Permit IN CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
0 COMMUNITY DEVELOPMENT Permit #: ELR2010 00202
T [ G,\ R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/29/2010
Parcel: 1S127DD01200
Jurisdiction: Tigard
Site address: 10031 SW CASCADE AVE
Subdivision: LEVITZ BLDG Lot: 0
Project: Ultimate Electronics
Project Description: (8) HVAC systems.
Owner: FEES
ULTIMATE ELECTRONICS Description Date Amount
321 W. 84TH AVE., STE. A Restricted Energy Permit 09/29/2010 $600.00
THORNTON, CO 80260 12% State Surcharge - Electrical 09/29/2010 $72.00
PHONE: 303 -412 -2500
Contractor:
ENERGY SAVERS INC
P.O. BOX 2829
OREGON CITY, OR 97045
PHONE: 503 - 512 -5338
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 8
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $672.00
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 ma obt= a co. of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
_�
Issued By _ —1 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.
CaII 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.
From: Jeremy Hickman Fax: +1 (503) 512 -5339 ' 0 To: Fax 1 503' 598-1960 Pa e 3 f / 12:40
REC�I
Electrical Permit Application R er r l !(1 'l 1 () •
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tk ? � . � .� � Iteceavcd ......, ,, /
City of Tigard DateB . I 1M ea J17 . %�
'lir --.' a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ,
9 f;. Phone: 503.639.4171 Fax 503.598.1960 S L I 2 0 2010 Date/Bv: other Permit: I (v — t r Ci (
ins ction Line: 503.639.4175 Date Ready/By: iu 0 See Page 2 for
T ., I , `' .. Internet: www.ti ardor. ov g g CITY OF TIGARD Notiffed/Method: ' I Ci Supplemental Information
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TYPE OF WO'1!1{ PLAN REVIEW
❑ New construction Add iti on/alterati on/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 IN Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND I.00ATiON ❑ Addition of new motor load of ❑ "A ", "g", "I - 2 ", "1 - 3 ",
I00HP or more. occupancy.
Job no.: Job site address: f �' / 5e,../ n .- ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: � ❑ }health - care facilities. ❑ Supply voltage for more than
t -n. V [ i] Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ��„ �l �. f.� ; c i ❑ Service or feeder 600 amps or more.
Iw f r .i i FEE SCHEDULE
Cross street/directions to job site: Description I Dry. 1 Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. f1. or less 168.54 4
Ea. add'! 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 00 /,/�t� ..")0 " 2
i i , / t . r • fit. 4.5.-- residential (with above sq. ft.) 75.
.) v""'
Services or feeders installation, alteration, and/or relocation •�L 13 C_ S Y' .S •/ e, —.) 200 amps or less 100.70 2
❑ PROPERTY OWNER 537 TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: U t f : 01-07"Z.. � /e�ly-�j,--r tZ.s 601 amps to 1,000 amps 301.04 2
Address: Lt ! (.4./ `J" 0e A t1 . . c _ , Over 1,000 amps or volts 552.26 2
f✓ Temporary services or feeders installation, alteration, and /or
City / State/ZiP: 7 h r), 012_ q7)..,3 3 relocation
Fax: ( ) 200 amps or Tess 59.36 1
Phone: ( )
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
p APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: te , t/ S 00c rs / `'� . B. Fee for branch circuits without
service or feeder fee, first 5618 2
branch circuit
Contact name:
r y-- , it V� ' Each add'I branch circuit 7.42 2
Address: PO c , k , 7fg) a) Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: b �.G- _, ( y. p2 7 Q 7° ' dwelling, service and/or feeder
Phone: (50 j) �). , - v , / Fax:. ( 3) s /1 _g 3 3 7 Pump Reconnect only 67.84 2
o irrigation circle 67.84 2
E / Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) Or limited- energy '� •-/
panel, alteration, or extension. ' Page 2 ld y0 2
Business name: .� S. ' , Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: .> Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
-_ — specifically listed ('h hr min) -
CCB Lic.: /1 7 q). 4 Electrical Lic.: L /E/2 iq S Suprv. Lic.: . ELECTRICAL PERMIT FEES
tt
p11 7 / / Subtotal: F tX, ` >�
Suprv. F,lectricia$ >Tire, required: � Plan review (25% of permit fee):
Print name: Date: el/2 State surcharge (12% of permit fee): 7.).
TOTAL PL:RMTT FEE: 6 7,), _
Authorized signature: f7 f 'f his permit application expires if a permit is not obtained within 180
i days after it has been accepted as complete.
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