Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00004
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011
TIGARD Parcel: 2S113AB00101
Jurisdiction: TIGARD
Site address: 16101 SW 72ND AVE 130
Project: Siemens Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Low voltage for HVAC
Contractor: PROTEMP ASSOCIATES INC Owner: PACIFIC REALTY ASSOCIATES
9788 SE 17TH AVE 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97222 PORTLAND, OR 97224
PHONE: 503 - 233 -6911 PHONE: 503 - 624 -6300
FAX: 503 - 238 -9767
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/05/2011 $75.00
12% State Surcharge - Electrical 01/05/2011 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 throu R 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 13 5003.232.1987 or 1.800.332.2344
X �.
Issued By: Permittee Signature: 4.h�6
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 the next available inspection date.
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 ApplicationRE CEINED FOR OFFICE USE ONLY
City of Tigard Received
JAN 0 2011 6 �i Pennit No.: ... D�� ^QQ�(J
a 13125 SW Hall Blvd., Tigard, OR 97223 JAN Date /B : Plan Review
' C Phone: 503.639.4171 Fax: 503.598.1960 pT1 Date /B : Other Permit:
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION 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 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.: 9956 Job site address: 16101 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: SIEMENS REAL ESTATE ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I
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 75.00 2
DESCRIPTION OF WORK (with above sq. R.)
RELOCATE THERMOSTATS 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 ❑ 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 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
0 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 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
Business Signal circuit(s) or limited-
usiness name: SAME AS ABOVE
energy panel, alteration, or 1 ?spp
Address: extension. Describe: 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: ( 1 , Subtotal: 76.00 •
Plan review (25% of permit fee):
Print name: MONTY SCHROEDER Date: 1/5/10
State surcharge (12% of permit fee): ..
Authorized signature: TOTAL PERMIT FEE: 8� GU
This permit application expires if a permit is not obtained within 180
Print name: BRUCE BUTNER Date: 1/5/11 days after it has been accepted as complete.
* Number of inspections allowed per permit.
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