Permit — q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2013 -00004
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/09/2013
Parcel: 2S112AD00700
Jurisdiction: Tigard
Site address: 14830 SW 72ND AVE
Project: Pioneer Waterproofing Subdivision: BONITA GARDENS Lot: 4
Project Description: (2) low voltage permits for thermostats
Contractor: OREGON HEATING & AIR CONDITIONING Owner: UNION CENTRAL LIFE
19300 SW 118TH AVE TREASURY SERVICES
TUALATIN, OR 97062 ATTN: DIANE THOMAS
PO BOX 888
CINCINNATI, OH 45240
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 01/09/2013 $150.00
12% State Surcharge - Electrical 01/09/2013 $18.00
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: 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 $168.00
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.
,�i �tU AAA P 1 4 to AL
Issued By: . 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.
01/08/2013 09:20 503 - 691 -8556 OREGON HEATING PAGE 03/04
nr r
Electrical Permit Application Ei " FOR OFFICE t-iSL (.)NLY
City of Tigard JAN 0 8 2013 M (I (3 Permit No•: c�L� a0I 3 - C
III _ • 13125 SW Hall Blvd., Tigard, OR :97223 Plan Review
Phone: 503.639.4171 Fax: 503.398.196�TY �Gp>� Dote/B :
Other Permit: j) t r a - 4.5 .
Inspection Line: 503.639.4175 Date Ready/By: Atria /' El See Page 2 for
'r' I CiA£.D Internet: www.tigard -or.gov ' BUILDING DIVISIO Notified/method: 1! t'J Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New eORSirUCtion arP►dditiOlUalterxUOr/rePlaet Yrierit
Please check all that apply (submit I sets of plans w/items checked below):
0 Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
less to ground or exceeds 14,000 0 Commercial -nee agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings,
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. 0 installation of 75 KVA or
. 0 Emergency system larger separately derived system,
JOB SITE INFORMATION AND LCK ATION ❑ Addition of new motor load of 0 "A ", - E", "1 - 2 - , "1 - ".
Job no tI
t 00HP or mote, oca�atKY
1— a Job site address: t { Q 30 S t j ' ' +�e 0 Six or more residential units. ❑ Recreational vehicle parks.
o Ty /State /Z1 �` a ` Q t '
Ci ❑ Health-care facilities. es.
El voltage for more than
GC ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: / _ Project name: p: Brt. e r (N/Y1 er , F ;f ;r 0 s.,v^oe or feeder 600 amps or mom.
FEE I
SCHEDULE
Cross .. . • • . Desert.tien Qtr. I Pee. Total
New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. Or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 i
Tax map/parcel no.Limited energy, residential
1 r M• e OF e'
(with above sq. R) 75.00 2
Limited energy, multi- family 75.00 2
residential with above • , ft.)
. Services or
200 amps ►, m
ID PROPERTY OWNER 0 'TENANT 201 amps to 400 amps 133.56 2
401i:imps to 600 amps 203,34 2
Name: &Ramps tit . ,- - 301.04 in
Address; Over 1,000 amps or volts 552.26 2
. Temporary services or feeders installation, alteration, and/or
City/State/2(P: • ' relocation
. Owner installation: This installation is being made on property that I own which is not
401 amps to 549 amps 168.54 2
intended for sale, lease, rent, or exchange, aecording to ORS 447, 449, 670. and 701.
Branch circuits - new, alteration, or extension, per nel
Owner signature: Date:
above service OT feeder fee,
❑ APPLICANT I' . ONTACT PERSON 7.42 2
Business name: Off r �}BG f1 A 7 r' C cy 1• . B. Fee for branch circuib without
service or feeder fee. ftrst -
56.18 2
. Contact name: .-- (95l. ‘ ,.. d 5+-e branch circuit
..--- Each midi branch circuit 7.42 2
Address: /0/300 5 Lt/ 11 g.1- k not
Each manufactured or modular III
El
City/State/ZIP: ! � Cot n 1 0 le 9 ?Q'6 1 / 67 service antVor feeder
Phone: (. 03 ) b �. _ 0 / 0 ' p Fax:: (SO 3) 6 [ ) ` 1.5 .5-(7 67.84 El
Pump or irrigation circie MI 67.84 �
E-mail:. ♦., f at Orr Aka„ itece( `n.• - ( 004. MI 67.84 ii
CONTRACT t MEM 1 rO
.. el, alteration, or extension, Business name: -0r1 rti )/�A• / /4 ( 0 • ;4 • - . �J 1
G, additional 1
Address: I -/ 3 t 0 st 111441,_,. �,re, Ad ditional inspection (1 hr min) ME , 66.251 hr of
�
City/State/ZiP:' f ^ tc.ct. a k.. q r � INN.
Phone: (S03) Cc l `16 ' I Fax: ( Sol) 691 gr g rr inspections . 90.00 / hr �
CCB Lic.: - a (Q Electrical Lic.: f , j yo Suprv. Lic.: )')3 . ELECTRICA.L PERMIT FEES
•11.11.--- Subtotal: gc7- GO
Suprv. Electrician sig7nature, required: -- . -- = Plan review (25% of permit fee):
r eta_ Date: O to gj/ State surcharge (12% of permit fee): g,co
TOTAL PERMIT FEE: 1 4 . _oc,
Authorized signature: 1,71)5 This permit application expires if a permit is not obtained within Igo
Print name: -'- S L ., FOS t e Bat O . i/t, Vic), days after it has been accepted as complete.
• Numbe of inspections ellowed.per permit.
... . _ . . -- - - , . . ........ ean.sa t erg 1 m /c6/COM/WEB
01/08/2013 09:20 503- 691 -8556 OREGON HEATING PAGE 04/04
Electrical Permit Application - City of Tigard
Pa 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY;
Fee for all residential systems combined ... $75.00
Check Type of Work Involved_
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
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 •
a
Other
Total number of commercial systems!
*No licenses are required. Licenses are required
for all other installations
;.x
01/08/2013 09:20 503- 691 -8556 OREGON HEATING PAGE 01/04
Oregon Heating & AC
19300 SW 118 Ave
Tualatin, OR 97062
i - Phone: 503-691-9699
1 , .''"� . Fax 503- 691 -8556
www.oregonheatin • .corn •
IF -I
To: ( oyA -- r, G� From: J g7s k 0 ({Z? #' T\ I NCk :i'l-
Fax: S0 - .S i ( 1 i 0 Pages: c-1
Phone: $ c -- — L ' I t 7 / Date: 01 / 0( 3//
Re: Pror eer 11/'c4'1'e {' rde f.,- cc:
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply 121 Please Recycle
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14830 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
199 Electrical final
03/27/2013 00:00
ELR2013-00004
PASS - No C of O
Violation Summary:
Inspector Contractor