Permit s"
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 1 a COMMUNITY DEVELOPMENT Permit #: ELR2009 -00286
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/03/2009
Parcel: 1S133AD16000
Jurisdiction: Tigard
Site address: 12744 SW NORTH DAKOTA ST
Subdivision: Lot: 0
Project: Key Bank
Project Description: Low voltage for HVAC.
Owner: FEES
HALL, DONALD W & GRACE L & Description Date Amount
HALL, JOHN G ET AL, BY FIRST AMERICAN Restricted Energy Permit 09/03/2009 $75.00
REAL ESTATE TA, 8435 N STEMMONS 12% State Surcharge - Electrical 09/03/2009 $9.00
PHONE:
Contractor:
JACOBS HEATING & AIR CONDITIONING
4474 SE MILWAUKIE
PORTLAND, OR 97202
PHONE: 503 - 234 -7331
FAX: 503 - 808 -9108
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 Total $84.00
Intercom/Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N •
•
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 •• •AR 9 -111 -011 s. ou : y obtain a copy of the rules or direct questions to OUNC by calling 51 - • • or 1.800.332.2344.
Iss • d By: / _ � / / Permittee Signat � iii •
•
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 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 Ap cT' \� D rOh, (,l:rt(l; t,.1 ; ()f.\
City of Tigard ltnctd �J; a v e( SW Hull Blvd.. Tigard, K 7 3 3 2009 Da e/Bv : I Q / Permit No.: „ ,._
9b(1 plan Review •
Phone: 503.639.4171 Fax: 8. D : Other Permit:
. 1 . 1 (. A R 0 Inspection Line: 503.639.4175 m !, "D Da Re /8 Turin ® See P r 2 fur
Internet: www,tig ur.go,�IT O� TI� „ fi t t Not ed/Mabod; /. _ Slupplem utal lafermation
,b,'. G: • ' :.ii'il!I'liI
� " ;i1:X; 1P':iq v,.. 0. Y , :Ir . ,. .pad,. r ,; ,,,, .
q wp
•, i rl '„ ::i r r ,',I: iiiii n I . " "il!1, , .6 k f!. ' m .o- {. ! r.. ,
A New construction ❑ Addition/alteration/replacement Please check all that apply (submit j sale aF pions w /itwm clealud below):
❑ Service or feedur 400 amps or more ❑ Building over three stories,
Q Demolition 0 Other:
! ., : .. i _ l , • c � rp �� where the available fault current 0 Marinas and bualytrds.
'
. :i , : ; i :: : ,� ..YR:M,_ : ::' , ill � Y 1 'i ''i• : I :i Vi ', " •'':! exceeds 10 0t0u am t 150 v 1
. .... ... ' . ,.,.1,� :,.1' ..,'. �......, rii
. ! !!t• it 'i' 1 I t !... ... :' , Ps a 50 u u or ❑Floating buildings.
El 1 - and 2- family dwelling % Commercial/industrial CI Accessory building less to ground, ur exceeds 14,000 ❑ Commercial -use agricultural
amps for all other installations. buildings.
❑ Multi - fancily ❑ Master builder
. Fire pump. Ittgtill of 75 KVA or
.� .:. .... :: i ; ii:i, � h; �
1 :'!,,'r .ri,,l' :!ullb :l u ;l! :rll,:l i tt Ig I• " i "• •. ❑ fimc sy ar g er separ u:ly.bored system.
r' tC "' air'^' �T' Mt'! tt�N '.A''.�cr•�Q�il :. : :iibi :��i� >I :j :i'! �U
- � �• • : " ❑Addniun abler stem mo tor load of r• - . ••
Job no.: Job site address: t - 1( IOOHP ur tlturr. ❑ l
oe trprmcy. l a 1 t
AA ❑ Sin ur more residential tutus. 0 Recreational vehicle parks,
• ❑ kealUn = facilities. ❑ Supply voltage+ for more than
Sul[e/bldg. /a ❑ 1lacnrdous tensions. 000 volts Iwmiaul,
pt no.: Project name: L, boll ❑ Service or limier 600 amps or more
Cross street/directions t0 Job site: ., r..::•; �. :, . . .: . • .: ': . . ; ;1;' '' :.:. ; ; :� , : . :., ;. . ;; ':
Description i Qtr, I .. F e e I Twat I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. !t. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. tt, or portion 33.40 1
! Y•i i it 1 , n IIre i
' , :',,; r•I ... Limited energy, residential
I..;. ! ;!�I!li' :J�l { : ! ii.! ! : : : ;, . o sq
.
