Permit C ITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2005 -00164
DEVELOPMENT SERVICES DATE ISSUED: 7/11/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112DD -01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 ZONING: I -P
SUBDIVISION: PACIFIC CORP. CENTER LOT: JURISDICTION: TIG
Project Description: T -stats and low voltage wiring.
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: 503- 624 -6300 Phone: 503- 233 -6911
Reg #: ELE 26- 1063CRE
LIC 38868
FEES SUP 2613LEP
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 7/11/2005 • $75.00
[TAX] 8% State Surcharl 7/11/2005 $6.00
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 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010
through OAR 952- 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: — 1 J�p.;2�( T 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'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.
r Mr ______ ,-
/'
Electrical Permit Application/ ''' FOR OFFICE USE ONLY
City of Tigard ,F,-
f - 5 - F _ (r ! • ‘■, \ ij , - LI Received A. A .
i " L ' - ' - Date/By: Veric:0 D • Permit No-7 _ ) c„),,,
13125 SW Hall Blvd., Tigard, OR 972 '---- . Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 ' 'f ei.r ',, . Date/By: Other Permit:
Inspection Line: 503.639.4175 " 'N .' 2 44,u;1;) , i
, , . - Date Ready/By: ,..) j • • ra See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / 65 .....;- 91-- - 7 / 4 Supplemental Information
.f. ..:.: -: .:, . • - •
--4 , , •,,,,,,„....‘„ ,, , ,, , Ire.,-,-.0-511-_,01.0E--, , ,,,-.4.1.,:-. , ,,, , , , ,•••••-•-•-• ,,,, --.,, ,..,• • -
12 New construction gAc:BiiiiingtAitk4ine131acement Please check all that apply: -'.3
O Service over 225 amps, comm'l ['Hazardous location I
0 Demolition 0 Other:
S,. 0 ervice over 320 amps - rating 0Buildng over 10,000 sq. ft., cl<9
-''' 1"2;1 7 , ' 74'-' 'v ;4 " 1-1 ' .-i i f idOWtik tOtkOlititill*Wgi of 1 - and 2 dwellings 4 or more new residential
.'..._',,...: ';'• .7.st •",•• ■ A.• .,•••-, ,_ • - • , ..X ' , , ,Z,• -•,...,.• '; ''''.. ',', x. Y., _ 4.S. Cti•
0 1- and 2-family dwelling Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
D Building over three stories 0Feeders, 400 amps or more (I \
0 Multi U Master builder 0 Other:
['Occupant load over 99 persons I:Manufactured structures or
Vl 'SGli-V ' 15A f liisiN --,A)'• •IiidAT'' i6 0 Egresoighting plan RV. park . Cl
Job no.: WC Lt Job site address: /,s ? 5 s _r /7/(4,), DHealth-care facility ['Other: ....
Submit 2 sets of plans with any of the above.
City/State/ZIP: 1# 0.46 The above are not applicable to temporary construction service.
011..e- ? 7 2 . 1 4- 1
,W.J
Suite/bldg./apt. no.:/2 j? Project name:4•1,7-„, r spec. ...„„/„.....,_ 4 ,,,,,. . „.,.......__........,,,,....,_.,..._.... ,....._>_,....„..,.. . . ,
Description I Q I Fee I Total I .. z
Cross street/directions to job site: New residential single- or multi-family dwelling unit. N
Includes attached garage. GC)
1,000 sq. ft. or less 145.15 4 i
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 • 1
Limited energy, residential 75.00 2 r
Tax map/parcel no.: .
Limited energy, non-residential 75.00 • 2
'•-'.''-;• ; i ; ki-"? .' ,P: . : %-. 7; ••• 1 ;0'5.. Y % " .,- f :•" " *J.It - ii; i ::• 1 `11 1 ....it../ .;1! ; 1.: Each manufactured or modular
t dwelling, service and/or feeder 90.90 2
/ r -- "l exo, ,-..-.....--
0 .5 if ailiq'AlsoK Ater Zee/ 4 4 trol-14... toli ite-c... Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
,•,.... -:;;-,,,,,,., f.,•tri.-..,;-„, '-f,'"RI" ..:;,4,v,,,,iiii,,; _7:-1•7'‘ ,.. 201 amps to 400 amps 106.85 2
•...,_, P.`-, : -- - !4-74=F- 1 --- ± G '•-
- '. , '%-•• • ' • ' - % I. ' •'•.' '-'";"- `.. '' "" " '''. " 1.-- .4 -1'""'Ik"'.. 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: • Over 1,000 amps or volts 454.65 2
Reconnect only • 66.85 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
''. ''''' A. Fee for branch circuits with
f" ':-.A.1. '.1. , , ,- ' -.,..:.-;-,, - • , -.1: ...i'• 4 .A- '%:.1 , . z'',.: .., ...,z,.., ..... ,. ,' service or feeder fee, each
6.65 2
Business name: rr i tit..ssa /4 4.4-r c. ' c . branch circuit
• '
B. Fee for branch circuits
Contact name: AC) C-4-.- At/ 1";-/•1.-fr- without service or feeder fee,
46.85 2
each branch circuit r
Address: ? 7 78 Se- /7 4 4_,......e._ Each add'I branch circuit 6.65 2
City/State/ZIP: reyCr7-- 011e-gIA) Miscellaneous (service or feeder not included)
Pump or irrigation circle \ 53.40 2
Phone: (03 ) 6 9 _g / 9 9 Fax: : (603 ) 23 e--, 7 C 2 Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
ig.• ;:•:, ;`,:,:'.' i:-*00 ,.Z energy panel, alteration, or
extension. Describe: / Page 2 2
Business name: ...,e/40.1.,..,-(____ •
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: .. Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax ( ) Industrial plant per hour 73.75
;•:.' ':''..i.
CCB Lic.3 gg S' Electrical Lic.:24/ 00 e Suprv. Lic.39 yy LeS Subtotal
Suprv. Electrician signature, required: t`e( Plan review (25% of permit fee)
St A i ,------ Date: 6,1e-0 s--- ate surcharge (8% of permit fee)
Print name'
' IleAile-A- TOTAL PERMIT FEE qt
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: iat.e.... (2,17fae.,.._ Date: 6.16-- • Fee methodology set by Tri Building Industry Service Board
** Number of inspections per permit allowed.
i: \Building1PermitsMC-PerrnitApp.doc 12/03 440-4615T(10/02/C0M/WEB
w
,
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
r400.�1 *: - ;r4, r.��^: ::w. -
Fee for each commercial system $75.00
(SEE OAR 918 - 260 - 260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
•
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\Building\Pamit ELC- PemritApp.doe 04/03
7
`CITY QF TIGARD
I BUILT DIVISION PERMIT #: ELR2005 -00164
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/11/2005
Phone: (503) 639 -4171
At
�, �, � l i ,, I,
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 73
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORP. CENTER LOT #: TYPE OF USE:
PROJECT NAME: SPEC OFFICE
DESCRIPTION: T -stats and low voltage wiring.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 - 624 -6300
CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 503
Inspection Request Scheduled For: Date: 7/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
- •IItage 011366-03 503 - 519-6199 N
orrrectibns /Co mment'/Y ruc 'ons:
— I(
Iz411la5
4% C\--
la - ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: .4_ `M LJ Date: 7 — / V--rPhone #: (503) 718-
,