Permit CITY O T I GA R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
l DEVELOPMENT SERVICES PERMIT #: ELR2003 -00363
Ail 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/26/03
SITE ADDRESS:, 15860 SW UPPER BOONES FERRYRD B -15 PARCEL: 2S112DD -00500
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
•
BLOCK: LOT: JURISDICTION: TIG
Project Description: Limited energy for HVAC
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATAITELE 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 PROTEMP ASSOCIATES INC
15350 SW SEQUOIA PKWY #300 807 NE COUCH
PORTLAND, OR 97223 PORTLAND, OR 97232
Phone: 503- 624 -6300 • Phone: 233 -6911
• Reg #: ELE 26- 1063CRE
LIC 38868
SUP 2613LEP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/26/03 $75.00 Elect'I Final
[TAX] 8% State Surchari 11/26/03 $6.00 •
Total $81.00
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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 Fules- adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuc
Air
k
Issued by " / � %.!i - Permittee Signature Ad
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
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Electrical Permit Application , FOR OFFICE USE ONLY . -- , . , .
Received 6,-)„.. �� Electrical
Date/By // / // [/ 1 G
Permit No : Gi
� ,& _ 1 (/
City of Tigard Planning Approval Sign
Date /By Permit No
13125 SW Hall Blvd. Plan R eview Other
Tigard, Oregon 97223 Date/By Permit No •
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
g j Date /By Case No •
Internet: www.ci.tigard.or.us a..'' Conta Juns
24 -hour Inspection Request: 503- 639 -4175 1 � Su See Page for
p q Name /Method % �/�. Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction El Demolition ❑ Service over 225 amps- ❑ Health -care facility
El commercial ❑ Hazardous location
Addition/alteration/replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
' ' JOB SITE INFORMATION and LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: lS- on i , t , '/ /'/ Bryjk,g5 tLR - - FEE* SCHEDULE
Suite #: 1 Bldg. /Apt. #: 7 Number of inspections per permit allowed
Project Name: , Aie REP, Description Qty Fee(ea.) Total i
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq ft or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 1
Subdivision: Limited energy, residential 75 00 2
Lot #' Limited energy, non residential 75 00 2
Tax map /parcel #: Each manufactured home or modular dwelling
- DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
7 57'7' alteration or relocation:
200 amps or less 80 30 2
201 amps to 400 amps 106 85 2
401 amps to 600 amps 160 60 2
[OPERTY OWNER . . I ❑ TENANT • . ., 601 amps to 1000 amps 240.60 2
Name: /� Over 1000 amps or volts 454.65 2
�C -'7 i" 1-/.5 / Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100 30 2
❑ APPLICANT 0 CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46 85 2
Phone: Fax: Each additional branch circuit 6 65 2
E -mail: Misc (Service or feeder not included).
' . CONTRACTOR - Each pump or irrigation circle 53 40 2
Each sign or outline lighting 53.40 2
Job No: Signal circun(s) or a limited energy panel, /
Business Name: P' 'Ye - alteration, or extension / Page 2 2
Description
74
Address: -2> g v 5,5 i 7`7 /dvr`
City /State /Zip: jq:qc7�,d,,,p 9-72- Each additional inspection over the allowable in any of the above:
Per inspection per hour (mm. I hour) 62.50
Phone: ^ 7 $ Fax: a,s-8 - 6)76.7 Investigation fee
Other
CCB Lic. #: 3le- ■G 8 Lic. #:,c„„ - / v CgZ' Electrical Permit Fees*
Supervising electrician Subtotal $ 96%0
signature required: Plan Review (25% of Permit Fee) S
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ Co. 00
TOTAL PERMIT FEE S gj ,DO
Authorized � �/ Notice: This permit application expires if a permit is not obtained within
Signature Date /i /�J /to 180 days after it has been accepted as complete.
e LLL
•Fee methodology set by Tri- County Building Industry Service Board.
lease print name)
i \Dsts \Permit Forms \ElcPerrnitApp doc 01/03
Electrical Permit Application - City of Tigard I
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems - $75.00
Check Type of Work Involved:
11 Audio and Stereo Systems
▪ Burglar Alarm
11 Garage Door Opener
El Heating, Ventilation and Air Conditioning System
El Vacuum Systems*
• Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
Boiler Controls
0 Clock Systems
0 Data Telecommunication Installation
El Fire Alarm Installation
•
HVAC
Instrumentation
❑ Intercom and Paging Systems •
El Landscape Irrigation Control
Medic
Nurse Calls •
El Outdoor Landscape Lighting •
Protective Signaling \ - +
•
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
•
is \Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03