Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00002
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/04/2012
Parcel: 1 S136CD00401
Jurisdiction: Tigard
Site address: 7910 SW PFAFFLE ST
Project: Proforma Graphics Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: HVAC system.
Contractor: OREGON HEATING & AIR CONDITIONING Owner: E &S HOLDINGS LLC
PO BOX 241 8020 SW PFAFFLE ST
DUNDEE, OR 97115 TIGARD, OR 97223
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/04/2012 $75.00
12% State Surcharge - Electrical 01/04/2012 $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 obtain a copy of the rul- estions to OUNC by calling 503.232.1987 or 1.800 332.2344.
Issued By: —,at Permittee Signature: T
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.
01/04/2012 08:43 503- G91 OREGON HEATING PAGE 01/03
1
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard ti0'1' Dace/9r Received ��• � P No,r ; - (1;-e- - • \ )'
13125 SW Hail Blvd. Tigard. 'el ' ° �96 ® Plan Review
Phone: 503.639.4171 Fax: 50 , '.,196Q ' �i
Date/By: Other Permit: i/ 0 -
f/_ s
i ICA.RD Inspection Line: 503.639,4175 C '\� ,,�\� Date Ready /By: lulls: El See Page 2 for
Internet: www.tigard- or.gov �� ® h ` Notifiefl.7vIethod: 'FM , SupplementolInformation
TYPE OF WO]1+ '; PLAN REVIEW
❑ New construction (c4.ddi #ion /alteratioi'aacemcnt Please check all that apply (submit 2 sets of plans w /items checked below):
'❑ Service or feeder 400 amps or more 0 9uilding over three stories,
❑ Demolition ❑ Other where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
loss to gcouod, or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling i .Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Ftre pump. ❑ Installation of 75 KVA or
30S SITE ANFOKNAA A AON AND LOCATION
El Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E' ", "l -2 ". "I -3 ".
Job no.: a p ( I Jot> site address: 1 91 P j 128 J - . 1001-I? or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /.ZIP: c,4. q 7 V- .3 El Heal±h care facilities. ❑ Supply voltage for mere then
Tad ID Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.:
Proje name: pEeoied4-14.5 . Service or fteder 600 amps or more. w
Cross street/directions to job site: • Descr;prroe I Qty_ 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 14
Ea. add') 500 op ft or portion 33.92 1
Tax ttlttp(p &reel no,: Limited energy, residential 75.00 2
DESCRIFTAON OF 'WORK (with above sq. ft.)
[),! Limited energy, multi - family 75.00 2
ur1 bra ' � !7 V4c .
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
•
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 . 2
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26
City/State/ZIP: • Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) F ax: ( ) • 200 amps or less 59.36 3
Owner installation: This installation is being made on property that 1 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
Branch circuits - new, alteration, or extension, , er panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
(Cr1,NT ❑ CONTACT PERSON 7.42 2
_._....... _ each branch circuit
S. Fee for branch circuits without
Business name: i t , / / , .n -, t / • /. v / s o r feeder fee, first
� j 56.18 2
Contact name: Li d lY r S branch circuit
� each add') branch circuit 7.42 2
Address: �11� a
�Q'/ Miscellaneous (service or feeder not included)
City /State /ZIP; O te Ok_ 9 ' 7//6" Each n, service Manufactured or modular 67.84 2
dwelling, service and /or feeder
Phone: ('SD {� J C), c 9 Fax: : ( 7) 3 4,Q, / R6 J Reconnect only 67.84 2
,{� v p r (� Pamp or irrigation circle 67.84 2
E-mail: !
a 1x ' Q Pt/ } i �4/oi ' L i Sign or outline lighting 67.84 2
"TRACTOR Signal circuit(5) or limited - energy
Business name:
panel, alteration. or eatensiou. , ( Page 2 �1 S " '" I 2
Each additional inspection over allowable in any of the above
• Address:
OW (� J� Additional inspection (1 hr min) 66.25/ hr
( " ' Investigation (1 hrmio) GG.25/ hr
City /State /ZIP: industrial plant (1 hr min) 78.1$/ hr
•
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr
p specifically listed (V hr min
CCB Lic.:41'p„+ Electrical Lic. :L 2/ Suprv. Lic,:)'7 BL A ELECTRICAL PER T FEES
Suprv. Electrician i �f required: 4 1 W 1" ... - - -- to / O Subtotal: OD
• Plan review (25% of permit fee):
-
Print name: r, . * a r�_a_. Date: /— C/--! 2,_ State surcharge (12% of permit fee): C) " 0
• ` TOTAL PER MIT F EE: 4i v
Authorized signature: � . i
� i � a
„ f ltta
This permit application expires if a permit it Ott ol wI thin 380
Print name: 1 l �� [// [/1„ days after it has been accepted as complete.
4•
Y GtA T Date: `� e Number of inspections allowed per permit. •
',In Ax,.mt„ incrna rnrmo
01/04/2012 08:43 503 -691 -8556 OREGON HEATING • PAGE 02/03
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*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fec for Lakh, commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved: •
❑ Audio and Stereo Systems •
C Boiler Controls
n C lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
I-IVAC
❑ I nstrumentation
❑ I ntercom and Pang 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