Permit (179) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 ~ COMMUNITY DEVELOPMENT Permit#: ELR2020-00095
Date Issued: 8/17/2020
Ti G,ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S101 BB01300
Jurisdiction: Tigard
Site address: 11950 SW GARDEN PL 100
Project: State of Oregon Employment Department Subdivision: CROW PARK 217 Lot: 1
Project Description: HVAC controls.
Contractor: WILLAMETTE HVAC LLC Owner: BKM PARK BC 252 LLC
3075 SW 234TH AVE.#206 1701 QUAIL ST STE 100
HILLSBORO, OR 97123 NEWPORT BEACH, CA 92660
PHONE: 503-259-3200 PHONE:
FAX: 503-848-2597
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/17/2020 $75.00
12%State Surcharge-Electrical 08/17/2020 $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 through
h OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By�i`Lfi L2lcr-4---- Permittee Signature: ��✓ /97°/3f- I c47,-7(7hi
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.
Electrical Permit ApplicatioRECEIVED FOR Of FILE ESE ONLY
Cityof Tigard Received Permit N
DmBy: "/7 23/� �n Ns tie 20'Zo'- OO9.O5
;�: 13125 SW Hall Blvd.,Tigard,OR 97223 J U N 2 3 2020 Plan Review ether Permit
Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
T I e alt o Inspection Line: 503.639.4175 CITY OF TIGAR D Date Ready/By: / �' kris: El See Page 2 for
Internet: www.tigard-or.gov BUI1 DIN( [11\f1Q.IOhi Natified/Method: i Sapplemeatal Information
TYPE OF WORK PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wiitems checked below):
❑Service or feeder 400 amps or more 0 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.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ I-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. ❑Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
0 Addition anew motor load of 0"A",..E'.,"1-2", 1-3",
Job no.: Job site address: 11950 SW Garden PI 100HP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard OR ❑Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 100 Project name:Oregon Unemployment 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Taal I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.it.or less 168.54 4
Ea.add'I 500 sq ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.fl.)
—_ Limited energy,multi-family 75.00 2
Relocate thermostats residential(with above sq.fl.)
Services or feeders Installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 I
Owner installation:This installation is beingmade property201 amps to 400 amps 125.08 2
on that I own which is not 401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Branch circuits—new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
0 APPLICANT 0 CONTACT PERSON above service or render fee, 7.42 2
each branch circuit
Business name:same as below B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name: branch circuit
Each addl branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax::( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Business name:Willamette HVAC LLC panel,alteration,or extension. I Paget 2
Each additional inspection over allowable in any of the above
Address:3075 SE Century Blvd Suite 206 Additional inspection(I hr min) 66.25/hr
City/State/ZIP:Hillsboro,OR 97123 Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)259.3200 Fax:(503)848.2597 Inspections for which no fee is 90.00/hr
specifically listed(h hr min)
CCB Lic.: 56951 Electrical LiL 34346CRE Lic.: 4025LEB ELECTRICAL PERMIT FEES
' Subtotal: 75" p Q
Suprv.Electrician signature,required: Plan review(25%of permit fee):
Print name: mike sicard Date: 6/15/20 State surcharge(12%of permit fee): 9 c 'n
^ryx 0_}— TOTAL PERMIT FEE: pi/,oi
Authorized signature: qy� r s td�}Y`t6W1 This permit application expires if a permit B not obtained within 1S0
Print name: Michael Matstrom Date: 6/15/20 •
days after it has been accepted as complete.
Number of inspections allowed per permit.
i:'Building\Pemrits,ELC-PermitApp,doe 0n1m10 440-461STI11/OS/COMM1VEB