Permit rANS7 y� CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
't. COMMUNITY DEVELOPMENT Permit #: ELR2010 -00120
7 E G 1CR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/09/2010
„,-,,r!.' ; , Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Stash Tea
Project Description: HVAC
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 07/09/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 07/09/2010 $9.00
PHONE: 503 - 624 -6300
Contractor:
ARJAE SHEET METAL CO, INC.
5510 SE MCLOUGHLIN BLVD.
PORTLAND, OR 97202
PHONE: 503 - 231 -7717
FAX: 503 - 230 -4888
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 $84.00
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 is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a.d`� II other pi-AII work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of iss nce, •r /” work is , '.' � } for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility NoYrficati Ce» r,/ Those i� set forth in OAR
952- 001 -0010 through • • R 952- 001 -$100. Y• • - - • . - copy of - rules or direct questions to OUNC by calling 50 .246.79' or 1.: r.
Issued By. � �_ Permittee Signature: �. -
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.
Electrical Permit Application � FOR OFFICE USE ONLY
an g 0 City of Ti d Received Permit No aateBy: �l ( h7) " !- L/11 .. I J 0 I`
° 13125 SW Hall Blvd., Tigard, OR 97223 ( r ' 1� ` an Review [ ry ■ P h
a � v Da _ :y; Other Permit: / LiY" p ' 9 Nv W ( H
Phone: 503.639.4171 Fax 503.598.1960 \\\\ 11`
TI GA R D Inspection Line: 503.639.4175 0 t t': V. e..yBy: Juris: ® ee Page 2 for
Internet: www.tigard- or.gov O SIN .: +1 Ti(t ethod: Supplemental Information
TYPE OF WORK � ` �1 PLAN REVIEW
nt Please check all that apply (submit 2 sets of plans w /items checked below)
❑ New construction []Addition /alteration /replae
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 2 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
A
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "I - ",
]� �Z i D I00HP or more. occupancy.
Job no.: Job site address: ' V �s ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: < SCZ ❑ Health -care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: D Project name: "-- <-j- _ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. 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. ft.)
' Limited energy, multi- family 75.00 2
(XL 1 /\31 < 3-- 5 residential (with above sq. ft.)
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
t� 401 amps to 600 amps 200.34 2
'J
Name: ? fl G ---Trevi- 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 Tess 59.36
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 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
- APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
B Fee for branch circuits without
Business name: 2 L f't� 7 `� �� i f \, service or feeder fee, first
Contact name: K ` ; J / (ONO A
branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: 5'5 (I f i . ih c. LQ 1 1 (e fH ,- / (3 1 Miscellaneous (service or feeder not included)
Cit /State /ZIP: i N ,' (12 'I Q 2 Each manufactured or modular 67.84 2
Y 4 Tl. Z dwelling, service and/or feeder
Phone: (SG)) 13 I. ( '7 ( Fax: : (5 j) 'Zj G . L{ L Q y Reconnect only 67.84 2
v n � Pump or irrigation circle 67.84 2
E - mail: /(t: lrrt '4 . OA Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy d
Business name: (VOA � / �{ "^— panel, alteration, or extension. ' Page 2 7t ' 2
( ✓''r ` 1*' ' �l' ( A✓�• Each additional inspection over allowable in any of the above -
Address: 5510 f L; ' (A` LQ u G t f-(� lam II Le d Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: POAT��d CA 9 ?Lc 2
Investigation (1 hr min) 66.25/hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ('St )) 2 1_ -7 "71) Fax: ( (511) Z 7n 4 z t z Inspections for which no fee is 90.00/ hr
specifically listed (%S hr min)
CCB Lic.: C t3 6 Electrical Lic.:Z(p cot uprv. Lic.: ) ('r L ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: R. q Su fee): r cA+
Plan review (25% of permit fee):
Print name: N l";\J i 1 UN) 6.-4. Date: L/ ) [ Q State surcharge (12% of permit fee): 1, %Ka
/�� /l TOTAL PERMIT FEE.,
Authorized signature: U/ (�fJ This permit application expires if a permit is not obtained within 180
Print name: / Q " J / � L ( 07-1Z Date: ) ' r (} days after it has been accepted as complete.
' Number of inspections allowed per permit.
1-\ Building •,Permits\ELC- PermitApp. doc 07/01/10 440- 4615T( 1 1/05 /COM/WEB
Electrical Permit Application City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
0 Audio and Stereo Systems*
• Burglar Alarm
0 Garage Door Opener*
0 Heating, Ventilation and Air Conditioning System*
0 Vacuum Systems*
0 Other:
" COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
0 Audio and Stereo Systems
0 Boiler Controls
• Clock Systems
O Data Telecommunication Installation
O Fire Alarm Installation
/: HVAC
O Instrumentation
0 Intercom and Paging Systems
• Landscape Irrigation Control*
Ej Medical
O Nurse Calls
0 Outdoor Landscape Lighting*
O Protective Signaling
E] Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 : \ Building \Permits\ELC- PermitApp.doc 07/01/10