Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
N . q
. . o COMMUNITY DEVELOPMENT Permit #: ELR2009 -00162
T 1 G;,,,.RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/25/2009
Parcel: 1S136DD05300
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 110
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: Grange Capitol
Project Description: Install restricted energy for (2) relocated VAV boxes.
Owner: FEES
PNWP LLC#2 & Description Date Amount
PNWP LLC, 6600 SW 105TH AVE #175 Restricted Energy Permit 06/25/2009 $75.00
BEAVERTON, OR 97008 12% State Surcharge - Electrical 06/25/2009 $9.00
PHONE:
Contractor:
LORENZ ELECTRICAL CONSTRUCTION INC
PO BOX 3580
HILLSBORO, OR 97123
PHONE: 503 - 614 -0400
FAX: 503 - 614 -0401
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 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 -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: Permittee Signature: 7/ ---
_
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.
Can 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.
; l iectrical Permit Application R ECF I\Jr' L l OR oii ic:h: tist: ON,.,
City of Tigard DateBea Permit No.: • 0Q, Q
° 13125 SW Hall Blvd., Tigard, OR 97223 JUN 2 2 2009 Plan Review
li Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit ( `� O ': 6 r
"I I G A It D Inspection Line: 503.639 CITY OF TIGARD Date Ready /B El See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
TYPE OF WO RUILDING DIVISION PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check 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 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 ® 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.
❑ Addition of new motor load of ❑ "A ", "E ",' 1 - ", "I - ",
Job no.: Job site address: 11850 SW 67 Avenue I OOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, Oregon 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Grange Capital ❑ Service or feeder 600 amps or more.
FEE SCHEDUL
Cross street/directions to job site: - Description 1 Qt 1 Fee. 1 Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Low voltage control wiring for (2) relocated VAV boxes. Boxes are existing. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ® TENANT 201 amps to 400 amps 106.85 2 -
Name: Grange Capital 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 11850 SW 67 Avenue Over 1,000 amps or volts 454.65 2
City /State /ZIP: Tigard, Oregon 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
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, 6.65 2
each branch circuit
Business name: Accurate Heating, Inc. B. Fee for branch circuits
Contact name: Kim Williams without service or feeder fee, 46.85 2
first branch circuit
Address: 27350 SW 95 Avenue, Suite 3010 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Wilsonville, Oregon 97007 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 650.1229 Fax: : (503) 650.4845 Reconnect only 66.85 2
E -mail: service2 @accurateheating.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal
Business name: Lorenz Electrical Contractors p at(s) or limited -
panel, energy panel, alteration, or
Address: 2074 NW Alockel Drive, #214 extension. Describe: I Page 2 2
HVAC Low voltage
City/State /ZIP: Hillsboro, Oregon Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 614.0400 Fax: (503) 614.0401 Investigation per hour (1 hr min) 62.50
CCB Lic.: 138608 Electrical Lic.: .4 -516C_ Suprv. Lic.: 46735 Industrial plant per hour 73.75
j ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: a , r Subtotal:
Print name: Andy Lor- . : I t . 19 Plan review (25% of permit fee):
/. // State surcharge (12% of permit fee):
Authorized signs t . W/ / /�/ TOTAL PERMIT FEE: 8 1. 1 co
�° This permit application expires if a permit is not obtained within 180
Print name: Kim t i liams Date: 06.22.09 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitAppdoc 05 /23/06 440- 4615T(II /05 /COM.'WEB /, 56 / 7
• 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:
❑ 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
1 PermitApp.doc 03/23/06