Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 1- COMMUNITY DEVELOPMENT Permit #: ELR2011 -00116
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2011
Parcel: 2S 112 DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 130
Project: Yecuris Subdivision: Lot: 0
Project Description: HVAC system.
Contractor: HYDRO -TEMP MECHANICAL INC Owner: PACIFIC REALTY ASSOCIATES
28465 SW BOBERG RD 15350 SW SEQUOIA PKWY #300
WILSONVILLE, OR 97070 PORTLAND, OR 97224
PHONE: 503 - 582 -8525 PHONE: 503 - 624 -6300
FAX: 503 - 582 -1914
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/24/2011 $75.00
12% State Surcharge - Electrical 05/24/2011 $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 a • all othe appli /de law. Al work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, cif work s su ,•e •ed for m• e the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by -� the Oregon Utility Notification C r. Tho.e r are set f• in OAR
952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a co• of the r ect questions to OUNC by calling 503.232 •87 or 1.88 8.332.2 • • .
Issued Permittee Signature: a�i /
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 USE ONLY
City of Tigard C O 4 + Da e ed Q � _ Permit No: '� • ,_� I i c
° 13125 SW Hall Blvd., Ti ard, OR 97223 r� `\ ��� —
14 g t, Plan Review
C " Phone: 503.718.2439 Fax: 503.598.19 �l � % • '� D.,,IB : Other Permit: � • / ._ • c t
Inspection Line: 503.639 `�P Gr , R ead y /B , • • Page 2 for
TIGARD Internet: www.tigard- or.gov �` 0 �� ` � . ot L� Supplemental Information
' TYPE OF WORK ., V4 • " PLAN REVIEW '
y Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction X Addition/alteration/repl\ht
��DD�� ❑ Service or feeder 400 amps or more El Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
' ., 2:'CATEGORY OF CONSTRUCTION. ..
a ' ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
�• a �� .
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling jigl Commercialindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or
. , ..- , - - ,,. • , ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATIO=.AD LOCATION x %" q . ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
100HP or more. occupancy.
Job no.: Job site address: / QS 5 S 1.4 0 MI 7444 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 16 vi e 9 - 2' �'3 */ ❑ Health-care facilities. ❑ Supply voltage for more than
J ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: !/gei s ❑ Service or feeder 600 amps or more.
.. FEE SCHEDULE s5" .. ' .. ', • ': :,:
Cross street/directions to job site: erv/ii -T S /L0/4a/4 pac ption 1 Qty. I Fee. 1 Total i •
New residential single- or multi- family dwelling unit.
IPA fl gi09 Ji Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
C r� � Ea. add'I 500 sq. ft. or portion 33.92 1
S
Tax map /parcel no.: a I f 0,4 ( /5 U Limited energy, residential
DESCRIPTION OF'WORIC .,•`'. `' s (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
114/4e /l�_„e,�/i Li ® i ', r �� P p`/ J m residential (with above sq. ft.)
c �r.°f7� !//f l��l ' 1 ,i Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 'PROPERTY OWNER ,❑ TE ..' ° j , , 201 amps to 400 amps 133.56 2
�/96l e, 401 amps to 600 amps 200.34 2
Name:
��A a " 4��v�.ptl1 t � Y� 601 amps to 1,000 amps 301.04 2
Address: /5-3372 3 1,0 5 1/ � j 4 / , ?/ ' Over 1,000 amps or volts 552.26 2
Ci /State /ZIP: �' 4/712 t 7 r - J co Temporary services or feeders installation, alteration, and /or
relocation
Phone: 055 ) 6 L9 . .63 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits- new, alteration, or extension, ter panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee
APPLICANT
CONTACT +PERSON 7.42 2
each branch circuit
Business name: ` i ep r -ri r� ,f4,hI l e , , 7 L f.. B. Fee for branch circuits without
Y✓ service or feeder fee, first 56.18 2
Contact name: 2.16.3. le)' J branch circuit
�� Each add'I branch circuit 7.42 2
Address: g/ S) jl/ 1,7O0/X6 /`EAt Miscellaneous (service or feeder not included)
City /State /ZIP: // 4. •, Z/ ,/1 9 IC>7 dwwelel ling , 0 d manufactured , service or f er
v�4 ) �/ C D 67.84 2
l/} L �py� [� fl e a and/o r r feeedder
Phone: (S e/3) 9_ . g -- Fax: : 3) _03 2 -! 9// Reconnect only 67.84 2
7 Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
.y . , . , _ ;CONTRACTOR • r -' . .,, ,:."'f , ,. Signal circuit(s) or limited-energy
Business name: ykIO O _ /iP � "L1, f L p alteration, e I Page n �S 2
Eaach ch adddditi I inspection ion. over allowable in any of the above
Address: 2 9 z/ S' to yt pe pea'. a Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: q/ I, Ls��j/y + Investigation (1 hr min) 66.25/ hr
i , J I /c !� Industrial plant (1 hr min) 78.18/ hr
P ( b 3 c 9 Fax: , 3) r'f1 - 2 _. / 4* Inspections for which no fee is 90.00/ hr
G� specifically listed CA hr min)
CCB Lie,: 0 3 9}}��) �� � V‘9 Electrical Lic V‘9 ES r r • � �' .,„ -.• . ^.,ELECTRICAL PERMIT' FE AP .
Sup Electrician si afu 4C, � r"equired: 71,10 S ubtotal: —
7 Plan review (25% of peMIT r fee):
Print name: 17G , Date:, p .2O y/ State surchazge (12% PERof permit fee): #. 9 iit
TOTAL FEE:
Authorized signature: `
This permit application expires if a permit is not obtained wit in 180
days after it has been accepted as complete.
Print name: P41' / ) r `J Date: g✓ // s N umber of inspections allowed per permit.
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*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n 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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I: \Building \Permits\ELC - PermitApp doc 07/01/10