Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
" `7 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00034
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/10/2011
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 300
Project: Food Sales West Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: HVAC system.
Contractor: OREGON HEATING & AIR CONDITIONING Owner: PACIFIC REALTY ASSOCIATES
PO BOX 241 15350 SW SEQUOIA PKWY #300
DUNDEE, OR 97115 PORTLAND, OR 97224
PHONE: 503 - 691 -9699 PHONE: 503 - 624 -6300
FAX: 503 - 691 -8556
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/10/2011 $75.00
12% State Surcharge - Electrical 02/10/2011 $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 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 -0090. You may obt f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ermittee 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 FOR OFFICE IISE ONLY
Received
City of Tigard Dare/a / / i i Permit No,. , _ >
° 13125 SW Hall Blvd., Tigard, OR 97223 CC 2 Plan Review
- • Phone: 503.639.4171 Fax: 503.598.1960 Darc/B : (hhcrPermit: a,, f _ _ell
Inspection Line: 503.639.4175 Date Ready /Sy. tuna: • Page 2 for
T i G :LR_I5 Internet: www.tigard- or.go�' j � 4)' Notified/Method: Supplemental leforroatioe
TYPE OF ' t RR V PLAN REVIEW
o New construction Addition /alieratioil/replac,cmcnt Please check all that apply (submit 2 sets of plans *items checked below):
❑ Service or feeder 400 amps or more • ❑ Building over three stones.
0 Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds I0,000 amps at 150 voles or ❑ Floating buildings.
lees to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for at other installations. buildings,
❑ Multi - family Master builder 0 Other 0 Fire pump. ❑ Installation of 75 KVA of
JOR SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system,
CI Addit Addition o m
n of new motor load of ❑ "A" "EE ", "1-2". "1 -3 ",
•
Job no.: 11 Job site address: I ig 1 9 55 a Ay. • l CP or more.
❑ o p�cy.
ei+u Six ix or more residential units. ❑ R eati 1 vehicle parks.
City/State/ZIP: '^�� ❑ Health -care facilities. ❑ Supply volt* for more than
1 Q I�( ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: 308 Project name: d St 5 tt _ ❑ Service or feeder 600 amps or more.
v� FEE SCHEDULE
Cross Street/directions to job site: Description I City. I Fee i Total I " ...
New residential single- or multi - family dwelling unit.
• Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. edd'l 500 Sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORKK (with above sq. ft.) 75,00 2
ItA•S`Crai Li energy, multifamily 75.00 2
+ P r C /; r "s residential (with above sq. ft )
6� "`-" Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER lit TENANT - 201 amps to 400 amps 133.56 - 2
Name:
7,..
401 amps to 600 amps 200.34 2
• 4 `- ,� . l ' • � 1 / — I. 601 amps to 1,000 amps 301.04 2
Address: E La k �A s - � a over 1.000 amps or volts 552.26 2
City /State/ZIP: q 7 1 relocatio s ervices or feeders installation, alteration, and/or
Phone: ( ) Pay(: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own Which is not 20.1 amps to 599 amps 125.08 2
intended for sale, lease, rem, or exchange, according to ORS 447, 449, 670, and 701. 801 amps to 599 amps I68.54 - 2
Branch circuits —new, alteration, or extension, per panel
Owner signature: - Date: A. Fee for branch circuits with
- 1 APPLICANT 1 0 CONTACT PERSON above service or feeder fee. 7.42 2
each branch circuit _
Business name: B, Fee for branch circuits without
/ ~ � i1 A. ra it } Of ' r A 0.. P le—e, service or feeder fee, first
Contact name:
r �� - t _ branch circuit 56.18 2
~ • �r 4►. _ � _ a l
a r ■ Y/ Each ode branch circuit 7.42 2
Address: . a 1 [ (3X aL. ( Miscellaneous (service or feeder not included) _
'l \ 1 , , i e e C1,1 1
Each in , service or r modular 67.84 .. 2
City/State /ZIP:
>kl -IAIr �l�^�— ` l� dwelling, service and/or feeder
Phone: a) ! oc ( ( (�1(.�G� Fax:: �/ta) ( Pump only 67,24 2
lJ� �"-- Pump or irrigation circle 67,84 2
E -mail: _ . Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy i — 7e - 4G-
Business name: rrr���^^^^^^'''''' 1r. / _panel, alteration, or extension. � Page 2 / 7 s 2
rQ t l� C�'' �! / Each additional inspection over allowable in any of the above
Address: • 0 , Sj � . att ( Additional inspection (1 hr min) 66.25/ hr
City /State /ZiP: v 0 (� tt Investigation (1 hr min) 66.25/ hr
_ �''L" L L ,",,,, Industrial plant (1 hr min) .,, ,. 78.18/ hr ,
Phone: ) l "i ( Fax: ) _ trill W specifically cally I sted ( hr m n) 90.00 / hr MN
CcB Li c. Zad ace Electrical Lic.:L r yo Suprv, ELECTRICAL rouv.in FEES
Suprv. Electrician signature, required: -- - Subtotal:
. Plan review (25% of permit fee):
Print name: r , • rte, Date: t l State surcharge (12% of permit fee): q ,
i s � f TOTAL PERMIT FEE: '4 , (C)
`
Authorized Si a r
tature• g 4 j `,_.,�1
. This permltipplicaiien expires if a permit is not obtained within 180
�
a days after it has been accepted as complete.
1 ! : tt,. � ..a . Date: . C. M ° Number of inspections allowed per permit.
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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*
❑ Hcating, Ventilation and Air Conditioning System*
fl 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
11 Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
fl Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems;
*No licenses are requited. Licenses are required
for all other installations
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