Permit I y p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II II • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00228
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 10/08/2012
Parcel: 1 S 135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST
Project: Plaza West Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: (1) low voltage for HVAC
Contractor: HUNTER DAVISSON INC Owner: SUN LIFE ASSURANCE CO OF CANADA
1800 SW PERSHING ST BY NORRIS BEGGS & SIMPSON
PORTLAND, OR 97202 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE: 503 - 542 -3628 PHONE:
FAX 503 - 542 -3654
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 10/08/2012 $75 00
12% State Surcharge - Electrical 10/08/2012 $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 OA 95 - 001 -0090 You may obtain a copy � of the rules or direct questions to OUNC by calling 503 - 2 or 1 800 332.2344
Issued By: kf� �c�t/1 Permittee Signature: 7 ' C
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 Applicati 6�--4 ,i ; FOR OFFICE USE ONLY
#. F
t - --' i � Received Permit No..0 R� /a er-
Ili City of Tigard Date/B � / v��► •
a 13125 SW Hall Blvd., Tigard, OR 97223 „ ,,,, .., ,)ni9 Plan Review
. C • Phone 503 639.4171 Fax: 503.598.1 *, I t u IL Date/B Other Permit 616 ZQ /,2 DQ vf
Inspection Line: 503.639.4175 Date Ready /By ,,y �� inns ® See Page 2 for
T I G A R D 7 - t ,; _ .i,} �' ” Notified/Method•/ O / it ! %/' 7 Supplemental Information
Internet: www tigard-or gov r.i`, e " �
�
YPE OF^V ikk ► °• •' 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
Lrj
❑ 1- 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 - ",
I OOHP or more occupancy
Job no.: Job site address:
(200 St.t2 Qctk S-6. • ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: i i ✓, � ra O 2 q- 3.Z-L3 ❑ Health-care a Hazardous facilities on ❑ Supply volts voltage for more than
J 1 ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: P l ti lu e„, t ❑ 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
DESCRIPTION OF WORK (with above sq ft) 75.00 2
1 11 Limited energy, multi - family 75.00 2
'c.,-tn ✓t ec. t in r� I w.v vo 1�c H V:A C Cc>ti.`E � I4 residential (with above sq ft )
J Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ 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 [g CONTACT PERSON above service or feeder fee, 6 65 2
1 each branch circuit
Business name: NU vx �V t S50 vi S.-VI G B Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: ��\ v �( Q.JI first branch circuit
Address: Each add'I branch circuit 6.65 2
��� G E , 7 IrN C Miscellaneous (service or feeder not included)
City/State /ZIP: - 0 i rid 1 €5Z c1 0 -Z Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: 0--s) r Z_ - sC a Z,6 Fax: : D3) 5142- 3&54 Reconnect only 66.85 2
E- mail: - 1 \J c . , d,ovi e 1 l2. vt 4 1, vvt, -64- 0.k.„, 5 4r , 0 • C cyvA Pump or irrigation circle 53.40 2
ONTRACTOR Sign or outline lighting 53 40 2
Signal circuit(s) or limited -
Business name:
Sov�
t vx. ah c„. toNe
et. energy panel, alteration, or
Address: extension. Describe: I Page 2 1 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Ph ne: ( ) / J � ( ) Investigation per hour (1 hr mm) 62.50
CCB Lic.: \Co \ �/ /Electrical Lic.: Z( -( (1,0uprv. Lic.: 31 Industrial plant per hour 73.75
EL ECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / 70 64 /0 / / Subtotal
Print name: C h �II .Date: 7/ Jiz. Pla n review (25% of permit fee).
pl Y 1S YV1 Z B State surcharge (8% of permit fee).
Authorized signature: - �� /��c.0 TOTAL PERMIT FEE.
This permit application expires if a permit is not obtained within 180
Print name: — \ vct,vt ^ \ )t>��•Q i Date: 111 / IZ days after it has been accepted as complete.
y / • Number of inspections allowed per permit
I \Building�PermuskELC- PermitApp doe 05/23/06 440 -46 5T(1 I /05 /COM/WEB