Permit (79) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00171
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/01 /2012
Parcel: 1 S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE# 140
Project: Broad River Expansion Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Relocate thermostats
Contractor: AMERICAN HEATING INC Owner: PNWP LLC #2
1339 SE GIDEON ST PNWP LLC
PORTLAND, OR 97202 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 08/01/2012 $75.00
Type of Use: COM Restricted Energy Plan Review 08/01/2012 $18.75
12% State Surcharge - Electrical 08/01/2012 $9.00
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N .�
Data & Telecommunications: N Fire Alarm: N
HVAC: N- Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: Y Total $102.75
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 1.800.332.2344
Issued By: Permittee Signature: �ie c•
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
• • RECEIVED FOR 01:11( I. 1 Si : . �\l.\
1,1
City of Tigard ' ' c", 1 ?012 eceved
Date/B . d t let (WI. Permit No. *1-fe °VP.'" eV i ii
11,„ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• I Phone: 503.639.4171 Fax 503.598.19e y OIFT Date/B . Other Permit: et p 30 l oo
a - r .,
HOARD Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
Internet: www.tigard-or.gov T1,7.7, NcIlifiedMeth°d: Supplemental Information
- 2:,', - , , , :-_, , Ir, ', .,, :, ' r: • ••::•; , .,TV . t , -2: ' , jj -6 :....,.•••,-;.,.., --.,.,,,..,„•-:.-:-- -,-...:-.,•:::‘, .,,_-•.,-.‘'. , . - .- : -,- •:: . ; ' j(ttiWiRt8ilitr:
'; ' . • • : _ 7 ..:' ,..;.. S ', • '. • '.!.•‘: •'":.:':..',, - .' ' ' ' 'i• .' '-''; 1: •- •.Z • , ; _,_'''.',' .' ..." !!... • - — - . , • • . •-• , - .- •.'---,,
0 New construction CXAddition/alteration/replacement Please check all that apply (submit a sets of plans w/itetos checked below):
0 Service or feeder 400 amps or more El Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
A1t ,.,,,• ,..,•.:,., :::.--•,., exceeds woo amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
D l- and 2-family dwelling RCommercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 builder 0 Other: El Fire pump. 0 Installation of 75 KVA or
larger separately derived system.
' .• '.. '''' .. ..‘ ... 7 ";'.
JOB SITE lati$0.104110 :WO ATIOTc : . '`;'.:, '' , ' ':,!: " -- < ' v ' 0 Addition of new motor load of 0 "A", "E", "1 -1-3-,
100HP or more occupancy.
Job no.: ( Job site address: a t5s 4 L) 4, 7 4. Az 0 six ... resdent 0 Recreational vehicle parks.
City/State/ZIP: - 1 — ■ (... p D,._ C;D-. i 7 -1_72-'3 o Health-care facilities.
Ei Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
Suite/bldg./apt no.: Project name: 0 Service or feeder 600 amps or more.
:' '''''' -: '= . . ':.' ' :. FEE ,SCHEDULE
Cross street/directions to job site: Co 7+4.. 4- il. rd.... iiie•iiripdoi; I Qty. 1 Fee. 1 Teta 1 •
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'1500 sq. ft or portion 33.92 1
Tax map/parcel no.: Limited energy, residential 75.00 2
,"':'':-;::‘'. ., '''.:,' •-- . , ,., -:iit*RiF „-' ,'-'',-, -. '-', . ,- I . -, :''. ,'-.-- : (with above sq. ft.) • .
Limited energy, multi-family 75.00 2
. k.e.k.c, Le.,k-e...- "Il....w_Av".0 Sk-c..\-S residential (with above sq. ft.)
Services or feeders installation, alteradon, and/or relocation
200 amps or less 100.70 , 2
:...,' ':,:•:': .:-.. :3,,POPEITY -..iiNVNER :=1*..,piAli,Fr: -... l',; ., -. ;. _,, ,:' • 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/Z1P: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
: IYAI*C-*X ., '' ', -' -'-'[- re0
::: '; ,, V,1'1,1*q- PERSON ' ' 742 2
- each branch circuit
Business name:
B. Fee for branch circuits without
n
frrvrtpfiCiivl 4ectt-; a 0 i - kykr . service,or feeder fee, first 56.18 2
Contact name: ti 44 (..j cure-- branch circuit
Each add'l branch circuit ., 7.42 2
Address: L
vo3 9 I SE Gt, clan -t- Miscellaneous (service or feeder not included)
Each manufactaued or modular
City/State/ZIP: p 0 k ili-to r id 1 ,e_ etiao dwelling, service and/or feeder 67.84 2
1
Phone: ( 56 a 00 Fax: : (63) -10 Fteconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
. • -...:" - ' ' :., :' - - '- , :s tit:Ol ".i.' '',' '', : . . .. ,. Signal circuit(s) or limited-energy t
‘ panel, alteration, or extension. 1 Page 2
Business name: Nvyt o vi i ca 1.4 (k t a: .
Each additional Inspection over allowable in any of the above 2
Address: (. -- b C l. s e a■atod St Additional inspection (1 hr min) 66.25/hr
City/State/ZIP: - 0\/.1 - ayva 0 e_ On '.0 . Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/hr
I
Phone: ( t 6), p.. '? 3 C,1 ; _ . , eyo Fax: ( 66 2- - 1(Z Inspections for which no fee is
specifically listed (I hr min) 90.00/ hr •
CCB Lic.: k 6 -c Electrical Lie.: •k f _ • q fi i Suprv. Lic.: e 4 Lfr)(,..EL , : .. ., ELECTRICAL PERMIT,- FEES. . ' . , : ''' '
a.
Suprv. i. - xtrician signature, required:
Subtotal:
Plan review (25% of permit fee):
Print name: --r- , 34 ‘ f - e. A yo IAA Date: 1 State surcharge (12% of permit fee): 9
TOTAL PERMIT FEE:
Authorized signature: te C,J
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: t oik a s- , a (c Date: 65/ 1 / 1 2— • Number of inspections allowed per permit.
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