Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELR2012 -00040
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/29/2012
Parcel: 2S 101 AB00100
Jurisdiction: TIGARD
Site address: 12005 SW 70TH AVE
Project: Meridian Acupuncture Clinic Subdivision: 1996 -024 PARTITION PLAT Lot: 2
Project Description: (2) HVAC systems.
Contractor: OREGON HEATING & AIR CONDITIONING Owner: RED ROCK BUSINESS ASSOCIATES LLC
PO BOX 241 23077 SW NEWLAND RD
DUNDEE, OR 97115 WILSONVILLE, OR 97070
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/29/2012 $150.00
12% State Surcharge - Electrical 02/29/2012 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
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 $168.00
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 rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
. 1
Issued By Permittee Signature: Gl
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.
02/28/2012 14: 30 503 - 691 -8556 OREGON HEATING PAGE 01/03
Electrical Permit AppiiRECEIVED FOR OFFICE USE c)NLY
Ci of Tigard Itecaivad
ty g Date g : • �� Permit No.: . L - / Z - "" r. r) i
13125 SW Hall Blvd., Tigard, 0k5�!23�v 8' 2012 Plan Review
:�
• 2 Phone: 503.639.4171 Fax: 503.598.1960 DaocB . Other Permit:
T I GA RD Inspection Line: 503.639.41'Zrry OF TIGARD Date Ready/By: la See Page 2 for
Internet: www.tigard or.g1 III DING DIVISION Nonf ed Supplemental Information
TYPE OF WORK PLAIN REVIEW
❑ New construction ddition/alteration /replacement ` please check all th apply (su bmit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 )] Commercial -use agricultural
❑ 1- and 2- family dwelling mmercial /industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 rile Pump• CI lttstatlation of 75 KVA or
• dOB 6I I E INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A'°, "6". "1 -2" ^1 -3 ^,
Job no.: ' l — D C 0 Job site a rZ o C 6u) "
1001* ix or or more. occupancy.
❑ Six or more residential unfit. ❑ Recreational vehicle pasts.
City /State/ZIP: r'r n t (a l ( --1 a ss ❑ Health -care facilities. ❑ Supply voltage for more than
J ❑ Hazardous locations. 600 volts nominal.
no.: Project name: ❑ Service or feeder 000 amps or more.
✓1 L� i (AA) Cf Cci p(,h/ �-�y, � FEE SCHEDULE
Cross street/directions to job site: CA ; N )‘c, peser;i";ca i Q . I Fee. i Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: L no.: 000 sq. ft. or less 168.54 4
— Ea. add'I 500 sq. ft or iumion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCIR/PTION OF WORK (with alum sq. ft) 75.00 2
• A'.t1l,.^�' ' t Limited energy, multi- family 75.00 2
residential (with above sq. ft.)
I �.I 8--� i v t `,St.) I " I ��'� Services or feeders nstaJlatjon, alteration, and/or relocation
I ?-- 200 amps or less 100.70 2
❑ PROPERTY OWNER l ❑ 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 12
City /S18te /21P: • Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) • 200 amps or less 59,36 1
Owner installation; This installation is being made on property that I 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 168.5 z
Branch circuits — new, alteration, or extension, per panel
Owner signature: _ Date: A. Fee for branch circuits with
❑ APPLICANT I CQ�VTACT PERSON — above service or feeder fee, 7,42 2
f each branch circuit
Business name: o I 40 • , 4 AC I B. Fee for branch circuits without
e feeder fee, first
56.18 2
Contact name:
I ' t bra circuit
- Each add'I branch cii cult 7.42 2
Address : !� (,i I Miscellaneous iservice or feeder not included) ,
City / State/ZIP: r'� f z � 1 F 1 L g Each manufact or modular 67.84 2
6 t�� � dwelling, service and /or feeder
Phone: 1_, ° f Fax: : 6� / u � C 1 . g - Reconnect only 67.84 2
��� 111 L'�[ l O �7�� Sp Pump or irrigation circle 67.84 2
E - mail: A C� '
14� 4, a ■ & 1 + a — Si gnor out lighting 67.84 2
-- e FAC a '4 Signal circuit(s) or limited - energy ��jj / 1
Business name: • panel, alteration, or extension. t7, Page 2 2
Each additional inspection over allowable io any of the abov
Address: Additional inspection (h hr thin) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr '
Industrial plant (1 hr min) 78.18/ hr
•
Phone: ( ) Fax: ( ) Inspections for which no fee is
90.00/ hr
jifically listed (h hr min)
CCB Lie.: ia. a u2 Electrical Lic.: , r 440 Suprv. Lie.:) • I ELECTRICAL PERMIT FEES
4. Subtotal: l5
Suprv. Electrician signature, required: -- - — . i Plan review % of 25
Print name ( o permit fee): f
r1 . �� Dat e:�� -- �� � _ Stat surcharge (12% of �$
Authorized signature'
f TOTAL PERMIT FEE: L (� DoD
Print name: / eV: This permit application expires it a permit is not obtained wit X 80
days after It has been accepted as complete.
– Date ` �`� • Number of lnspections allowed •per permit.
,
r:\Bwl erar
dinglPits\ EL .PennItApp.dQe 07/01/10 440-4615111 I /05/WWWEB
02/28/2012 14:30 503 - 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 ,au 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*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of corametcial systems: _
•
*No licenses are required. Licenses are required
for all other installations
1 • !RIrilAintAPxmix11 , 3 t- Permil Ant 67/01/10