Permit 91i - 8..► f,
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Iii .1,', , ,, COMMUNITY DEVELOPME Permit #: ELR2012 -00085
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2012
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15955 SW 72ND AVE .
Project: Guitarish Music/Advantage Point Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Low voltage for HVAC. 2/13/12, reprinted to correct address and project name.
Contractor: OREGON HEATING & AIR CONDITIONING Owner: PACIFIC REALTY ASSOCIATES
PO BOX 241 ATTN: N PIVEN
DUNDEE, OR 97115 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 691 -9699 PHONE:
FAX: 503- 691 -8556
FEES
Description r Date Amount
Specifics: Restricted Energy Permit 05/08/2012 $150.00
12% State Surcharge - Electrical 05/08/2012 $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. ATTENTI . Orego law re. ires you to follow the rules adopted by the Oregon Utility Notificati• . . _ •ter. Those rules are set forth in OAR
952 - 001 -0010 rough OAR 95 06 -0096. Y• may obtain a copy of the rules or direct questions to OUNC by 4,.3.232.1987 or 1.800.332,2344.
Issued By. G2 , 0 / Permittee Signet�� i �-
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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
•." COMMUNITY DEVELOPMENT Permit #: ELR2012 -00085
TI G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2012
Parcel: 2S 112DC00701
Jurisdiction: Tigard
Site address: 15957 SW 72ND AVE
Project: Advantage Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Install HVAC, thermostats
Contractor: OREGON HEATING & AIR CONDITIONING Owner: PACIFIC REALTY ASSOCIATES
PO BOX 241 ATTN: N PIVEN
DUNDEE, OR 97115 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/08/2012 $150.00
12% State Surcharge - Electrical 05/08/2012 $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
L� �V 95 - 00011- 0090. You
�l or
may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987or 1.800.332.2344. l'
Issued By: �ZL Lt. u h Q Permittee Signature: 4 , 1 Ppy_i
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.
05/03/2012 10:12 503 - 691 -8556 OREGON HEATING PAGE 01/03
Electr Per Applicat RECEIVE
lig r. City of Tigard V — 3 2 012 Bey 3 (1/ S : Permit N et i ' Do d - 00049 �
13125 S W Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Dete/By: Other Permit:
T 1 t - A R D inspection Line: 503.639.4175 CITY OF TIGARD Dare Ready/By: l wis : ® See Page 2 for
Internet: www.tigard or.gov BUILDING DIVISIC P4letifed.Method: ' . +� Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction �r ddit alteratio • • lacement Please check all that apply (submit 2 sets of plans whims 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 areeeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to pound. or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling (k'ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fi pump. ❑ installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ' E" w - z" °t - °',
I in 0005 / 5 ,S t fa ' J rd Six or more residential occupancy.
Job no.: Jo b site address:
_ ❑Six or more residential wiq. ❑Recreational vehicle parks.
Ci /State /ZIP: p C? ❑ Healthcare facilities. ❑ Supply voltage for more Than
tY ii Q � Q L ` � 13 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: v Project name; Adtiori &b O Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: o ,cripeios I Qtr. 1 RI- I Toll 1 •
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 168.54 4
Ea. add') 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.DD 2
I / — I Limited energy, multi- family 75.00 2
L rt Sit/ L 4 /4 91 A ,yrn . l� It �S residential (with above sq. ft) _
V ' ✓` �' `F t J� �tiafc Services or feeders installation, alterat and/or relocation
. 200 amps or less I I 100.70 f 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
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 2
Temporary services or feeders installation, alteration, and/o
City/State/ZIP: ' relocation
200 amps or less 59.36 1
201 amps to
Owner installation: This installation is being made un property that I own which is not 599 amps 125.08 2 .
intended for sale, lease rent, or exchange, according to ORS 447, 449, 670, and 701. r anch circuuitit
Branch amps to amps 168.54 2
Brs - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
L'�•.1<Co1T I O. CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: O k Nitabi6 at A_C B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
,/� -- Each add'l branch circuit 7.42 2
Address: 'V, b • % 1 �/ 7 _�-1 ' Miscellaneous (service or feeder not included)
- / 0 (E q ^ ' k Sr • Each mz ufBOWretl or modular 67.84 2
City/State/ZIP: I ) dwelling, service and/or feeder
Phone:(] WC I . o1ua Fa x: : f7D..5 bct ( - 855t Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E mail: a . . A • • •Jot, * • i .t ' .• a _►, a. Sign or outline lighting 67.84 2
CO OR Signal circuit(s) or limited - energy
Business name: panel, alteration, or extension. 0 Page 2 2
Each additional inspection over allowable in an of the above
Address: bbVQ , . Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
CitylState /Zips \\‘'\' Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) a\( \ � Fax: ( )11.% f Inspections for which no fee is 90,00/ hr
specifically listed (1 hr min)
CCB Lic.: J1a(a(,Q Electrical Lic.: S/Ql Suprv. Lic. :) 5, ELECTRICAL PERMIT FEES
Subtotal: /67) .
Suprv- Electrician signature, required: � Plan review (25% of permit fee):
Print name: G red • • t - Date: State surcharge (12% of permit fee): a • pd
TOTAL PERMIT FEE: 1 f g_ DD ,
Authorized signature.' , t This permit Application expires if a permit is not obtained within 180 /
,.," /42.. days after k has been accepted as complete. '}/
Print name: ka e ;� Date: - • Number of inspections allowcd.per permit
•
05/03/2012 10:12 503 - 691 -8556 OREGON HEATING PAGE 02/03
-
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: .
RESIDENTIAL WORE ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ C,arage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑
Other-.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 9I 8-309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
� HVteC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape it igation Control*
[] Medical
LI Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: U
*No licenses are required. Licenses are required
for all other installations