Permit . ,,,. q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' r Permit #: ELR2009 -00356
Li COMMUNITY DEVELOP
T i GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/10/2009
Parcel: 2S113AA00700
Jurisdiction: Tigard
Site address: 16600 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK I Lot: 0
Project: Benchcraft
Project Description: Low voltage for HVAC
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 12/10/2009 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 12/10/2009 $8.14
PHONE: 503 - 624 -6300
Contractor:
GOHMAN MECHANICAL
14505 SE HWY 212
CLACKAMAS, OR 97015
PHONE: 503 - 658 -1892
FAX: 503 - 658 -6925
Type of Use: COM
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: Y Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit i sued 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 ' accordance with ap.roved 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. TTENTION: Oregon la; re. ires you to follow the rules adopted by the Oregon Utility Notifica'•. Center. Those rules are set forth in OAR
952- 01 -0010 thro gh OAR 95. r r 1 -01 1. ou may obtain a copy of the rules or direct questions to OUNC by caIli ,: r.!- ‘• - • •99 or 1.800.332.2 44.
I sued By: �I . 1' IJL4 t Permittee Sig - - = i% J1 � ( � � — �
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 an inspection that business day.
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.
' 12/10/2009 1 1 : 57 5036586925 RECEIVED GOHMAN MECHANICAL PAGE 02/04
Electrical Permit Application volt (wricv , (ISE ONLY
DEC 1 0 2009
,..
City of Tigard Received
q , , A a
Dateay: r r P r " r Permit No.: ehla009-00,5,5-6
1111 13125 SW Hall Blvd., Tigard, OR 97221 ITY OF TIGARD Plan Revie w
: 1 . Phone: 503.639,4171 Fax: 503,598.1 Other Permit
TIGAKD
Inspection Line: 503.639,4175 IYEILDING DIVISIO D(12
Date Ready/By; luji../
El See Page 2 for
Internet: vrww.tigard-or.gov Notified/Method: ."7 /62 supplemental information
,'J':..t:Ii;■':.,?;',:7-,r,",a,.?4Xi4,1f5,70_11?,W.VOrgi.AO:rigi'=1 ',".;(::';.,r7.:.N:-,',1''-,PErq 11;7itt4Y1E3;*'-'
0 New construction 0 Addition/alteration/replacement Picasc check all that apply (submit 2 Acts of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three Alettics,
0
Demolition 0 Other:
where die Available fault eutrem 0 Marinas and boatynrds.
eketdditt . eitrt f*Slifttefil5S - ',....-';'.', -"' -7 "-- exceedA 10.000 amps at 150 volts or 0 Floating buildings
less to ground. or exceeds 14,000 ID Commercinlqisc agricultural
0 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other instnlIntions. bulldinps,
0 multi-family 1 Master builder 0 Other: 0 Firo pump. a Installation of 75 KVA or
:. ''',,' ' .,.: ': , ''''t! •,,: 4611"Itit ANIM.1tittsaiiksw;,jo kbl . „ ,,, . ,. ,, ... 0 Emergency system larger separately ticri ved system.
100HP crr more, occupancy,
lobno,:jobsitcaddze:3 .e. — 7 &JO 1;
IA' f - - .L•" 1:ISix ar more residential units ID Recreational vehicle parks.
City/State/ZIP: 7 0 e› • 9 74; 4 0 Hoahh-Carc facilities.
0 Hazardous locations, ID Supply ....Imp for morc than
600 volls nnminal
Suite/bldg./apt, no,: Project name: ,e3,."...-)/4/4/ C2.4 P*7 0 Service or feedcr 600 amps or more.
.! ;,; j1,. ; .'114,1;StillftliVLE
Cross street/directions to job site:
DescriptInn I Qty. I Fre0. 1 Toth! 1 •
New residential single- nr multi dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less i 68,54 4 .,
Ea. add'i 500 sq. R. or portion 33.92 1
Tax map/parcel no.:
Limited energy. residential
67.84 2
1YEgtRiPtitill'?of .WOlkk , ' '- : , . -.: . ' '' (with above sq. fl.)
