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Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ,' COMMUNITY DEVELOPMENT Permit #: ELR2013 -00046 .TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/12/2013 Parcel: 26102AC01100 Jurisdiction: Tigard Site address: 12568 SW MAIN ST Project: Main Street Tigard Subdivision: BURNHAM TRACT Lot: 1 Project Description: Low voltage for HVAC Contractor: ARROW MECHANICAL Owner: MAIN STREET LLC & 10330 SW TUALATIN RD DUDUNAKIS, MICHAEL P TUALATIN, OR 97062 2839 SW SECOND AVE PORTLAND, OR 97201 PHONE: 503 - 692 -1565 PHONE: FAX: 503 - 691 -1879 • FEES Description Date Amount Specifics: Restricted Energy Permit 03/12/2013 $75.00 12% State Surcharge - Electrical 03/12/2013 $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 $84.00 Other Desc: Required Items and Reports (Conditions) 2 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will • be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspend .d for more the 180 days. AT ' • 1 : : -gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. h• -- rules a e set forth in OAR 952-001-6010 through OA' ' 52 -1 • -6190 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 o r .2344. Issue. :y: I / . 0 Permittee Signature: Al 4 4 OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. This permit card shall be kept In a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Applicat E® FOR OFFICE USE ONLY City of Tigard Received `'f g 1 Date/B ( ° Permit No.: Za i j #0, 13125 SW Hall Blvd., Tigard, OR 23 �'� Plan y h �� Revi O. Phone: 503.718.2439 Fax: 503.59$A)0 5 20 Date/By: Other Permit: T 1 GA l: D Inspection Line: 503.639.4175 1 ``�t`' T � (' �� Date Ready/13y: Julia: la See Page 2 for Internet: www.tigardor.gov 1V e { 1L Notified/Method: Supplemental Information TYPE ilitatti G�VI"' PLAN REVIEW DA New construction El Additioation/replacement Please check all that apply (submit 2 sets of plans whtems checked below): El Demolition ❑ �: 13 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 ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 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 ", "1 -2" "1 -3 ", d _ IOOHP or more. occupancy. Job no.: I J ob si te address: 1 3 MLA. yc �) i ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than T t �,A 1 � t' 1j q IY► • J ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: P r o j e c t name: pi.l,.„,,4 ,0 T i c . a IA). El 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: I Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 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 14:12%4 12/:: Y= I Tip t • 5 I A'( ' 4- 4 r ii- G- residential (with above sq. R) - v Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 (;19 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Name: pp� 401 amps to 600 amps 200.34 2 �3A iC exAtD A I a::;;-Arc 601 amps to 1,000 amps 301.04 2 Address: 'Z t 3ci ...t 2.4.0 A fib` Over 1,000 amps or volts 552.26 2 City/State/ZIP: pc sZr(,grW„ © A1 etnei re lit services or feeders installation, alteration, and/or Phone: (663 ) 49 •Z °/6-6 I Fax: (1 3 ) 6c7 — 6 77 200 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 . ® APPLICANT - ; ® ' above service or feeder fee, CpNTACT PERSON branch circuit 7.42 2 Business name: Arrow Mechanical B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: D K, � L.pmeie branch circuit Each add', branch circuit 7.42 2 Address: 10330 SW Tualatin Rd Miscellaneous (service or feeder not included) City/State/ZIP: Tualatin OR 97062 Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: (503) 692 - 1565 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 - : : COl1NTRAGTUR, . ' . • , . • - Signal circuit(s) or limited-energy Business name: Arrow Mechanical panet, alteration, or extension. Page 2 _ c I 2 Each additional inspection over allowable in any of 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 tine : - ( $0 3 ) 6 9 2 - 1 5 6 _ 5 _ . . . _... _ . .. _... _ Fax:.(50_ 3)491.1879- _ _ - Inspections for which min) fee is .- � 78.18/ hr - _ a - s pecifically listed (Y hr m — -.— 7 . _, _ T 00 /hi in) - CCB Lic.: 5193 I Electrical Lic.: 34 -47CLE I Su p rv. Lie.: 4647LEB - ELECTRICAL PE • _ IEES Suprv. Electrician signature, required: Subtotal: 75, Z Plan review (25% of permit fee) `6P^ Print name: John Chamberlain I Date: 2 / j 3 State surcharge (12% of permit fee): 8 el o Authorized signature: p . /A ® TOTAL PERMIT FEE " J f� This permit application empires if a permit is not obtained within 180 Print name: / days after it has been accepted as compl /` c7° ���6 ^ j A Date: Z/�// 3 • Number of inspectionsallowed per permit. [A � G / 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 12568 SW MAIN ST, TIGARD, OR, 97223 Commercial - Electricial Limited Energy 135 Low voltage 04/15/2013 00:00 ELR2013-00046 PASS Violation Summary: Inspector Contractor