Permit a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.1111 0 COMMUNITY DEVELOPMENT Permit #: ELR2010 00237
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2010
Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11515 SW DURHAM RD E -4
Subdivision: Lot: 0
Project: Willowbrook
Project Description: HVAC system.
FEES
Owner:
HIP WILLOWBROOK LLC Description Date Amount
BY TAX DEPARTMENT, PO BOX 2708 Restricted Energy Permit 10/29/2010 $75.00
PORTLAND, OR 97208 12% State Surcharge - Electrical 10/29/2010 $9.00
PHONE:
Contractor:
REITMEIER MECHANICAL
19570 SW 90TH CT
TUALATIN, OR 97062
PHONE: 503 - 603 -0205
FAX: 503- 603 -0150
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 OAR 952 - 001 -0100. You m- • • - - • • • • - E. es or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:—�` � Permittee Signature: 2gd /A -
erJ
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 Applicatio t li\D FOR OFFICE LSE: ONI Y
City Tigard of Ti and ? Received
Date/B : v 9'4 id o.: ut N 2 _
e 13125 SW Hall Blvd., Tigard, OR 3 q 010 Plan Review rit- 6
/
C Phone: 503.639.4171 Fax: 503.598.194 C'\ !� ` � D : Other Permit: /yl T t _ `�
f I G A K D Inspection Line: 503.639.4175 1^ A8O Date Ready /By: VI See Page 2 for
Internet: www.tigard or.gov r ,� O� D V , � i , � �,0� Notified/Method: �/ Supplemental Informadon
TYPE OF W V p ykp ”-- PLAN REVIEW
I=1 New construction P3 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 -2 "1 -3 ",
n 100HP or more. occupancy.
Job no.: Job site address: 11,515 SGJ l/t., ( yv1 R01 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: '' ❑ Health-care facilities. ❑ Supply voltage for more than
ty A. r f o I q 72 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: &_)/7 /060be.c.x.,4 ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: uescr1 don FEE SCHEDULE
J p 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Vol 1 Limited energy, multi - family 75.00 2
//
r—p[.0 ( e U) ki / YO / w le I hg residential (with above sq. ft.)
l Services or feeders installation, alteration, and/or relocation
200 amps or Tess 100.70 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: kiGtrSCIN -4 Pope( Tie- / 601 amps to 1,000 amps 301.04 2
Address: / 51,0 Byokat Ludt->, Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: , r f knot t3 n Q 720 I relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I 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
5 APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 • 4. `l each branch circuit
Business name: � elf Wl e A
er' A. 4a N ICA- J B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: 07 1/ goye r$ branch circuit
Each add'l branch circuit 7.42 2
Address: ) 7s 7, !l,c) 9Q f-A 62,-_r± Miscellaneous (service or feeder not included)
.�. Each manufactured or modular
City/State/ZIP: 67.84 2
tY ) t /ct ! I n � ale 0 fj Z dwelling, service and/or feeder
Phone: (5 Ga 3 ` d ZO S Fax: : (5 3) � � 3 _ D /So Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E m a il: ,ct rt ri errs Ore.; i' iCfIn erLlatnt4t I. tm r')7 Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy r y,
1 • I panel, alteration, or extension. 1 Page 1 % 2
Business name:
Re 1441 e le AeG h, vi, Lc, I Each additional inspection over allowable in any of the above
Address: 115&..› !� e f-A Cc,c,Y j Additional inspection (1 hr min) 66.25/ hr
R investigation (I hr min) 66.25/ hr
City/State/ZIP: Lt /`
�pt �Gt�l h / C/ � � 2
industrial plant (1 hr min) 78.18 / hr
Phone: 5 ) 6; - 04, c Fax: (5) j ) 03 — 01s U inspections for which no fee is 90.00 / hr
specifically listed (Vs hr min)
CCB Lic.: /5 3'770 Electrical Lic.: _00 CRI Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: n / Subtotal: 7S at., iF� �"____ Plan review (25% of permit fee):
Print name: ) C ( �, 4P „. Date: 1 0/227/& State surcharge (12 %ofpermit fee): phut)
�� TOTAL PERMIT FEE: $Z(, ( JO
signature: 2y� �LG e6L3� 4 L This permit application expires if a permit is not obtained within 180
» days after It has been accepted as complete.
Print name: , i' 1A e g e r Date: 10/22_7 ) U • Number of inspections allowed per permit.
L:\ Building \ Permits \ ELC- PemtitApp.doc 07/01/10 / 440-46I5T(11 /05 /COM/WEB