Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00101
Date Issued: 04/06/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S101 C800500
Jurisdiction:
Site address: 12670 SW HALL BLVD BLDG 1
Subdivision: Lot: 0
Project: APEX INDUSTRIES
Project Description: Low voltage for
FEES
Owner:
TCTPI LLC Description Date Amount
25977 SW CANYON CREEK RD #J Restricted Energy Permit 04/06/2009 $75.00
WILSONVILLE, OR 97070 12% State Surcharge - Restricted Energy 04/06/2009 $9.00
PHONE:
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123
PHONE: 503 - 628 -6841
FAX: 503- 848 -2597
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm:
HVAC: Y Instrumentation: Total $84.00
Intercom /Paging: Landscape /irrigation:
Required Items and Reports (Conditions)
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other:
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 d- •s, ATTNTION: Ore. law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 1010 t ough OAR 95 101 -1111. You may obtain a •py of the rules or direct questions to OUNC by calling 503.246.6699 or ii .332.144.
Issue By: _/ Zi �I J. 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'N 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 Application " y r 'FOR; ROEFICE USE ONLY - - - .
..
City of Tigard Received /
Date /By:
rt
't 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review i10 d Permit No. �-��� �t / Q (
Phone: 503.639.4171 Fax: 503.598.1960 Date /Bv. Other Permit:
TIGARD Inspection Line. 503.639.4175 Date Ready /By: 1 0 See Page 2 for
. Internet: www.tigard•or.gov Notified/Method: ( Supplemental Information
TYPE OF WORK . . - PLAN,REVIEW:,
❑ New construction E 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
excee 10 amps at 150 vo lts or ❑ Floating buildings.
-= ,T ' , �� - i ' ' CATEGORY 'OF CONSTRUCTION - D
" ' 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
❑ Emergency system. larger separately derived system.
:l . ' -- ` -= J.OI3 SITE : INFORMATIONf .AND L O C ATION i 2 " _
__ ❑ Addition of new motor load of ❑ "A" "E° "I - 1 3
Job no.: Job site address: 12670 SW hall blvd IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks
City /State /ZIP: Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Apex ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF =WORK (with above sq. ft.) 75.00 2
Limited energy, multi-family 75.00 2
Install one t -Stat residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ :TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. } ❑ APPLICANT• . ' _E, CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder _
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal panel, or limited -
Business name: Willamette HVAC
energy panel, alteration, or
Address: 3075 SW 234 Ave Ste 206 extension. Describe: I Page 2 2
City /State /ZIP: Hillsboro OR 97123 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 628.6841 Fax: (503) 848.2597 Investigation per hour(1 hr min) 62.50
CCB Lie.: 56951 Electrical Lie.: 343 6CRE . uprv. Lie.: 4025LEB Industrial plant per hour 73 75
..= A� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: — Subtotal:
Print name: Mike Sicard Date: 4/6/09 Plan review (25% of permit feel
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE 1 ,..-.1" co
This permit application expires if a permit is not obtained within ISO
Print Date: 4/6/09
I I Itll Hanle: Mike Sicard days after it has been accepted as complete.
* Number of inspections allowed per permit.
1 \ Building \Permits\ELC- PcnnitApp.doc 05/23/06 440- 4615T(t I /05 /COM/WEII