Permit v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11111 I COMMUNITY DEVELOPMENT Permit #: ELR2011 00086
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/12/2011
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 130
Project: Yecuris Subdivision: Lot: 0
Project Description: HVAC system.
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 04/12/2011 $75.00
12% State Surcharge - Electrical 04/12/2011 $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 through OAR 952 - 001 -0090. You may obtain a copy of as or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By . _ / c . — 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 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 Application FOR OFFICE USE ONLY
R eceived
City of Tigard �(~�
E pp
13125 SW Hall Blvd., Tigard , OR 972 -tf Date /B : �1 Permit No.: i_ 4,6 �T ,,t 4. Plan Review
Phone: 503.639.4171 Fax: 503.598.1 t Date/B ; Other Permit: I. ; 11 .0,
TIGARD Inspection Line: 503.639.4175 RQ Rate Ready /By: n See Page 2 for -
Internet: www.tigard - or.gov e4C_I c, ' Notified 'Method: UM Supplemental information
TYPE OF WORK :°'' PLAN REVIEW
1
❑ New construction ® /tC
Addition/alteration pl� Please check all that apply y (submit 2 sets of plans items checked below):
V' ❑ 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 dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ A ", "E ", "I -2 ", "l -3 ",
Job no.: 3029 Job site address: 15055 SW SEQUOIA PKWY 1001IP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: TIGARD OREGON 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: #130 Project name: YECURIS ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. 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 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited ener
gy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 67.84 2
RELOCATE THERMOSTAT residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER CI TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ® CONTACT PERSON above service or feeder fee, 7 42
each branch circuit
Business name: PROTEMP ASSOCIATES B. Fee for branch circuits without
_ service or feeder fee, first 56.18 2
Contact name: BRUCE BUTNER branch circuit
Each add'l branch circuit 7.42 2
Address: 9788 SE 17 AVE Miscellaneous (service or feeder not included) _
Each or City/State/ZIP: PORTLAND OREGON 97222 dw 11 ng, manufactured service and/o ffeeder 67.84 2
Phone: (503) 519 -6199 Fax: : (503) 238 -9767 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: bruce(riprotmp
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: SAME AS ABOVE panel, alteration, or extension. 1 Page2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City / State/ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed ('A hr min) 90.00 / hr
CCB Lic.: 38868 Electrical Lic.: 261036 Suprv. Lie.: 2613LEB ELECTRICAL PERMIT FEES
9,..) Subtotal: -75"; Suprv. Electrician signature, required: ,�,) o
Plan rev iew (25% of permit fee):
Print name: MONTY SCHROEDER Date: 4/12/11 State surcharge (12% of permit fee): ei
GC��C TOTAL PERMIT FEE:
Authorized signature: This perm application expires if a permit is not obtained within 180
Print name: BRUCE BUTNER Date: 4/12/11 • days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\ Budding \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(l1ro5 /COM/WEB