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Permit
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT s . COMMUNITY DEVELOPMENT Permit #: ELR2012 -00091 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2012 Parcel: 2S 101 DA00104 Jurisdiction: TIGARD Site address: 13333 SW 68TH PKWY Project: Channel Subdivision: VARNS ACRES Lot: 9 Project Description: HVAC system Contractor: BOB'S ELECTRIC Owner: TRIANGLE POINTE LLC 2700 NE BURTON ROAD STE A 901 NE GLISAN ST, #100 VANCOUVER, WA 98662 PORTLAND, OR 97232 PHONE: 360 - 254 -7200 PHONE: FAX: 360 - 254 -8219 FEES Description Date Amount Specifics: Restricted Energy Permit 05/10/2012 $75.00 12% State Surcharge - Electrical 05/10/2012 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /� Issued By: Permittee Signature: 1) t ( ' or `ep I &!) ( T I o u 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 503.839.4175 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. FROM (FRI)MAV 11 2012 2:02/ST. 2:31 114o.93O2e26739 P 2 Electrical Permit Applica t O CEIVED 1 ) I ( 1 ) I I I ( i . 1 ,1: (1 \ I.1 City of Tigard Da 5 /0 /e?'" Permit No.: 1.4 0 10 a - O 00' / : I 13125 SW Hall Blvd., Tigard, OR 972: 1 O 2 012 l other i' N`�C°a�0lo� pg65 Phone: 503.639.4171 Fax: 503.58. • : 1 I C , \ I2 h \ Inspection Line: 503.639A175 Date Ready/13y: IS See Page 2 for Internal: www.egard-or.gov CITY OF TIGARD Notified/Method: j - Supplemental Information �_ -, ❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w /itemm checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards. --I P p ! -r t' s ' exceeds 10.000 apps at 150 volts or ❑ Floating buildings. lrf.ut , ..!;'11 - 1;, , I , .. e€ ' -.) r . . - _.. ., a - s , .. „, , ., : r' Iesa to ground, or exceeds 14,000 ❑ Commercial.uee agricultural ❑ I and 2 - family dwelling ® Commercial/industrial ❑ Accessory building ' amps for all other installation. buildings. • ❑ Multi family ❑ Master builder ❑ Other ❑ rile pump. ❑ installation of 75 KVA or .-t r r, s, , ❑ EmergeicY system larger separately derived system. u:� .t .. _. Y v , . .•':;:: ' ._...r ,.x.:, .. . _ - .,. , _;:. :: 4 j . - ❑ Addition of new motor load of O "A .. „1.2 "1-3", 100HP or Job no.: 12_563 Job site address: 13333 SW 68th Pk . ❑s ormorerresidentialunits. ❑ Recre�tional vehicle parks. City/State/ZIP: Ti _ a _ � . OR ❑ Health -cate facilities. ❑ Supply voltage for more than � ❑Hazardous location. 600 volts nominal Suite/bldg.apt. no.: Project name: YI7'71�� t� �� ❑ service or fouler 600 sops Of more _ , - . a +J F T- Cross street/directions to job site: �j--v/4 r, I 0 nesertpaon otv_ Fee. Twat • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: l,000 sq. ft. or less 168.54 4 Ea. sal 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential • 7 4, f,v -,..,F,.; : . :,41;,-....::13,',„?, rc ..__.r - , Y x:. ,,,,-,',3;i:- ' 4 ilz a- (with above sq. .) Limited energy, mu i - fam 67.84 2 1 HVAC s stem residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 4: : t-.a -+ c1 7 4 ;' .,,, i i : _ Y i:'.f , ∎ ` ' &{ l 201 amps to 400 amps 133.56 2 , : ,4 _ : .. . :, ,. . _ r t_: _,r.. . n _, ...1,.!?.. .. . , ,..,� . >r,., _._ , .. : ■ 401 amps to 600 amps 200.34 2 Name: Clear Channel 401 amps to 1,000 smnps 301.04 2 Address: 13 . 33 SW . • 1 ' A.A. Over 1,000 amps or volts 552.26 2 Ci /State/ZIP: • Temporary services or feeders Installation, alteration, and/or h Ti .and s R relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits - new, alteration, or extension, er. panel Owner signature: Date: A. Fee for branch circuits with F-- • t f ` t t > + F ' ' i . i „{ : _ above service or feeder fee, 7.42 2 "N.'.‘.1 •q ... .-...t..: . i .. •.., r,.. .,,, ,,, "3 . . .-Jtl' . ' ".:' each ea branch circuit Business name: B. Fee for branch circuits wit/tour service or feeder fee, first 56.18 2 Contact name: branch circuit , Each add'! branch circuit 7.42 2 Address: Miscellaneous. (service or feeder not Included) Each manufactured or modular City/State/ZIP: 67.84 2 dwelling, service and/or feeds Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail ' Sign Or outline lighting 67.84 2 ,.,y_ . f sv _. .. _.;. ';,:.Z . .�h�_ a_ , _. : .f,( '.__?._-- :. Signal circuit(s)orlimited- energy Business name: _ panel, alteration, or extension. _ 1 Page 2 67.84 2 Bo b Bb s • Electric Each additional inspection over allowable in anyof the above Address: 2700 NE Burton Rd. Ste. A Additional inspection (1 hr min) 66.25/hr Investigation (1 tie min) 6625/ hr e • .._ Industrial plant (1 hr min) 78.18/ hr Phone: ( 360 )254-720i Fax: ( 36 r )254 - 8219 Inspections for which no fee is 90.00/ hr • , . it ifteall listed hhrmin :uprv. Lic.: 4322S '''° = T -• ` 'a. --,•, ctJ' z / Suprv. Electrician signature, required � i Subtotal: - , • • ! � L it!!� Plan review (25% of permit fee): Print name: Kevin Broselle Date: 5/10/12 State surcharge (12% of permit fee): $!14 4• TOTAL PERMIT FEE: 75:9$ Authorized signature: This permit application expires If a permit is not obtained within 180 days after It has been accepted as complete. Print name: Date: • , L Number of inspection allowed per permit. g"[' 1:\ auildiog\Permim\ELC- PermitApp.doc 10101/09 440.4615T(11/OSICOM/WEB FROM <FRI)MAY 11 2012 2:32/ST. 2: 31 /Mo. 9302925730 P 3 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $67.84 Check Type of Work Involved: • ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other. Fee for each commercial $67.84 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 © HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: 1 *No licenses are requited. Licenses are required for all other installations I: \&lildineamita\E►..c- Perm1App.me 10ro1ro9