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Permit
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT g • COMMUNITY DEVELOPMENT Permit #: ELR2013 00110 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2013 Parcel: 25101 DA00104 Jurisdiction: TIGARD Site address: 13333 SW 68TH PKWY, STE# 210 Project: Xerox Subdivision: VARNS ACRES Lot: 9 Project Description: Low voltage for HVAC Contractor: HVAC INC Owner: TRIANGLE POINTE LLC 5188 SE INTERNATIONAL WAY 901 NE GLISAN ST, #100 MILWAUKIE, OR 97222 PORTLAND, OR 97232 PHONE: 503 -462 -4822 PHONE: FAX: 503 - 462 -6555 FEES Description Date Amount Specifics: Restricted Energy Permit 05/21/2013 $75.00 12% State Surcharge - Electrical 05/21/2013 $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) 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. ATT ': • - . •n 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 9' -0f -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. PO Iss d By: / f / Permittee Signature: 1' , _ , , ' r� 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. 05/15/2013 09:19 5034626555 (( HVAC INC PAGE 03/04 Permit Application CEI V E I ri . u1.1 11 I. l tit. l)�i.ti Electrical Perms pU 2 Received 7/laird-MA PcrmitNo.: ELea4I3 -xaiia City of Tigard MAY 1 5 2013 oat 11, 13125 SW Hall Blvd__ Tigard, OR 97223 Plan Review Other Permit Phone; 503.718.2439 Fax: 503.59X.196 'ITY OF TIGARD Dal Ready/By: brit: WI See 'Page 2 for Inspection Line: 503.639.4175 M Sre merr e2 fo Afratat9lm Internet: www•ngard-or.gov BUILDINGDIVISIOI ► No tified/Method: • : ,..... • ..:,.. � ... .. Please cheek all that apply (submit / :cts of plans w/itcros checked below): ❑ New construction jk] Addition/alteration/replacement p Service or feeder noes amps or more ❑ )ardlding over three stories. ❑ Demolition ❑ Other: where the available huh aanem ❑ Marinas and boatyards. . .. �:: - ; , � � - . ��,�IQ . ' . : exceeds 10 A 00 amps at ISO vo Flouting _� ,dtural ; .: • :.•. 7 : • .•'•'.' , ;'':..' . ..:. . .: :.•. . C19'IC t�'` �'� .' .. , ,, Iessto g tnund. or ercoeda 14,000 C ere ago • or 00 i] ;al 'c ❑ 1- and 2- family dwelling 121 Commercial /industrial ❑ Accessory building amps nor all cacr installations, buildings. _ '!l'It ❑ Other. ❑ Firc pomp. 0 installation of 75 KVA or ❑ Multi - family El Master builder ❑Em derived cy system. larger separately d d system. ,;..::' .. ' : 1 1'Q CI Addition of new motor load of ❑ "A ". -E..-1-2-.-1-r. • • n 1 J3 3 5 \ '/ 0 Six or or more residential mare. occupancy. Job no.: Job site address: i � j � ❑ Six or more r emits El Re . Rcctctueational vclricic mss. City/State/ZiP: 4-i OA 1: th ireocuti locutions. ❑ Supply voleigc ibr more than t. - D Ha do+LS lowtlitie 600 molts morainal. Suite/bldg./apt. no.: _ is Project namc: 1 \V (KA ( f 'af, E , 1 ❑ Sc v�ec nr ib cdcr 600 amps errmm. , . ; Cros. . , • - ob site: mot • ;Oa Waal ==.1111111EN c New residential single- or multi - family dwelling mil. dt i oZ1O Includes attached garage. Subdivision: Lot no.: 1.000 sq. ft. or Iess 168.54 Ea. add'I 500 sq. ft. or portion 33.92 II Tax map/parcel no.: Limited residential , o 'mired energy, test ante 7 5 0 with above a. ti.. Limited energy, multi- family I. 75.00 © ' . residential with above ; i , ft Il 1 r - J — Services or feeders Insd alteration and/or relocation J 200 amps or less 111.11 100.70 El 'ELI�Yrt 201 amps to 400 amps MI 133.5E � © 401 amino, 600 200.34 Name: 601 amps to 1,000 amps 301.04® Address: Over 1.000 amps or volts - Q Temporary services or feeders installation, alteration. and /or Ci ty/Statc/ZiP: relocation Phone: ( ) l 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 116 8.54 2 intended for sate, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits —new, alteration., or extension, . panel Owner signature: Date: A. Fee for branch circuits with )I►E11� feeder . 7.42 ,.. service or • s11P�t�141'i'l'�;: )� •- . , . . .. �^` . each branch circuit Business name: F1( (--- B. Fcc for branch circuits without service or fader Ice, first 56.18 Il Contact name: ! d'' y • Jr t branch circuit ��_ = �,� � I , Each add'I oh circuit _ 7.42 Address: r � I Mi 11 noun ue aerviceor!>' in I i d ■ t• V n^ d wint. s e rscc a d/ rfeed er M� el W R C f Each n;,, service and/or feeder 'kW Reconnect only 67.114 �� Phone: 6 ) o . ''"� -r d' t! Fax: ' ■ 13) i . / Pump or irrigation circle 67.84 � E -mail: ' I“ 1 r V O . ,. Cti 1/" 1 Signor outline lighting MN 67,84 � e a Signal circuit(s) or limitedcncrgy nip" II ww Business name: r ■ el alteration or mansion. V Each additional inspection over allowable in an of the above Addre Additional inspection (I hr min) Ill 66.25/ he � , City /5tatc/ZIP: / l investigation (I hr min) 66.25/ hr i , Indusuiai plant (1 hr min) - 78.18/ hr - i nspections f or w hich no fee is (>bonc: ( ) OF Fax: ( ) ■ 9(1,00/ In It — . s i tifical listed hr min CCR Lie.: St ,On Electrical Lic.:A.S11 C Suprv. Lie.: "3 t . u .... SLECTRICA1 r!' ltillIrFOS ' ' Suprv. Electrician signature, required: r e Subtotal ,p 1 � ` , ( ` � Plan review (25% /e of permit fee): M S (/V'111 Da le : 5115 l3 State surcharge (12% anemia fee): I'. Print name'. ) � Dale: TOTAL PERMIT FEE: f ' V Authorized signature: I ' i This parade application expires if a permit is net obtained within ISO ! I dsyn after it has been accepted as eemplete. Print name: l / Al Date: '$" LS l3 • Number of inspections nllowod per permit. Nur t:lRuIlding\Pumitc • • aepp.nnc n 1 MO 440.4atrTm/05/ROMAWI3 05/15/2013 09:19 5034626555 HVAC INC PAGE 04/04 Electrical Permit Application - City of Tigard Page 2- Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined $75.00 Check Type of Work Involved: Audio and Stereo Systems* O Burglar Alarm El Garage Door Opener* El Heating, Ventilation and Air Conditioning System* 0 Vacuum Systems* El Other: ..totigent • . •• . Fee for emit commercial $75.00 system (SEE OAR 918-309-0000) Check Type of Work Involved: 0 Audio and Stereo Systems O Boiler Controls 0 Clock Systems • Data I'elecommunication Iflsthllaion El Fire Alarm Installation. IT.VAC Li Instrumentation • Intercom and Paging Systems O Landscape Irrigation Control* El Medical El Nurse Calls O Outdoor Landscape T...ighting* Li Protective Signaling El ottict Total number of commercial systems: *No licensee arc required. Licenses are required for all other installations I :UM Id in rperrmilASLC-rom I AmInc 07/01 /1 I)