Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
' ° COMMUNITY DEVELOPMENT Permit #: ELC2013 -00313
Date Issued: 06/05/2013
T IGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 1S126D602800
Jurisdiction: Tigard
Site address: 9370 SW GREENBURG RD 311
Project: Dr. Bilstrom Subdivision: 1991 -018 PARTITION PLAT Lot: 1
Project Description: (1) branch circuit to reconnect heat pump.
Contractor: WILLAMETTE HVAC LLC Owner: FRANKLIN COMMONS ASSOCIATES, LLC
3075 SW 234TH AVE. #206 BY NORRIS & STEVENS
HILLSBORO, OR 97123 621 SW MORRISON STE 800
PORTLAND, OR 97205
PHONE: 503 - 259 -3200 PHONE:
FAX 503 - 848 -2597
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/05/2013 $56 18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/05/2013 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62 92
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 accords . - , • h 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 ATTEN •N• Oregon :w re. -- you to follow the rules adopted by the Oregon Utility Not cation Center Those ru are set forth in OAR
952- 001 -0010 throu a OAR 952-001 090 Yo y obtain a copy of the rules or direct questions to OUNC by calling 03 232 1987 or�8 .332. 4
Issued By. /� 0 f_A 4, � 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 603.639.4175 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.
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Electrical Permit Application RECEIVE D FOR OFFICE USE ONLY ■
City of Tigard P ermit No
1 14
JUN 04 2013 Date /By /y ,13 � Eu i3
° 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone' 503 718 2439 Fax: 503 598 1960 �r�J ( ( ; �R� D Date Ready /By Jur s ate/By Other Perrot /1��/ -a9, d
T 1 G A R D Inspection Line' 503 639 C l s � �GAR ICJ See Page 2 for
BUI •
Internet: www.tigard-or.gov ISIO t Notified/Metho 77 Supplemental Information
TYPE OF WORK 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 stones
❑ 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
❑ 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 ", "I - ",
Job no.: Job site address: 9370 SW Greenburg Rd
100H or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: Tigard OR ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: 311 Project name: Dr. Bilstrom ❑ 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 168 54 ,4
Ea add'l 500 sq ft. or portion 33.92 .I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq ft) L.'.
Limited energy, multi - family
reconnect heat pump residential (with above sq ft ) 75 00 2
Services or feeders installation, alteration, and/or relocation b
200 amps or less 100 70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200 34 2
Name: 601 amps to 1,000 amps 301 04 2
Address: Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) 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
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: same as below B Fee for branch circuits without o
service or feeder fee, first I
Contact name: branch circuit 56.18 2
Each add'l branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included) , •
City/State/ZIP: Each manufactured or modular 67 84 2
Y dwelling, service and/or feeder _
Phone: ( ) Fax: : ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E - mail: Sign or outline lighting 67 84 2
' CONTRACTOR Signal circuit(s) or limited- energy
Business name: Willamette hvac LLC panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address: 3075 SW 234 Ave Suite 206 Additional inspection (I hr min) 66 25/ hr
City/State /ZIP: Hillsboro, OR 97123 Investigation (I hr min) 66 25/ hr
Industrial plant (I hr min) 78 18/ hr
Phone: (503) 259.3200 Fax: (503) 848.2597 Inspections for which no fee is 90 00/ hr
specifically listed CA hr min)
CCB Lic.: 56951 Electrical Lic.: 34346CRE Su . Lic.: 4025LEB ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal.
/ %%�
Plan review (25% of permit fee))
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Print name: mike sicard Date: 6/4/13 State surcharge (12 % of permit fee)
_ , TOTAL PERMIT FEE
Authorized signature:
1i This permit application expires if a permit is not obtained within I80''4� }.
days after it has been accepted as complete. ar
Print name: Michael Malstrom Date: 6/4/13 • Number of inspections allowed per permit ' ,i
I\ Budding \Permns\ELC- Permit App doe 07/01/10 440- 4615T(1i /05 /COM/WEB ,
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