Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
$ COMMUNITY DEVELOPMENT Permit #: ELR2012 -00099
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/16/2012
Parcel: 2S 115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 140
Project: Spec Subdivision: 2004 -015 PARTITION PLAT Lot: 2
Project Description: Low voltage for HVAC
Contractor: WILLAMETTE HVAC Owner: SN PROPERTIES PARTNERSHIP
3075 SW 234TH AVE. #206 1121 SW SALMON ST
HILLSBORO, OR 97123 PORTLAND, OR 97205
PHONE: 503 - 628 -6841 PHONE:
FAX: 503 - 848 -2597
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/16/2012 $75.00
12% State Surcharge - Electrical 05/16/2012 $9.00
Type of Use:
Class of Work:
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N 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 su.j • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done I • accordance with app • ed 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. • TENTION: Oregon law re , ' . you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 r -0010 thro a h OAR 952 -0011 0. o y obtain a copy of the rules or direct questions to OUNC by calling 503.23 1987 or 1.800.33 .2344.
Iss ed • I� / PermitteeSignature: `� wr / !v im
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.
May 16 2012 1:21PM WILLAMETTE HVRC 5038482597 page 2
Electrical Permit A . plicati r O t: 111 I l (t c 1. I 0\1 I : .1
City of Tigar s VED tat S Permit No EL, Rota i /. p s
• 13125 SW Hall Blvd, Tigard, OR 97223 C Plan Review
Phone: 503.718.2439 Fax: 503.598. 16 2012 Dat i y: Other Permit:
1 lc f! Internet ww tad r 9.4175
, F TIGAI�D Notified/method: twits: Supplemental I hfolmation
OWE ,, I ;, ' '
it, -II'I � .^ h pcnt l _ ilntll= -II T -�1 �I� - 4 {�4. S.�i� I�I�ii I C y� II (� I a l I I ' lik
�' :.NIN I!111�4.�- 4f • ,1, I . I ...,:�,' { &::r2.71 I IfUi +a . ...,, ... -. E [r , .:- k -_ -_ - -_ IIII�
Il 1iL:; : 1 .. 1 _r ...i 1. L. V, 1�If� i NM( 1 -: •,H k fR �fl -,-7F4
❑ New construction Addition/alteration/replacement Please cheek all that apply (submit a sets aphis wlitems checked below):
a Service or feeder 400 amps or more O Building over three Stories.
❑ Demolition ❑ Other. where the available huh affront 0 Marinas and boaty cis.
NAME 1 a 1:: n F H - mu h I , ,uplR i c ,�nyi t - t;,' f I'l21(1" exceeds 10.000 amps at ISO volt or ° Floatia bsul
1: -ii _:l al i ,l l ; I nJ. lil4 5 �., .._.: g '
II l - + JF Il mL,I 1. _ 1till,, . ..ul aP : tl �:' �. less to ground, or exceeds 14,000 OCOmmetC181 -use aglCUltnral
❑ 1 - and 2- family dwelling ;.51 Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: OFire pump. ❑ Installation of 75 Kt/A or
g1 (- r nlet:.rl;lqm^ - 11i ::.wlFlul:,�r:ax l I " $ 4:;- 0Emergencysy stem. larger separately derivedsyitea
III�� S y I , ulnlf = 5 3utli�,, �� � at-_ 4A,n i i t nil r - -- : ±_' ' lli8 D inn of new m otor load of 0 "A ", "E "1.2", "1 -3 ",
Job no.: Job site address: / , - 30 lama . occupancy.
Recreational
_ _ _ .u__ 0 Six or more residential units. nal vehicid parka.
City/StateiZIP: / 0 4 / / ❑Health -care facilities. O supply voltage for More than
� \
0 Hazardous locations. 600 veld nominal.
�
Suite/bldg. /apt. no.: I Project name: 9 c lPt e ,„ T er T S � e �� rviceorfeeder6 00 ampso rr
`:11�illl1.. ilillf " t �ilx�__.., l n
' �.__, r It "^ itlifi
Cross street/directions to job site: nee ctptiee ow. ne. alai •
New residential single- or maid- family dwelling unit.
includes attached garage.
