Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
g ' - COMMUNITY DEVELOPMENT Permit #: ELR2011 -00001
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/04/2011
TIGARD Parcel: 2S101AD03500
Jurisdiction: Tigard
Site address: 6600 SW HAMPTON ST
Project: Quest Diagnostics Subdivision: Lot: 0
Project Description: Low voltage for HVAC
Contractor: AMERICAN HEATING INC Owner: PACIFIC REALTY ASSOCIATES
1339 SE GIDEON ST 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97202 PORTLAND, OR 97224
PHONE: 503 - 239 -4600 PHONE: 503 - 624 -6300
FAX: 503 - 239 -7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/04/2011 $75.00
12% State Surcharge - Electrical 01/04/2011 $9.00
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
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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 i - ordance wi - pproved 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. A ENTION: Oregon la . requir- - you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 952-00 -1 S. You m tain a copy of the rules or direct questions to OUNC by calling 503.232.19 or 1.800.332.2344.
�J (_cJ M c J CIC fr' -
Iss � � 'd By:
! /i 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 the next available inspection date.
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 RECEIVED :
FOR OFFICE USE ONLY
City of Tigard not trial AM Permit No.. ELJL19pIt -06D6/
13125 SW Hall Blvd., Tigard, OR 97223 JAN 0 4. ' Plan Review
' a. Phone: 503.639.4171 Fax: 503.598.1960 DateB : Other Permit:
Inspection Line: 503.639.4175 ' �: ' 7'" fans: 0 See Page z
TIGARD Ins p ('� ('jc' T > Date E for
Internet: www,tigard - or.gov •, Notified/Melhod: Supplemental Information
.fitit;
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❑ New construction Addition/alteration /replacement Please check all that apply (submit 3 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 -
a tM t :*3-1- t, x v
,t v {� j -y; � ^5-'; - G cJ.y�y -� : �' ij�`�"t�` t ; r ' exceeds 10,000 amps at 150 molts or ❑ Floating buildings.
-L^ tS »; Vii . -. i-,'=; ' ;; ... • 'aw f f « u . ' +r X�' ' ._ ,
9 " ' ^' less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling C Commercial/industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi- family } ❑ Master builder ❑ Other: 13 Fire pump• ❑ Installation of 75 KVA or
yr • r a '� "i� , ` ��`1 e.... T11 „ 0 a ,. ® t g ' y1 *v '�'IVN x, : - � - � ❑ Emergency system. larger separately derived system.
' *,
• . ., , f . ; +,:.r- . a , _ . ,.+«,ar,:. , . a � : n ,4:,,.....W..„ :-.. �- ' .. 0 Addition of new motor load of ❑ "n ", ••E", "I.2• "t _3
Job no.: I Job site address: (p (O 0 0 S W N'q rn - T0 r” 100HP or more, occupancy.
1 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: / le - + I ea n J O R "17223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg./apt. no.: I Project name: QV eS + Dig 5 n o s �1 C 5 ❑ SerY1ce or feeckr 600 amps or more. .
V 1 _nom � tf i'-.kiti " ill : b ` ..1 • ,'' -
Cross street/directions to job site: Description Qty. Fee. Total •
New residential single- or multi- family dwelling unit.
Includes attached garages
• Subdivision: I Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 . i
Tax map /parcel no
_ Limited energy, residential
Y, ' r'r x r =.:� rc q- c .tea s � E 67.84 2
.i ray ..t O.f t• ' i� Fa...:e• `''r`i . , _S t 3 .. - _ < t e1 - (with above 141 ft')
• 1 Limited energy, multi - family
/0K/ Vol +A 5 e . Y y / i i n 'j residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
_
` r J 9 fR ,. g ` , .3. i ` f , r a 3 ti � N4 1 t ' 201 amps to 400 amps 13336 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 atnps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
l •r,- ^ , vY�... :y + it, -h 11 Std {ka,rta, x r ,
-r ,_.- a'.�' - kW - s above service or feeder fee 7.42 2
each branch circuit
Business name: Arne r GA n H ea .S r first b br se cir cuui t l + J n B. Fee for branch circuits
Contact name: y R4 C A e Si firs sc s i feeder fee,
r✓ 56.18 2
rr
Address: 133 Cl SE t(/ j cJ o n S 'f' Each add'! branch circuit 7.42 2
q Miscellaneous (service or feeder not included)
City/State/ZIP: Pa r ' - f -' a n d (9 R / 7 2 02 Each manufactured or modular
dwelling, service and/or feeder 67'84 2
Phone: (5O3 )Z31- ile b 0 I Fax :: ( 'o3)Z 39' - S. Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
s7ra a r'rl- . . 4 ' f t 1_,, . 4 tt1 L s�2 Si or outline lighting 67.84 2 F
�' � .Y,, t,, ,�+ �• h � ��
>�?tT':�+ -. =r-h .°- Sti,!we ts�x.•.•2"e'....'�. -s^� ,� ?� ��?�''I.f�71^ a, ,. k ..�,^3s
Business name: ,4m ` o r ` / c' G H ,7 Signal circuit(s) e r limited -
d energy panel, alteration, or
Address: /331 SE (' t U e 6„I � j " extension. Describe: Page 2 2
City/State/ZIP: �0 r' Fax: o3 Investig ation / - d OR 972 492_ Each additional inspection over allowable in any of the above
Phone: $03) 2 31-- L/(000 I (S ) Z31 -7O3 $
Per estigattion ion inspection 66.25
( per hour (t hr min) 66.25
• CCB Lic.: 33 5 I Electrical Lic.:20113 (RE I Suprv. Lic.: 2 GYO LEg Industnal plant per hour 7118
Suprv. Electrician signature, required': \--
equired �— Subtotal:
1
Print name:
T S tc v e ` r 0 v el I
Date: ILI � f I Plan rview (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: i 7 # / ' r .4--- TOTAL PERMIT FEE:
/ /I e i--t,✓ D a te: 9k/5:///
Print name: ,
t : f - This permit application expires if a permit is Dot obtained within ISO
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1 I:\ Bui lding\Pcrmirs\ELC- PermitApp.doe 10/01/09 440 4615T(II/05 /COM/WEB