Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00117
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/24/2009
Parcel: 2S112BA05900
Jurisdiction: Tigard
Site address: 14058 SW MILTON CT
Subdivision: Lot: 0
Project: Westcon
Project Description: Install (2) limited energy systems to relocte (2) thermostats.
Owner: FEES
GOODHEAD, DAVID & JAN M Description Date Amount
9846 SW PEPPERTREE LN Restricted Energy Permit 04 /23/2009 $75.00
TIGARD, OR 97224 12% State Surcharge - Restricted Energy 04 /23/2009 $9.00
PHONE:
Contractor:
LORENZ ELECTRICAL CONSTRUCTION INC
PO BOX 3580
HILLSBORO, OR 97123
PHONE: 503 - 614 -0400
FAX: 503- 614 -0401
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm:
HVAC: Y Instrumentation: Total $84.00
Intercom/Paging: Landscape /Irrigation:
Landscape Lighting: Medical: Required Items and Reports (Conditions)
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 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 AR 952 - 001'0100. You may obtain a co y of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344.
Issued By: t..Ul `Q - 'V/ \ Permittee Signature: - _ 1 • Alt V
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.
p.3
Electrical Permit Applicat; ; cENFD
FOR OFFICE USE ONLY
1,1 City of Tigard 1 Received - I _
• 13125 SW Hall Blvd., Tigard, oR 972 PR 2 0 2009 D,te.B -: • • �► Permit No.: •� •-`
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ter Permit: r M
DateBv: Oh P i �i .i� �O • � la:
TIGARD
Inspection Line 503.639.4175 CITY OF TIGARD Date Ready / By: ® Page 2 for
Internet: www.tigard- or.goc BU nIVISION Notifed'Mctltod: Supplemental Information
TYPE OF W ORK PLAN REVIEW
❑ New construction ® 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 stones.
❑ Demolition ❑ Other:
w.were the mailable fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps a: 150 volts or ❑ Flowing buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- 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
JOB SITE INFORMATION AND LOCATION ' ❑ Emergency system. larger separately derived system.
❑ Addition of new tnctor load of ❑ "A" "E "1-2". "I -3"
Job no.: C001104 Job site address: 14058 SW Milton Court l otiPormore. occupancy.
❑ Six er more residential units. ❑ Rtxrcational vehicle parks.
City /State/ZIP: Tigard, Oregon ❑ Health -care facilities. ❑ Supply voltage for more tban
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: _ Project name: Westcon Remodel ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross strect/directions to job site_ Una I Qty. I Fee. I Toth I •
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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy. residential
75.00 2
DESCRIPTION OF WORK (with above sq. ti.)
Relocate (2) HVAC thermostats. Limited energy, multi - family 75.00 2
residential (with above. sq. ft.l
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: Goodhead, David & Jan M. 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 9846 SW Peppertree Lane Over 1,000 amps or volts 454.65 2
City /State/ZIP: Tigard, Oregon 97224 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 t
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
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
A. Fcc for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee.
each branch circuit 6.65 2
Business name: Accurate Heating, Inc. B. Fee for branch circuits '
without service or feeder fee,
Contact name: Kim Williams ` 46,85 2
first branch circuit
Address: 27350 SW 95 Avenue, Suite 3010 Each add'l branch circuit I ' 6.65 2
Miscellaneous (service or feeder not included) '
City /State/ZIP: Wilsonville, Oregon 97070 Each manufactured or modular
90 .90 2
dwelling, service and /or feeder
Phone: (503) 650.1229 Fax: : (503) 650.4845 Reconnect only 66.85 2
E -mail: service2@accurateheating.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Lorenz Electrical ecaQ■ert2.uv_e.'(Iv,3 / /-NC. energy panel, alteration, or
Address: 2074 NW Alockel Drive, 4214 extension. Describe: 2 Page 2 150.00 2
City /State/ZIP: Hillsboro, Oregon Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 614.0400 Fax: (503) 614.0401 Investigation �,
g 62.50
Al' CCB Lic.: 138608 1 Electrical Li • 3 anon perhour(Ihrmint 6. 4 -516C Suprv. Lie.: 46735 Industrial plant per hour 73.75
,. f----. 1 0- t - `O ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required: (- 2/- Z.:,,,,, Subtotal: 150.00
Lore. - Plan review (25% of permit fee): 3.75
Print name: Andy Date: 04.20.09
State surcharge (12% of permit fee): 18.45
Authorized sign. re: TOTAL PERMIT FEE: 172.20
�_' „✓ /J/�/.�-
Print name Kim Williams Date: 04.20.09 This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
• Number of inspections allowed per permit.
L: uauildirpWermiISSELC- PermitApp.doc 05/23/0.5 440- 4SI5r11 I i051COMAVEB