Permit f
t n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I "! g COM MUNITY DEVELOPMENT Permit #: ELR2009 -00135
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/15/2009
Ti Parcel: 2S113AB01400
Jurisdiction:
Site address: 7358 SW DURHAM RD BLDG G
Subdivision: Lot: 0
Project: CORAM
Project Description: TI - Low voltage for HVAC
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 05/15/2009 $75.00
#300 12% State Surcharge - Restricted Energy 05/15/2009 $9.00
PHONE:
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 Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 do accordance wi - .proved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day ATTENTION: Oregon law regyires) you, to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 - 001 -0010 thro h OAR 952 -001 2 1100. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344,
Is - •d By: i l rz _ ■ ■ f/fti —d` A Permittee Signature: �i'� —
r
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 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.
E - = FOR-OFFICE USE ONLY
DECEIVED - -
Electrical Permit Applicatio - - -- •
City Tigard Received . — ®a 9 Fw22dOQ 4d /3.5
Cit of Ti and Pe
13125 SW Hall Blvd., Tigard, OR 97223 MAY 1 J 2009 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960
N G nry DDate/13 Other Permit:
- r I G A R 1) Inspection Line: 503.639.4175 C ITY OF TIGAISIORD N Date Ready/By: 0 See Page 2 for
Internet: vvww.tigard- or.gov Notified/Method: Supplemental Information
BUILDI
. 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 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 load of ❑ "A" "E" "1 -2" "I -3"
Job no.: 9584 Job site address: 7358 SW DURHAM RI) 100HP 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.: Project name: CORAM HEALTH ❑ Service or feeder 600 amps or more.
FEE SCHEDULE .
Cross street/directions to job site: Description
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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 75.00 2
THERMOSTAT & WIRE 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
® APPLICANT ® CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
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'l 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,
Phone: (503) 519 - 6199 Fax:: (503) 238 - 9767 Reconnee ct t o on ly ye and/or feeder
Reconnect 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR , . Sign or outline lighting 53.40 2
Business name: SAME AS ABOVE Signal circuits) or limited-
energy panel, alteration, or „,,_
Address: extension. Describe: 1 Page 2 2
STAT & WIRE
City/State/ZIP: Each additional inspection over allowable in any of the above
Phone: Per inspection 62.50
hone: ( ) Fax:
( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: 38868 Electrical Lie.: 26 -1036 Suprv. Lie.: 2613LEB Industrial plant per hour 73.75 _
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:., ” ��ll p „� Subtotal: 7500
Print name: MONTY SCHROEDER Date: 5/4/09 Plan review (25% of permit fee): g-
State surcharge (12% of permit fee): 9_ 'O
Authorized signature: TOTAL PERMIT FEE: 8 -/ . e0
Print name: BRUCE BUTNER I Date: 5/4/09
This permit application expires if a permit is not obtained within 180
days after it has been accented as complete.