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Permit a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT a COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00357 TIGARD DATE ISSUED: 9/17/2007 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S113AD -01900 SITE ADDRESS: 16640 SW 72ND AVE B10 ZONING: I -L SUBDIVISION: OREGON BUSINESS PARK I LOT: 009 JURISDICTION: TIG PROJECT: VERIS Project Description: Install low voltage for HVAC wiring. Job No. 9233 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: X PROTECTIVE SIGNAL: INSTRUMENTATION: OTHER: 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: Contact #: PRI 503- 233 -6911 FAX 503- 238 -9767 FEES Reg #: ELE 26- 1063CRE LIC 38868 Description Date Amount [ELPRMT] ELR Permit 9/17/2007 $75.00 [TAX] 8% State Surchar€ 9/17/2007 $6.00 REQUIRED ITEMS AND REPORTS 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 aocordanoe 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 a : - forth in 1 ' - 952 -001 -8110 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503. • 6.6699 or 1.800.3 !.2 • a Issu• • By: � 1,1 j. _1I Permittee Signature: c 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 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. Eectrical Permit Application EoR OFFICE USE ONLY City of Tigard Date /B : .:-'• L' £Lev007 -'10 ,357 07 Permit No.: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 0 0000000000 00000 110000000 DateB : Other Permit: TIGARD eigift ih6lLIIt�fC❑ 5ll3l6394t7 0 0 0 0 0 0 0 0 Date Ready/By: El See Page 2 for Internet: www.tigard - or.gov Notified/Method: Supplemental lnformation ' 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 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 ❑ I- 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 ", "I -3 ", Job no.: 9233 Job site address: 16640 SW 72 AVE I00HP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: TIGARD OREGON 97223 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: VERIS INDUSTRIES ❑ 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 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.) THERMOSTATS & WIRING Limited energy, multi- family 75.00 2 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ ' PROPERTY OWNER I ❑ 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 g A. Fee for branch circuits with ® APPLICANT ' ® 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 OREGON Each manufactured or modular 90.90 2 503 519 -6199 Fax: (503) 238 -9767 Reconnect dwelling, t on service and /or feeder Phone: ( ) ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 ' _ CONTRACTOR • Sign or outline lighting 53.40 2 • Business Signal circuit(s) or limited - usiness name: SAME AS ABOVE energy panel, alteration, or Address: extension. Describe: 1 Page 2 2 THERMOSTATS &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.: 261063CR Suprv. Lic.: 2613LEB Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: M-.� , j � J Subtotal: 76--.0e) 76--.0e) 1/ t;, —) --()? Plan review (25% of permit fee): Print name: MONTY SCHROEDER Date: ,. — State surcharge (8% of permit fee): G ,00 Authorized signature: / ,( / TOTAL PERMIT FEE: D 1 , 00 Print name: BRUCE BUTNER Date. 7 J 7 This p ermit application expires if a permit is not obtained within 180 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 CITY OF TIGARD BUILDING DIVISION , -� ` , PERMIT #: EI 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/17/2007 Phone: (503) 639 -4171 y Inspection Requests (24 Hrs.): (503) 639 -4175 _. ' I II .. INSPECTION WORKSHEET FOR DATE: 10/22/2007 TIME: 7 PAGE: 17 SITE ADDRESS: 16A0 SW 72ND AVE B10 CLASS OF WORK: SUBDIVISION: OREGON BUSINESS PARK 1 LOT #: 009 TYPE OF USE: PROJECT NAME: VERIS DESCRIPTION: Install low voltage for HVAC wiring. Job No. 9233 OWNER: PACII REALTY ASSOCIATES, PHONE #: CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 503233 -6911 Inspection Request Scheduled For: Date: 10/22/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Eloctiical final Q58046-02 503.519.6199 - Y Corrections /Comments/ Instructions: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: , kbe' Date: 10 Phone #: (503) 718 - 1-gig