Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
71
,, = COMMUNITY DEVELOPMENT Permit #: ELR2010 00162
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2010
?1GARD g Parcel: 2S112AD01000
Jurisdiction: Tigard
Site address: 7007 SW CARDINAL LN 105
Subdivision: Lot: 0
Project: Fax Back
Project Description: (1) HVAC for Mitsubishi heat pump
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 08/18/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 08/18/2010 $9.00
PHONE: ' 503 - 624 - 6300
Contractor:
OREGON HEATING & AIR CONDITIONING
PO BOX 241
DUNDEE, OR 97115
PHONE: 503 - 691 -9699
FAX: 503 - 691 -8556
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 Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 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 0 952- 001 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: rat' Permittee Signature:
oAr /9 e� /�U� 4
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 � � rt lz ,�F F�rF 1 isr. c>h �� `•
C of Tigard , ' if , _+ ,� , ; . ,itNo.;�L/1 020/0 ..„,,
13125 SW Hall Blvd Tigard OR 9722 i ' r .- „if i�, L i
Plan Review Other Permt,, /0 o t,f
a Phone; 503.639.4171 Fax: 503.598,1960 AUG 7 2 010 Datef) . i % g/
f 1 UP f` ., Inspection Line: 503.639.4175 u Date Ready'By: furls 153 See Page 2 for
Internet: v✓ww.tigard or.gov Notified/Method: Supplemental lofo mation
s1 t :e PLAN REVIEW
TYPE OP WORK .lwtt` s' .2'�iiClfl! \1
❑ New construction ,l Addition /alteratioenJre R ,„ place ' ment , ,. • — • Please cheek all that apply (submit 2 sets of plans w /items checked below):
[] Service or feeder 400 amps or more [] Building over three stories.
❑ Demolition ❑ Other: where the available flan current ❑ Marine 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
❑ I - and 2- family dwelling 1:■ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
❑ Emergon system. Larger separately derived system,
TOR STTE INFORMATION AND LOCATION El Addition o of new motor load of ❑ "A" "$ ". "1.2 ", "1 -3 "•
e. 10014P or more. occupancy.
Job no.: U r � s � Job site address: 001 �(i t . 0 A Lt__' 4. Q Six or more residential units. ❑ Recreational vehicle parks.
•
City /State /ZIP: El Health - care faoilities. ❑ Supply voltage for more than
Ti / ,,,,� ( ❑ Hazardous locations. 600 volts nominal.
■
? Suite /bldg. /apt. no.: $ Project name: rig / i . ❑ Service or feeder 600 amps O1 more.
f FEE SCHEDULE
Cross Street/directions to job site: Deecriotoe r Qv. 1 fee. 1 meat f.-
New residential single - rrr mu1G- family dwelling unit.
_ Includes attached garage.
Subdivision:
Lot n0.: 1,000 sq, U. or less 168.54 4
• Ea. add'1 500 sq. ft. or portion 33.92 3
Tax map /parcel no.: Limited energy. residential
75 2
DESCRIPTION OF WORK _Swab above seqft ft. )
(� ' �` Limited energy, multi - family 75.00 2
1 s [lit, t _ ._, Lra A residential (with above sq. ft.) L.. tI. - 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
2 00 amps or le ss 59.36 1 • Phone; ( ) Fax; ( )
aol 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
Ovvner signature: • Date: A. Fee for branch circuits with
CONTACT I P • above service or feeder fee, 7 42 2
I't APPLICANT eac br anch circuit
���� B. Fee for branch circuits without �� 1 �'1�w. f .ti l �a ■ service or feeder fee, first 56.18 2
// r" a ]. L branch circuit _ _
1 Each add') brand circuit 7 . 4 2 2
Address: & 0 Miscellaneous (service or feeder not included
Each manufactured or modular II. 6784 2
City/State /ZIP: dwelling service and/or feeder ...
Phone: !� ) r ..4 Pax:: / �� t . Pump o r it / 67.84 2
-hLJ �� Q F l,t Y Pump or irrigation circle III 67.84 2
E - snail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy NM
u 11.0aAlin s , /c . .anel, alteration, or extension. 2
business name: r�l ry, 6 Each additional inspection over allowable in any of the above
Address: 0 , ' ` r2, t Additional inspection (1 hr min) hr
S 1 Investigation (1 fir min) 66,25/ hr
City /State /ZIP: • - 7 t L Industrial plant (1 hr min) 78.18 / hr
Phone; ( a 1 C(,1. 01 Q � Fax: . I • I5S Inspections for which no f is 90.00 / hr
�... L. specifically listed (y, hr rr,in)
CCB Lie_:41. ( 1 Electrical Lic.: f L/ Suprv. Lic.;j g ELECTRICAL PERMIT FEES
M Subtotal: liniii, ,
Supiv, Electrician signature r= .uired: — " Plan review (25% permit fee): • Print name: r; •`�1'Z�.. Date: �b � M State surcharge (1 o perm fee): ` a
1 TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtain. � within 180
1��',�: �- LLl days after 11 has been accepted as complete,
titt MEM Date: Al 11 MIMI • Number of inspections al)owed.pet permit.
•
T:1 Building \Permi1P\ELC- PermitApp.doe 07/01!10 440- 4615T(11105 /COM A
E0 /T0 30dd ONIld3H NO0360 9958— I69 —E09 Z0:0t 0t0Z /9t/80
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined 375.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems;
*No licenses are required. Licenses are required
for all other installations
j l$ uildin ,C.PermitApp•doc 07/01/10
60/Z0 39Vd 9NI1d3H NOJ3d0 9998- t69 -E09 Z0 :0T 0T0Z /9I/80