Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
■ COMMUNITY DEVELOPMENT Permit#: ELR2020-00109
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/30/2020
Parcel: 2S101 DA02000
Jurisdiction: Tigard
Site address: 6980 SW VARNS ST
Project: Madrona Subdivision: VARNS ACRES Lot: 3
Project Description: Low voltage work for HVAC equipment and control
Contractor: LATIMER HVAC LLC Owner: WEST COAST LUMBER INSPECTION BUR
11230 SW MORGEN CT 6980 SW VARNS ST
TIGARD,OR 97223 PORTLAND,OR 97223
PHONE: 360-513-4505 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/22/2020 $75.00
12%State Surcharge-Electrical 09/22/2020 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 1 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports(Conditions)
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 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 thro h OAR 952-001-0090. You may obtain a copy of e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: See Dxpp ;'t
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 the next available inspection date.
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.
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1(i Electrical rermit A plication REr'P'\IF ' rule of IR I t S1: (IyL,
- City of Tigard Received fig- 2020 Permit It:t-U2��DOIO F
ilig • 13125 SW Hall Blvd.,Tigard,OR 97223 A U G 1 8 2020 plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#:
Inspection Line: 503.639.4175 CITY t F i O Ready Date/By: MEM I3 See Page 2 for
I I G A R D Internet: www.tigard-or.gov I^,' r x. Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ® Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wiitems checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:6980 SW Varns St 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97223 O Six or more residential units. 0occ Recreational upancy.
vehicle arks.
Health-care facilities. P
Suite/bldg./apt.#: Project name:Madrona ❑Hazardous locations. ❑Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I 'Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'1 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
low voltage work for HVAC equipment and control
(with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
® PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name:West Coast Lumber Inspection Bureau 200 amps or less 100.70 2
Address:6980 SW Varns St 201 amps to moo amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Portland,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 i
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: ,_ 401 snips to 599 amps 168.54 2
El APPLICANT ® CONTACT PERSON Branch circuits-new,alteration,or extension, .er panel
A.Fee for branch circuits with
Business name:Latimer HVAC LLC above service or feeder fee,
each branch circuit 7.42 2
Contact name:Clint Latimer B.Fee for branch circuits without
Address: 11230 SW Morgen Ct serviceran or feeder fee,first t 56.18 2
City/State/ZIP:Tigard,OR 97223 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(971)294-0879 Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:clint@latimerhvac.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Latimer HVAC LLC Sign or outline lighting 67.84 2
Address: 11230 SW Morgen Ct Signalel circuits)or extension. El See Page 2 2
g panel,alteration,or extension.
City/State/ZIP:Tigard,OR 97223 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(360)513-4505 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:carlle@latimerhvac.com Industrialplant(1hrmin) 78.18/hr
Inspections for which no fee is 90.00i hr
CCB Lie.: 220839 Electrical Lic.: LIIR406 Suprv.Lie.: 1798LEB specifically listed(Y hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: prt n,f A.." Subtotal:
Print name: Greg Boone Date: 7/31/2020 0 Plan Review Required(25%of permit fee):
�\� State surcharge(12%of permit fee):
Authorized signature: J /
TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within:ISO
Print name: Carlie Latimer Date: 7/31/2020 days after it has been accepted as complete.
' Number of inspections allowed per permit.
1:1Building\PermitslELC_PermitApp_E1.R_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB