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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2010 -00195 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2010 Parcel: 2S113AB00500 Jurisdiction: Tigard Site address: 16083 SW UPPER BOONES FERRY RD 130 Subdivision: Lot: 0 Project: State Farm Project Description: HVAC system. FEES Owner: G &S FC LLC Description Date Amount 516 SE MORRISON #100 Restricted Energy Permit 09/23/2010 $75.00 PORTLAND, OR 97214 12% State Surcharge - Electrical 09/23/2010 $9.00 PHONE: Contractor: CHERRY CITY ELECTRIC 1596 22ND ST SE SALEM, OR 97302 PHONE: 503 - 566 -5600 FAX: 503 -540 -8147 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 • , R 952- 001 -0100. You may obtain a copy of thr ect questions to OUNC by calling 503.246.6699 or 1.800.332.2344. 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. • . .. . , .•PLATI.REVIERr ::':. ,: :....:' . • New construMion ® Addition/alteration/replacement Q Service or feeder 400 maps or more Q Building over three stories. ❑ Demolition ❑ Other: • .; r,; : ; < ^;'; .,. .. c'C OF CONSIRUC1'IO ": • 1- and 2- family dwelling C6 Commercial industrial • Accessory building ■ Multi- family III Master builder II Other :•' : : :,JOa 4 Job no.:3S41041_37981 Job site address:15083 SW Upper Boones Ferry Road Ciry/StaterzIP: Tigard. OR 97224 _� Suitc/bldgJupt. tw.: earn a i e t L P nilineTenant Improvement • r State Farm Cross street/directions to job site: Scr.;co or ruder 60D nines ermina Subdivision: I Lot no,: Tax mup/pwcel no.: :∎::.::►, °:;,-;,. ... ....- DFSCRIPTION:OF ; =WO ,,,, - M Supply and Install DDC control wiring. 1,000 sq. R or less ... $:'..1 :.:>•'ROPT:RTY.OWNEIi;f� . ..'I ''.,::-:'' •, °:. Oy,T6 �ti�M:��:`::::;. ? Name: Address: City/SWlc/ZIP: Phone: ( ) 1 Fax: ( ) Owner installation: This installation is being made on property that I own which is not intended for sale, lease. rent, or exchange, according to ORS 447,449.670, and 701. Owner signature: Date: s "'' . 'N CQ : 'Al*E.1CANT:' . ... ; ;. ; 'I`; :'?.• tONTACI'•.';PERSON. :'; ... i'l Business iuunc: Contact name: Address: City/State/ZIP: Phone: ( ) l tax:: ( ) E -mail: .. .... .. CONTRACTOR...-. Business name: Cherry City Electric Address: 8100 NE St Johns Road, Ste. D101 City/State/LIP: Vancouver, WA 98665 Blanc: ( 380) 571 -4411 l_Fffic (360 ) 571 - 4410 CCB Lic.:91668 I Electri Lie.: 37 Suprv. Lic.: 3488S Suprv. Electrician signature. required: /1 --* Print name: Jon Orton Date:Sep. 22, 2010 .I Authorized signature: Print name: Sherri Seynaeve 1 TT ate: 22, 2010 . .. . , .•PLATI.REVIERr ::':. ,: :....:' . Please check all that apply (submita seta of plans w /items chatted below): Q Service or feeder 400 maps or more Q Building over three stories. when: the avealabtu fault aa+ent Q Marinas and boatyards. exc eeds 10,000 amp at 130 vole or Q Flowing buildings. leas to ground. or weeds 14.000 ❑ Commercial-use agriculuord amps for all other installadaaa. buildings. QFire pomp. CI lneta1ation of 75 KVA or Q Emergency system. larger separately derived system. Q Addidem uheew motpr Wed or Q "A "l:", "1-2; "1a ". 10014P or more. occupancy. ❑ Sac or more residential units. © Recreational vehiclepmlm. Q Hexdthsme facilities 0 Siepply voltage Mar more than Q Hazardous locations. 