-
Limited energy, multi-family
67.84 2
7 5 %A rs # U A --, residential (with above An, ft.)
Services or feeders installation, alteration, And/or relocation
200 amps or less 100.70 2
-
:1 :* ..,";!,',.,:-;: r.,. tOutrit; l',':!.‘' 201 amps to 400 amps 133.56 2
Name: PA 6- - 77z c, S .--r 401 amps to 600 amps 200,34 2 .
- 601 amps to 1,000 amps 301.04 2
Address:
O _ ver 1,000 amps or volts 552,26 2
City/State/ZIP: Temporary services or feeders installation. alteration. and/or
relocation _
Phone; (5 s ) C/A1.2. 9- & .3 0 0 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being madc on property that 1 own which is n 201 amps to 400 amps 125.0R 2 ot
intended for sale, lease, rent. or exchange, according to ORS 447, 449, 670_ and 701, _ 401 amps to 599 amps 168.54 2
_Branch circuits - new, alteration, or extensionper panel
Owner signature: Dater
A. Fcc for branch circuits loth
CI AVM0 ,.:;;I:,,r,.;:.:, .3' ::•.,:,..: above service or feeder fee,
7.42 2
each branch circuit
Business name:
B. Fcc for branch circuits
2 "Gcvri without service or feeder fee,
Contact name;
____ first branch circuit 56.18 2
Address: 16#17t Each add'l branch circuit 7,42 2
Miscellsneous (service or feeder not Included)
City/State/ZIP: Each manufactured or modular
67.84 2
dwelling, service and/ox feeder
Phone; ( ) Fax: : ( ) Reconnect only
67.84 i 2 -
E-mail; Pump or irrigation circle 67,84 2
: .. . , ,' • ' ' ..' - . • ,'.‘-:',.',,:„ ON : :V:: : Y, :'. • . ! ',:: ,,:: :':: ':'.:::':.:.: Sign or outline lighting 67.84 2
Signal circuit(s or I imitcd-
Business name: . /./4A/V /10#/ii.//e4C-- energy panel, al teration, or
Address: / — e 4 , , ,,, vy z , z extension, Describe: Page 2 2
. ..
C ity/Statc/ZIP! c4 k. 57 e... cy 7 0/6_ Each additional ins ection over allowable in an of the above
Per inspection 66.25
Phone: (.g ) 6. _ / F . z Fu ; ( 6 . D3 )cws -
Investigation per hour (1 hr min) 66,25
CCB Lic,:/,, 9 , 17t Electrical Lic.: s c ..-- 5u • Lic.: ',, 3 , Industriel plant hour 78.18
Suprv. Electrician signature. required.
. .... Ai _ /0 / Or _ ,_._...,,.,:vr.,, ELTZTRICAL :PERritit FEES:
tit '' '' - ' • ' • --
Subtotal: -
Print name: /14 ee .' Date:
Plan review (25% of permit fee): Lp 1 -
.4,11 44/ ..
.2. 0 p, State surcharge (12% of permit fee): 4 / , *._
-
Authorized signature: . 4111IMPF V " '
TOTAL PERMIT FEE: 11
a
Imo pertnit application mires if A PerMil iS nOt obtained within 180
Print narne; /XL Date:/2A
days after il ha% Fern accepted nit cnntpictc.
—
" Number of inspection allowed per permil
t■BuildlnocrmlitnELC-PermitAnadne 10/01/09 44M4A15711/05/CONI/WED
12/10/2009 11:57 5036586925 GOHMAN MECHANICAL PAGE 03/04
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information (C a�D
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener,*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other.:
CC}�VIIlr,CJ.
Fee for m,12, commercial $67.84
system
(SEE OAR 918
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installatiotn
❑ Fire Alarm Installation
�4VAC
❑ .Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
• Other
Total number of commercial systems:
*No licenses are required. Licenses arc required
for all other installations
1AHuilding \Perm 'IA \HLGPcrmitApp, <10c 10/01/09