Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00053
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 460
Project: State Farm Subdivision: VARNS ACRES Lot: 9
Project Description: (1) low voltage for thermostat
Contractor: AMERICAN HEATING INC Owner: GK TRIANGLE CORPORATE PARK III L
1339 SE GIDEON ST BY THOMSON REUTERS INC
PORTLAND, OR 97202 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 - 239 -4600 PHONE: 503 - 221 -1900
FAX: 503 - 239 -7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/27/2012 $75.00
12% State Surcharge - Electrical 03/27/2012 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
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 co of the questions to OUNC by calling 503.232.19877 o 1.800.332.2344.
Issued rmittee Signature: g �� G h C S �Pr_
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.
•
Electrical Permit Applicatio a FOR oFFICF usl ONLY
City of Tigard Receive r� 201 Date/B d .27
rim Permit No.:62p , , 100
° 13125 SW Hall Blvd., Tigard, OR 972231v1� AR 2 1 Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960 Date /B : Other PermiMECa /� QQ 45
l' I G A It D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov BJ � ! ING DIVISION Notified/Method: 1 /G" Supplemental Information
TYPE OF WORK 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 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 ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder El Other: ❑ Fire pump. ❑ installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
0 Addition of new motor load of ❑ "A ", "E ", "I- 2 ", "1 -3 ",
Job no.: Job site address: 13221 SW 68 Parkway 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Gt4 Project name: State Farm 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee I Total I •
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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
low voltage wiring (t - stat) residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
h relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: American Heating B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Brad Manchester branch circuit
Each add'I branch circuit 7.42 2
Address: 1339 SE Gideon Street Miscellaneous (service or feeder not included)
City/ State/ZIP: Portland OR 97202 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 239 - 4600 Fax: : (503) 239 - 7038 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: American Heating panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1339 SE Gideon Street Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: Portland OR 97202 Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 239 -4600 Fax: (503) 239 - 7038 inspections for which no fee is 90.00/ hr
specifically listed (% hr min) _
CCB Lic.: 33135 Electrical Lic.: 26993CRE Suprv. Lic.: 2640 LE ELECTRICAL PERMIT FEES
Subtotal: '7., Ov
Suprv. Electrician signature, rep (25% Plan review (25% of permit fee):
Print name: T Steve Young Date: 3/26/2012 State surcharge (12% of permit fee):
- / _ TOTAL PERMIT FEE: �CC,r 0-0 Authorized signature: ,!/� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Brad Manchester Date: 3/26/2012
• Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitAppdoc 07/01/10 440 -461$T(I1 /05 /COM/WEB