600 volts nominal. Scr.;co or ruder 60D nines ermina ) CI ,.'....,;;:.''.:.!.:. ,; . .. ':`: :. _ , :•FELT; SCJIEDULE: `` r,, 'Y .. , '.1 ... _ tie.wpaew Qtt. 1 P T.nr New residential single or multi family dwelling unit Includes attached garage. 1,000 sq. R or less 168.54 4 Ea. add'I 500 sq. ft or portion 33.92 Limited energy, residential (with above aq.1L) 75.00 7., Limited energy. multi-finally residential (with above sq. R) 75.00 2 Services or feeders inslallnlio astern io and/or relocation 200 amps or less 100.70 2 201 amps to 400 uumps 133.56 2 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Over 1,000 amps or volts 552.26 _ 2 Temporary services or feeders installation. alteration, and/or relocation 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 401 amps to 599 maps 168.54 2 Branch circuits - new, alterat1o5 or extenatoo, r panel - A. Fa for branch circuits with above service or fader foe, each branch circuit , 7.4" 2 13. Fee for branch circuits without service or feeder fee. fast brunch circuit 56, I8 r. Each add'I branch circuit 7.42 2 Miscellaneous (service or feeder not included) Each manulbctured or modular dwelling, service and/or feeder 67.84 2 Reconnect only 67.114 2 Pump or irrigation circle 67.84 2 Sign or outline lighting 67.84 2 Signal circuit(s) or limited-enerby panel, alteration, or rue sioa 1 Page 2 $75.00 2 Each additional inspection over allowable in any of the abov Additional inspection (1 hr min) 662.5/ hr Investigation (1 hr min) 66.25/ hr Industrial plans (1 hr min) 76.18/ hr Inspections for which no fee is spocifically listed (X hr min) 90.00/ la .' - ,, .: ,... •::.. ; :•ELE TRICAL, PERMIT 1> S:•::•• ;..... ,; ......... , _ Subtotal: $75.00 Plan review (25% of permit fool: State surclurrgc (12% of permit fa): 9.00 TOTAL PERMIT FEE $64.00 SEP- 23- 2010(THU) 07:57 TtuAkn NOISIAIQ DNI4'1Iflg MOLL 30 A.LID Electrical Permit Application 0 l o Z cg d F S City of Tigard 13125 S Blvd.. Tigard, OR 97223�g A I`ll SO a Phone: 503.639.4171 Fax 503.598.1 503.63 inspoction Lino: 503.639.4175 Internet www.tiggard- or.gov itheiidintlr4nainaln4 av mitapprbe Canna Fort OFFICE. 1 F. 1.1 41046157p uos1toaenwtm P. 002/004 This permit application expires Ifa permltis not obtained within 180 Or aver it has been aecrpld as =winkle. • Number of inspections allowed par permit SEP-23-2010(THU) 01:51 P. 003/004 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LTIVIITED ENERGY PERMIT FEES: 7RESIDESTMEVORKofty:777.777.777:777.77 Fee for all residential systems combined........ $75.00 Check Type of Work Involved: p Audio and Stereo Systems* O Burglar Alarm El Garage Door Opener* 12 Heating, Ventilation and Air Conditioning System* El Vacuum Systems* ID Other: 7 to - 'higitittartkiiilfeignei" Fee for each commercial $75.00 system (SEE OAR 918-309-0000) Check Type of Work Involved: O Audio and Stereo Systems O Boiler Controls • Clock Systems 0 Data Telecommunication Installation O Firc Alarm Installation jJ HVAC 0 Instrumentation • Intercom and Paging Systems • Landscape Irrigation Control* • Medical 12 Nurse Calls o Outdoor Landscape Lighting* (2 Protective Signaling Other Total number of commercial systems: 1 *No licenses are required. Licenses are requked for all other installations MaildinalPelmitAELC•PermitAwdoc 117101110