Permit p .
I
C ITY • OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2005 -00165
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DEVELOPMENT H B r S O ERV 2CES -639 -4171 DATE ISSUED: 7/11/2005
PARCEL: 2 S 112 D D -01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 190 ZONING: I -P
SUBDIVISION: PACIFIC CORP. CENTER LOT: JURISDICTION: TIG
Project Description: T -stats and wiring for new AC unit.
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:
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 Surchart 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: ,7,,�Q5L. 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 ' Ilectrical Permit Application ` FOR OFFICE USE ONLY'
CI Of TI a F E Received M
�J g GY ra Date/13 : 'i1 /��� j 1 Permit No ' ' • 5 0 c / 6.5
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /Drs ry ' ( , k Date/By: Other Permit:
Inspection Line: 503.639.4175 ��t til 2 2 200 ,L ., I � Date Re Ready /By: m :a El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
VPki 6i4silitAilu, PLAN PEVIEW
"a�_ l lagp}9� � Please hk ll h
P ease cec all that apply:
El New construction >Addih pP y
❑ Demolition E] Other: ['Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps - rating ['Bulldog over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1 - and 2 family dwelling C ommercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
/ L Job site address: 9 1 ❑Health -care facility DOther:
Job no.:
8t / (? / S .�cM fI4
�r// �� Submit 2 sets of plans with any of the above.
City/State /ZIP:
1 - 0 D�LJGl � // The above are not applicable to temporary construction service.
Suite/bldg./apt. no.:/2A Project name: ,/ r FEE* SCHEDULE
• / 2/tQ 1 (. ` .O J' Description I Qty. I Fee. I Total I a "
Cross street/directions to job site: New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4 -
- .Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
S /N-t / 13rAr G4.1 r .4-Gi.t1 f /OA-; AJ.G!✓ "VC 'JAI' / f 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
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
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: p,.dg„,,,y , 4.gSOe , s branch circuit 6.65 2
Contact name: � ��I B. Fee for branch circuits
C7"4" - e„L tC/ / , - . without service or feeder fee,
each branch circuit 46.85 2
Address: 9 7 g'' S_ / 7 / A A v-._
Each add'1 branch circuit 6.65 2
City /State /ZIP: 81.4,5744,,A9 diL,_ g 7 2 Miscellaneous (service or feeder not included)
6
Phone: (Se .�' / 9 a Fax :: (sdam ) 9 p �? 7 Pump or irrigation circle 53.40 2
S 9 �d O Sign or outline lighting 53.40 2
E Signal circuit(s) or limited -
CONI'RACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: X40,,` As diorr^
Address: Each additional inspection over allowable in any of the above - -_
Per inspection 62.50
City/State /ZIP: Investigation per hour (I hr min) 62.50 -
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75 -
ELECTRICAL PERMIT FEES*
. CCB Lic.:� Q
8' 'C g- Electrical ' .:2 ( t c . n Supry . Lie.: 31 ei g' s Subtotal ) ' 2.
Suprv. Elec signature, require Plan review (25% of permit fee)
mil
Print name: p S G ,�/, /�� � Date: �L .� State surcharge (8% of permit fee) C.
n � vl/ TOTAL PERMIT FEE "S ,
Authorized signature:`/ / This permit application expires if a permit is not obtained within 180
KKR ��� days after it has been accepted as complete
� f �
Print name: 6/0[z_ d e k_ .../(-0 a 5- • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Permits \ELC- PernitApp.doc 12/03 440 4615T(10 /02/COM /WEB
I CITY OF TIGARD
BUILDING DIVISION . PERMIT #: ELR2005 -00165
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/11/2005
Phone: (503) 639 -4171 /mbq9114F�i�
Inspection Requests (24 Hrs.): (503) 639 -4175 'IL
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 74
SITE ADDRESS: 15495 SW SEQUOIA PKWY 190 CLASS OF WORK:
SUBDIVISION: PACIFIC CORP. CENTER LOT #: TYPE OF USE:
PROJECT NAME: OREGONIAN EXPANSION
DESCRIPTION: T -stats and wiring for new AC unit.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503-624-6300
CONTRACTOR: PROTEMP ASSOCIATES INC PHONE #: 503-233-6911
Inspection Request Scheduled For: Date: 7/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
1 Low voltage 011366-02 503-519.6199 N
Cor ectibns /Co ehts /instructions:
•
. ----- /0
.PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
, Qiw
Inspector: 1
i Date: 7-/ 7 -- v f Phone #: (503) 718-