:1illi !Illlili Ni".;'�. : Y :, I i :!��P:iOiii i i.. ,,; 1, . 75 „ •� , �J,' :' ;. %ii�i bi� ;ii G� . (with above gq11.)
L imited energy, multi - Family
75.00 2
,1 • wit. . •! As., 1 residential (with above sq. a.)
Services or feeders insUillatian, alteration, and/or relocation
�{l�q �p tt�� amps or less 80.30 2
: r'.. 7:e+.. . ii7 10 1 .. 11 'i. 4 )j ii �i :t -1 i$II ,'A .• .
QI.,, :. :. i
i. . ,;,:.,. ," ' , ig;;;l;!I..isi 201 amps to 400 amps 106.85 5 2
Name: 401 amps to amps 160.60 2
Address: 601 turps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City /State/Zlp: Temporary services or feeders installation, alteration, and/or
relocation
Phone; ( ) Fax ( ) 200 amps or less 66.85 I
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:
:' ...;t:'.•' lei, , , ; ;, „ ' ,1 • }, .Fee for branch circuits with • .: 'uf'il JAiryP'nl!ii(` i� ; :. �liiittllll '�
. ,,,:.,. ....,,,�.,• •. :.... :. ...�'��'' :. , ;ii-, : : :� iii ;i ;. : : ; :: above: service or feeder fee,
each branch circuit
Business name: 6.65 2
�� _
r AL \ :)1 13. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: • first branch circuit
It r Each add'! branch circuit _
6.65 1 2
Miscellaneous (service or feeder not included)
•
lib, A 0 "IIA II.. II. • _` Each manufactured or modular
Phone: 1 ^ M 1 Fax; ; ( ) dwelling service and/or feeder I 90,90 2
l Reconnect only 66.85
2
1:! :•)V:N ;l!]III :J :II , , .:..N'.4.,' „.;,:;1;!!!!':11i;'.14.!:
'aiCli,' Iyi '::,ili P : iae : .:w ' : n p ,..,. .... - Pump or irrigation circle 53,40 2
it l r ;..{ti a , i'..00 : :1!i!1'. ;0:(1 is i ' c " : ;r . � ;; i ;, hi I it ; ; ;tii : : !I `' . - Sign or outline lighting t 2
' .�
l ; �'. i �I- n Signal circuit(s) or limited-
IV R �
energy panel, alteration, or
Address: t L1 _ y J a L `, extension. Describe: I Page 2 2
6 )10 i , a! f ` ism . � s i tl Each additional ins • don over allowable in an of the above
111 r r wIKLg
Per inspection 62.50 _ � '� �L 1 Ott► Investigation per hour (I hr min) 62.50
ett.r (+ ` r, r ' r , Inour
t � �. a.I� � ■1 dustrial plicu � h
. uprv, Electrician sigh. ty�'irt:d" �• � -- r '• ri>:.: : :! ; :iir��A,Y,'�E> " b ' 73.75
• EES :� ;' : ... ." ,
_ Subt '�, 00
Print nttmc :. b ifigEtE0MIIIIII Date: ES SIF Plan review (25% of permit fax); 'R 00
Authorized signature: ( State surcharge (12% of permit fee): CI , r)0
1 I V
_ . J ! ' TOTAL PERMIT FEE;
A 111.1! 4 „ - I" Date; q Tots permit application expires if a permit is nut ebtalnaw,'ehin 1,80
• ��' • r 1 days niter it bas hen accepted as complete,
l: tau {IlJing‘PermitLC•pera,itp Usn� /o6 1 Number of inspections allowed par permit.
4404614x(1 I/US/COM/WEO
90/Z0 3EVd SNIIV3H SHOOGf LSZ6EI8£05 9£ :17t 600Z/E0/60
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
f] Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
• Vacuum Systems*
p Other:
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
IIVAC
❑ 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
imuildiNperrambix- pmnitApp.d 03/23/06
90/£0 39Vd 9NIltl3H SHOOGV LSZ6£Z8£05 9£U17t 600Z/£0/60