Permit � CITY OF TIGARD ELECTRICAL ENERGY
-
RESTRICTED ENERGY
DEVELOPMENT SERVICES PERMIT #: ELR2004 -00325
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/20/2004
SITE ADDRESS: 15575 SW SEQUOIA PKWY 150 PARCEL: 2S112DD -01600
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
• BLOCK: LOT: JURISDICTION: TIG
Project Description: Pull thermostat wire & mount (3).
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: 3
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: Phone: 503 233 - 6911
Reg #: E51B- 2382A76063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/20/2004 $225.00 Elect'I Final
[TAX] 8% State Surchart 10/20/2004 $18.00
Total $243.00
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.
4 1 <;
Issued by f�s 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application FOR OFFICE USE ONLY
City of �' ig a rd ��� Received _ / ..70° `
11 Date/B Permit No.: � .- w i1L; �'�
13125 SW Hall Blvd., Tigard,� ; - - t ' - Plan Review
•
Phone: 503.639.4171 Fax: A t - °' 4 Date/By: Other Permit:
Inspection Line: 503.639.4175 e` Date Ready/By: Juris: / p 0 See Page 2 for
Internet: www.ci.tigard.or.us 9 ( Notified/Method: � Supplemental Information
T_YPE.O ,WQ PLAN REVIEW \: •
❑ New construction Addihon/altetitiE tfeplacement Please check all that apply:
El Demolition ❑' Otfier: ['Service over 225 amps, comm'l ['Hazardous location \�
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
• CATEGORY OF CONSTRUCTION . , of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling .Commercial /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
^� r+ ❑Health -care facility ❑Other:
Job no.: Job site address: l, S� ,S,tt .,aa�,y `d i.l47Submit 2 sets of plans with any of the above.
City/State /ZIP: / IfA ti,� r `�7iJ7 The above are not applicable to temporary construction service.
�
Suite/bldg. /apt. no.S0;,,c /5 Project name: C,q�ie IL / /? Des cription Description I Qty. I Fee. I Total I **
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
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
• DESCRIPTION OF WORK Each manufactured or modular
/ a dwelling, service and /or feeder 90.90 2
c T+
Pv [ii/n 0 S Ti; I Li i Kam-- st 4.4 49000V re Services or feeders installation, alteration, and/or relocation
714-/PI f / tom 200 amps or less 80.30 2
,`PROPERTY OWNER I i ❑ TENANT . . . 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: /OA "� �
f A1j f 211.1E / 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
X APPLICANT - - CONTACT PERSON A. Fee for branch circuits with
service or Business name: i' branch circuit
fee, each 6.65 2
_ B. Fee for branch circuits
Contact name: , t? (le a Ne _, „ without service or feeder fee, 46.85 2
Address: 9 7 et ,S' ,� , /7i-4 1q''_
each branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: ®p/ I L/+�,� '-e � Miscellane (service or feeder not included )
ty v s a _ 9 7 ( Fax: Pump or irrigation circle 53.40 2
Phone:
�� ) S ci — 9 1 ( e5 � )� ` 9 4 Sign or outline lighting 53.40 2
E -mail: 8MJC e- e / / i , CO Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 3 2
Business name: ...54At e. /1.S ..QOr/ -e____
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
ELECTRICAL PERMIT FEES*
CCB Lic.:3 a y (;,8- Electrical Lic.;,206 cietSuprv. Lic.: 3 9 yyze Subtotal 2../%6-• 6''A
Suprv. Electrician signature, required: ,l Plan review (25% of permit fee) -
Print name: 8 D - — �C Date:, —/ 9, — e� Y State surcharge (8% of permit fee) 19
�' tl� I /� TOTAL PERMIT FEE 0' t� f 6)
Authorized signature: ,
� This permit application expires if a permit is not obtained within 150
�/ days after it has been accepted as complete
Print name: r) 4>6.4a ` AU i e l` Date:/6 4 S o y • Fee methodology set by Tri- County Building Industry Service Board
• Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PennitApp.doc 12/03 440- 4615T(10/02/COM/