Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2006 -00206
I16 DEVELOPMENT SERVICES DATE ISSUED: 9/25/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102CC - 00500
SITE ADDRESS: 13500 SW PACIFIC HWY 90 ZONING: C -G
SUBDIVISION: TIGARD MARKETPLACE LOT: JURISDICTION: TIG
Project Description: Thermostats
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC CORP /ELLIOTT ASSOCIATES WILLAMETTE HVAC
200 SW PINE ST, SUITE 200 PO BOX 23334
PORTLAND, OR 97204 TIGARD, OR 97281
Phone: 503- 224 -6791 Contact #: PRI 503- 628 -6841
FAX 503- 848 -2597
FEES Reg #: ELE 34- 346CRE
LIC 56951
Description Date Amount
[ELPRMT] ELR Permit 9/25/2006 $75.00
[TAX] 8% State Surcha 9/25/2006 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may pain copies of these
rules or direct questions to OUNC at 503 - 246 -6699. �,�"
Issued By: (2) & Ada 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.
• Imo ( . , :
1 Electrical Permit Application ' ' t -� � l -- i ''''' l ' l Olz c.>11 Icl: a l: oN1,N
City of Tigard Receiv•� Permit -
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13125 SW Hall Blvd., Tigard, OR 97223 AUG . LvU t plan Review �
`� g Phone: 503.639.4171 Fax: 503.598.1960. Date/B . Other Pe"m R �bvb W r'
T i C n iz t� Inspection Line: 503.639.4175 k4../ iii Oi 2 e f 1 to tuns: ® See Page 2 for
Internet: www.tigard No3fed/Method `b v lSl Supplemental Information
) T 121 . irlj• 4 • miaau
TYPE OF WORK Ai ' I i' 31) PLAN REVIEW
❑ New construction 'Addition/alteration/replacement • .. It all that apply (submit 2 sets of plans w /items checked below):
❑ Servi • 4 r feeder 400 amps or more ❑ 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 ❑ Commeraal -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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", E ", "I - ", "t - ",
Job no.: I Job site address: L 3 ,roc) S nac ;-6'.. 4t' 1001IP or more. upancy.
Y ❑ Six or more residential units. ❑ Recreational vehide parks.
City /State/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. 7s W I Project name: TAW t ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Tad 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'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
.,✓ G c ---7Z si Limited energy, l (with multi-family a oe q. 75.00 2
•fi 1 ,.� t7 �. 1 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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: ( ) I 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
Owner signature: Date: Branch circuits - new, alteration or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
/�/ Signal circuit(s) or limited -
Business name: > / ( I/ / p C energy panel, alteration, or
extension. Describe: _I--. Page 2 2
Address: . .j - 0 f 3d X� 3 3 y
City /State/ZIP: - 7 — a C7V �-( g, g 1 Each additional inspection over allowable in any of the above
Phone: ( ) " a Per inspection 62.50
Fes:
( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: g6 l s / I Electrical Lic.: 3 - T Y C ttirv. Lic.: z'0oz .57.66 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7 Subtotal:
Print name: vlit - Sr e Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE: j•
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Buitding\Pamiu\ELC- PamitApp.doc 05/23/06 410- 4615T(I1/05/COM/WFJ3
Electrical Permit Application - City of Tigard '
Page 2,- Supplemental Information .. •
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for ll 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 -260 -260)
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*
❑ 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
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