 -00229
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 215
Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project: Umpqua Bank
Project Description: Low voltage for HVAC
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 10/26/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 10/26/2010 $9.00
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 $84.00
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 egon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 952 -001 -: +0. Yo ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu B y: Lt /� / - PermitteeSignature. �`��
OWNER INSTALLATION ONLY
The installation is being made on property 1 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 Date /Bea / �fp / O / Permit No.: Ea ap /Q—OO ,4a`t
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review G�D�U 5 g
' 0 Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit: /y� O O r
T I G A R 1) Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK . 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 arnps 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.
Tess to ground. or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 0 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 Toad of ❑ "A ", "E ", "I -2 "1 -3 ".
Job no.: 9915 Job site address: 6650 SW REDWOOD LN 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: UMPQUA BANK ❑ Service or feeder 600 amps or more.
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. Tax map /parcel no.: td' en0 sq. ft. or portion 33.40 1
ergy,residential 75.00 2
DESCRIPTION OF WORK (with ed above sq. ft.)
RELOCATE THERMOSTATS Limited energy, multi- family 75.00 2
residential (with above sq. 6.)
Services or feeders installation,alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER J ❑ 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 l
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
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
Contact name: BRUCE BUTNER without service or feeder fee, 46.85 2
first branch circuit
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
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 alteration, 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.: 261036CR Suprv. Lic.: 2613LEB Industrial plant per hour - 73.75
' . , ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: r n s Subtotal:
Print name: MONTY SCHROEDER Date: 10/20/10 Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: BRUCE BUTNER Date: 10/20/10 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 /COM/WEB