Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
''1 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00073
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/24/2011
Parcel: 2S113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 400
Project: Micro Interconnects Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Low voltage for HVAC
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 03/24/2011 $75.00
12% State Surcharge - Electrical 03/24/2011 $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 . • . • e 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. • ENTION: Oregeq la "wires you to follow the rules adopted by the Oregon Utility Notificatio. enter. Those rules are set forth in OAR
952-P11-0010 through OAR 95, 101-N• P. You may obtain a copy of the rules or direct questions to OUNC 5y callin r. 1.'1" 987 or 1.800.332.2344.
I sued By: ji, Permittee Si• - • .0* di l /,/
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 pennit 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 FUR OFFICE I :SL ONLY
City of Tigard
', 2 3 2011 Received Permit No.:
II 13125 SW Hall Blvd.. Tigard, OR 97223 flan Review
Phone: 503.639.4171 Fax: 503.598.1 %0 Date/B : Other Permit:
Td GARD Inspection Line: 503.639,4175 Data Ready /By: on E1 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental information
TYPE OF WORK PLAN REVIEW
❑ New construction KAdditi on /alteration /replacement Please check all that apply (submit / sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available feat current 0 MArin .e and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ID Floating buildings.
lam Lo ground, of exceeds 14,000 ❑ Commercial -Use agricultural
❑ 1- and 2- family dwelling A Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: In Fire pump. 0Installation of 751(VA or
❑ Emergency system. larger separately derived system.
JOB SITE LNEORMATION AND LOCATION ❑ Addition of new motor load of ❑ °'A", "E', "1.7", "1 -3 ",
1001-1P or more. occupancy.
Job no.: • a , It Job site address: f f ._ A O. AII t CI Six or more residential units. ❑ Recreational vehicle parks,
City /State /ZIP: • 0 0 Health-ewe faeiliiies. 0 Supply voltage for more than
— loo • - . d Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no: • ♦ Project name: Sc v' IAA Y 1' 1 y / j ' ❑Service Of feeder 600 steps or more.
- a v +—mil V J v FEE SCIIEDCJLE
Cross street/directions to job site: Description i Qtv. I F « l total I ,
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq, tt. or less 168.54 4
- . Pa add'] 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: _ Limited energy, residential
DESCRIPTION OF WORK (with above sq. 8) 75.0 2
-- Limited energy, multi - family 7500 2
�. ` ` . tr y - i
_ rUll mi l - ' residential (With above sq. .
. ft.)
v Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 • 2
0 PROPERTY OWNER 1 r � TENANT 201 amps to 400 amps 133.56 + 2
�" 401 amps to 600 amps 200.34 2
Name: 1 AL a 4i1tI ► fa t _' _AP. 601 amps to 1.000 amps 301.04 2
Address; I bat M S CA `1 alexcc, As . N c: * . Over 1.000 amps or volts . 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: At a s sa--— ' relocation m
IS — Phone: ( ) . Fax: ( ) 200 amps or less 59.36 1
201 ampS.tq 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not _
intended for sale, lease. rent, or exchange, according to OILS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, r er . and
Owner signature: Date: A. Fee for branch circuits with
APPLICANT p CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: ' A 13. Fee for branch circuits without
` � f �j tti� # _ J Ai service or feeder fee, first
56,18 2
Contact name: ' ` l �� 14 • L �
• w branch Circuit .
• �1 .. 7,42 2
Eac add'/ branch circuit
Address: r P , O , OK D ( Miscellaneous (service or feeder not included) ,--.
City/State/ZIP /State /ZIP: {� —
Each manufactured or modular 67,84 2
ty J ° I R dwelling, service and /nr feeder
Phone: I I to Pax. % i, ) ,I / 0 Reconnect only 67.84 2
* ) As Pump or irrigation circle 67.84 2
E- mail_ "„ Sign or outline lighting 67.84 2
CONTRAC Olt Signal circuits) or limited- energy
—" ` panel, alteration or extension. Page 2 2
Business name; ■ — I . I ••' J ,^ Each additional ins ,ection over allowable in an of the above
Address: --;).C5- ., CAL DAL �, ` Additional inspection (1 hr min) 66.25/ hr
r te` — `�� Investigatim (1 hr min) 66.25/hr
Cii}' /State /ZlP: Indwtrie] plant (1 hr min) Mil 78.181 hr
Phone: r/ f ) I ,ry t /-; • . Fax: „� • %) � ( CC) Inspections for which no fee is 111 90.00 / hr
t!t 1 "l specificall liste (A hr min
CCB Lie.: 1� JJ Q Electrical Lic--L r y0 Supr. Lic.:)79B , ELECTRICAL PERMIT FEES
AilIll' 111.1111.1M1111.1==
Super. Electrician signature, required: --- — - . i Plan review (25% of permit fee):
/ / • s; Yi.R_. Date: a L_ t I tt State surcharge (12% of permit fee):
l �
t r I al PERMIT FEE: s
Authorized signature: t, • , � L� This permit application expires a permit is not obtains. within 1/10
C � � . • � ._
( days after It has been accepted as complete -
Print name; 1 . � �i t �► � a Date; a" a 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: •
Pee for lI residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
• 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
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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