Permit (112) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
-. COMMUNITY DEVELOPMENT111
Permit#: ELR2019 00180
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/02/2019
Parcel: 1S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE# 100
Project: The Partners Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Limited energy for HVAC.
Contractor: AMERICAN HEATING INC Owner: PNWP LLC#2
5035 SE 24TH AVE PNWP LLC
PORTLAND, OR 97202-4765 6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/01/2019 $75.00
12%State Surcharge-Electrical 10/01/2019 $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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503,232.1987 or 1.8/00.332.2344.
Issued By: �--� -I _ Permittee Signature: L f i'1 1., I �;`t i1...( � ),, ,�( '
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 Application FOR OFFICE USE ONLY
City of Tigard RECEIVE DateBed cal /1'
I( r 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review _
° C` Phone: 503.718.2439 Fax: 503.598.1960 SEP 17 2019 DateBy: efP�rxirt(JL /y)( , j
T 1 G AR 1l Inspection Line: 503.639.4175 Date Ready/By: /L1 / / JurisCl� H See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARDNotifired/Method: // Supplemental Information
fii Zai ,rw. .s y . y.,
Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction ®Addition/alteration/replacement
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
»x CATS $. '>%E H I' ' ;a exceeds 10,000 amps at 150 volts or 0 Floating buildings.
x<. ' ,,�• ,�, ,,, ,x. -%��».," - less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi family 0 Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
/0, Emergency system. larger separately derived system.
g h� gs B, # •TIot�1 11' f i�/�y,
�, •; , ,,.,..- ❑A wmotorloadof 1- ,
ddition of ne ❑"A" "E" "1 2"" 3"
Job no.: Job site address: 11850 SW 67th Ave 100HP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Portland,OR 97223 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:#100 I Project name:The Partners Group 0 Service or feeder 600 amps or more
kE 1 ,, g ,,
Cross street/directions to job site: Description Qty. I Fee. f Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
s 75.00 2
ti;,,, ' %1, 1 (with above sq.ft.)
Limited energy,multi-family
75.00 2
low voltage wiring and T-stats residential(with above sq.ft.)
Renewable Energy. 0 See Page 2
Services or feeders installation,alteration,and/or relocation
,4 200 amps or less 100.70 2
PROPERTY;
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
. sw ,' " , .... S ACT . RSO
A.Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name:American Heating Inc. each branch circuit
B.Fee for branch circuits without
Contact name:Amanda Bostic service or feeder fee,first 56.18 2
branch circuit
Address:5035 SE 24th Ave. Each add'1 branch circuit 7.42 2
City/State/ZIP:Portland,OR.,97202 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)239-4600 I Fax: :(503)239-7038 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:a.bostic@americanheating.net Pump or irrigation circle 67.84 2
. ''' ' ,✓rx ., /- , # " 'CTOR ,i F..: ..
Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)or limited-energy 1 See
panel,alteration,or extension. Page 2 2
Address:Amanda Bostic Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OR.,97202 Investigation(1 hr min) 66.25/hr
Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 33135 Electrical Lic.: 26993CRE Suprv.Lic.: 2640LEB s. cificall listed(%Z hr mm)
11 µ '
Suprv.Electrician signature,required:
Subtotal .
Print name: T Steve Young / 1 Date: 9/17/19 Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: ,(4j ej TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Amanda Bostic Date: 9/17/19 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB
Electric&l Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description Qty. Each T°gat `
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ B• urglar Alarm 25.01 to 50 kva 301.04 2
n Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n V• acuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr ]
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Ya hr min)
,C914":WAVWWK; I ` ;r` l , ELECTRICAL PERMIT FEES
Fee for each commercial system: $75,00 Subtotal(Enter on Page I):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 10/26/2017