Permit I
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CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00140
T I G AR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/27/2009
Parcel: 1S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 300
Subdivision: Lot: 0
Project: Horizon Pediatrics
Project Description: Low voltage for HVAC.
Owner: FEES
MCFADDEN, ARTHUR L Description Date Amount
BY ERIC SKLARZ, 621 SW MORRISON ST STE Restricted Energy Permit 05/27/2009 $75.00
#800 12% State Surcharge - Restricted Energy 05/27/2009 $9.00
PHONE:
Contractor:
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123 •
PHONE: 503 - 628 -6841
FAX: 503- 848 -2597
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 Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
•
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 ccordaltcewith 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 d s. ATTENTION: osegon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR •
952 -001 010 through OAR 952- 1 -01 0. ou may obtain a copy of the rules or direct questions to OUNC by calling 5 1.800.3 .2344. l
Issue y: - - 'G "�i/1 Y( Permittee Signature: /C /VrtifA "T-
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.
Electrical Permit Application FOR OFFICE USE ONLY
Received "��,(�
City of Tigard Date/By: 0 Q Permit No.: 7 + Od /old
q 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' C ' . Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
Permit:
TIGARD Inspection Line: 503.639 Date Ready/By: 3u s:..-- / � El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: ��%j� Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans wltems 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
❑ I - 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E "I -2 ", "I -3 ",
Job no.: Job site address: 9735 SW shady Ln I or more. occupancy.
❑ Six x o or r 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.: 300 Project name: Tigard Medical Mall ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I 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 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.)
Reconnect RTU Limited energy, multi-family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ 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: ( ) 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Same as below B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 2
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: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal panel, or limited -
Business name: Willamette HVAC
energy panel, alteration, or
Address: 3075 SW 234 Ave Ste 206 extension. Describe: Page 2 2
City/State /ZIP: Hillsboro, OR 97123 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 628.6841 Fax: (503) 848.2597 Investigation per hour(I hr min) 62.50
CCB Lie.: 56951 Electrical Lie.: 36346CRE Suprv. Lie.: 4025LEB Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: % Subtotal:
Print name: Mike Sicard V I f Date: 4/21/09 Plan review (25% of permit fee) —
State surcharge (12% of permit fee): cv
Authorized signature: TOTAL PERMIT FEE
g This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Build ing\Pennits1ELC- PennitApp.doc 05/23/06 440-46t5T(1I/05 /COM/WEB