Subdivision: I Lot no.: 1,000 sq. iR or less 168.54 4
Tax map/parcel no.: Ea add'l 500 sq. ft or portion 33.92 1
ap/P Limited atergy, residential
19 Jl 'I I'j 1°(U9 -u n r al 6 f' ��F(jr Il '. y u l ; -_ r � il (with sQ ) 75.0 2
1116 :.�11u ,�., ., il:.5- _ .yflfIL..
�. 11111 ?1hltil welt above ft.
Limited energy, multi - family 75.00 2
residential (with above sq. ff.) _
Services or feeders Installation alteration, and/or reification
200 an or less 100.70 2
:m- i n_s' B;c nrIr-- - - _�t _ F 1 ^ o z;a �::� ;q I : Icl � _�- ;t
• 't �lili J . 11l m 'Ian a l :1 I ��I::��I I II - y � i i I IE � -. !1111 201 aatpato400a''Ps 133.56 I 2
� � ink,.- , .3, -stunt ,.•.,- i
1 +1E' GIDI:7 =h T-- .sl,�ittai k,11
401 amps to 600 amps 200.34 i 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 i 2
Ci /State/ZIP: Temporary services or feeders installation, alteration, and/or
1}' relocation
•
Phone: ( ) I Fax: ( )
200 amps or less 59.36 1
Owner installation: This install ion 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 - change, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54
Branch circuits - new, alteration, or extension, Qer pdnel
Owner signature: Date: A. For for branch circuits with 1
Ifi: i 1 - ` k` �7 1ii I a ° _ •.^ r..; .., PPP.P` I - V' t 4.. I. iliJ { above feeder fee. 7.42
- � I J I � c 2:. l . . 111 � inl3,fllnu�tuu,.^- �� II i!:.`: 11p1111• I; �';- �� f.. A...: n, tlCntifu ..i::c(_- :.c- �r1;�lA-I serviceor teaCil biHilC CRCnIt �
Business name: i fZ B. Fero for branch circuits wirhow
service or teedder fee, drat 56.18
Contact name: branch circuit `
Each add' 1 breach circuit 7.42 i
Address: Miscellaneous (service or feeder not Included) or modular
City/State/ZIP: � and/or feeder 67.84
Reconnect only 67.84
Phone: ( ) Pumper irrigation circle 67.84
E - mail:
,1 :n, ,, 1 .:,. �- � 1 >,t , � , Signal cirruit(s)or limited
-energy �� '"•1 111• : IIC�y= -urt1`Jltl�'�.'.Id1I i..I: Illitf4'. :.I t mot: ll �S
Business name: Cu / d c, l I d C( Lc panel, alteration, or extension. Page 2
Each additional Inspection over allowable in any of the above
Address: '? v 7s D.,.; y, / Q ��Qc Additional inspection (1 hr min) . 66.25/ hr II
J "� Investigation (t hr min) 6625/ hr
City/State/ZIP: t 7-7/ a Industrial plant (1 hr Iran 78.18/ hr
q ^ (�
Phone: (S'03) ` . S / _ 1. I Fa x: (�3) l S 9 !os 1 wts for which no fee e
90.00/1u ,
s. - • t .
q f El _ '. listed f, M min
CCB Lic.: S6 'cal Lic.: 3 y 3 V- C/ Su J ic.: 07,
1 5' L/ ? il E f t ... h....1. I 11 1 _ , IIIIIIIIII.��jry...
Y:' . 4 f. ��.:: :.. J �-y rtrinf� :1.• t "'i4�Yl�ttlna^I
Suprv. Electrician signature, requ = ,! Subtotal:
/ Plan review (25% of permit fee):
Print name: Date: - - • / 4_ State surcharge (12% of pennit fee):
Authorized signature: / ,/ TOTAL PERMIT FEE: I
This p ermit application expires if a permit Is not obtained riithln 180
days after II has been accepted as complete.
Print name: tl� e ( 4 7 F i <) � Date: _5/ • dyer of inspections allowed per permit.
•18uiteiaglPermitelELC- PennitApp.doc 07/01 110 440.45157(1 t/a5A M/WEB
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