Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00197
Date Issued: 09/25/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 2S 101 DCO3800
Jurisdiction: Tigard
Site address: 7190 SW SANDBURG ST 5
Project: McCormack Properties Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: Low voltage for HVAC
Contractor: ARROW MECHANICAL Owner: MCCORMACK PROPERTIES LP
10330 SW TUALATIN RD 7190 SW SANDBURG ST
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -1565 PHONE: 503 - 624 -4649
FAX: 503 - 691 -1879
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/25/2012 $75.00
12% State Surcharge - Electrical 09/25/2012 $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 copy of the rules or direct questions to OUNC by calling 503.232 87 or 1.800.332.2344.
Issued By: Af L Permittee Signature:
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 Application RECEIVED I. FOR OFFICE USE ONLY
City of Tigard Received : + AUG 1 2 012 Date/By: Permit No.: £L./1- l --DO M
13125 SW Hall Blvd., Tigard, OR 97223 p ' I ' r Plan Review
G Phone: 503.718.2439 Fax: 503.598.1 Other Permit:
T I GARD Inspection Line: 503.639.4175 Date/13y:
OF TIGARD Date Ready/By: Juris• Si See Page 2 for
Internet: www.tigard-or.gov BU1LDINGDNISION Notified/Method: Supplemental Information
- - - - - -. - -- -- - -TYPE OF WORK . . , - FLAN REVIEW _ - _ __ - - - -- -
Please check all that apply (submit 2 sets of plans wfitems checked below):
❑ New construction I Additio . teratio replacemen
ID Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling X Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived systeo
❑ Addition of new motor load of ❑ "A ", "E", "1-2 ", "I -3 ",
Job no.: S� I Job site address: I00HP or more. occupancy.
1 Q SJ�at V 13J, S T ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: ..
. Ae, a C2 C I 712-3 ❑ Healthcare facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: El Service or feeder 600 amps or more.
t L [ �.n/� c aZ ® / aTI� FEE SCHEDULE
Cross street/directions to job site:
,;Pa I Orr. I Fee. Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea add'. 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
- - DESCRIPTION OF WORK - (with above sq. ft.)
_ Limited energy, multi-family 75.00 2
ti s �' V Tn J '- ‘At t itC 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: (--0.:..../.-A 401 amps to 600 amps 200.34 2
�' `" yiet 601 amps to 1,000 amps 301.04 2
Address: 7 7 ' 9 C' 6„4„ ,. ..7s. Over 1,000 amps or volts 552.26 2
City/ State/ZIP: ��� SO q 7'Z23 ' Temporary services or feeders installation, alteration, and/or
relocation
Phone: (50" 63 t 9 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
„ - ,
et APPLICANT '
,CpNTACT. PERSON > above service or feeder fee, each branch circuit 7.42 2
Business name: Arrow Mechanical B. Fee for branch circuits without
service or Contact name: s branch circuit
er fee, first
56.18 2
��`� Each add'1 branch circuit 7.42 2
Address: 10330 SW Tualatin Rd Miscellaneous (service or feeder included)
City / State/ZIP: Tualatin OR 97062 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 692 - 1565 I Fax: : (503) 691 - 1879 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
Sign or outline lighting • 67.84 2
:` - COPITRACTOR. ` - _ Signal circuit(s) or limited -energy
Business name: Arrow Mechanical panel, alteration, or extension. Page 2 7 5 2
Each additional inspection over allowable in any o f the above
Address: 10330 SW Tualatin Rd Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Tualatin OR 97062 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 692 - 1565 Fax: (503) 691 - 1879 Inspections for which no fee is
specifically listed (V2 hr min) 90.00/ hr
CCB Lic.: 5193 Electrical Lie.: 34 -47CLE Suprv. Lie.: 4647LEB ELECTRICAL :PERIVIIT FEES
Subtotal: '7 j -, , t
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: John Chamberlain Date: S / . State surcharge (12% of permit fee): q.0-0
Authorized signature: .1 �. TOTAL PER FEE , ' I.i
This perm app exp if a perm is not obtained within 180
t ,p - Date: days after it has been accepted as complete.
Print name:
{/te A/2 Z %f r 2 • Number of inspections allowed per permit.