Permit u CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
g. COMMUNITY DEVELOPMENT Permit #: ELR2013 00181
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/29/2013
Parcel: 2S 113AA01000
Jurisdiction: Tigard
Site address: 16570 SW 72ND AVE B9
Project: StayN Power Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C
Project Description: Low voltage for HVAC
Contractor: WILLAMETTE HVAC LLC Owner: PACIFIC REALTY ASSOCIATES
3075 SW 234TH AVE. #206 ATTN: N PIVEN
HILLSBORO, OR 97123 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 259 -3200 PHONE: 503 - 624 -6300
FAX: 503 -848 -2597
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/29/2013 $75.00
12% State Surcharge - Electrical 07/29/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 acc rrianne ith 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 TION: Oregon w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 010 thro h OAR 952 -0 -0090. Y ay fain a copy of the rules or direct ::::::::1l
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 FOR OFFICE USE ONLY
City of Tigard R eceived n/ `3 r , n n _90 �5
11111 . `J g Date /By: ( ill Permit No.: ...4 -co l �/
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review • Phone: 503.718.2439 Fax: 503.598.19 2 2013 Date /By: Other Permit: ) \ -#e Olc1 0D11l..V7
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris El See Page 2 for
Internet: www.tigard- or.gov CITY OFTIGARD Notified/Method: Supplemental Information
TYPE OB /INCiDIVISION 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
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder El 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 - ", "I -3
Job no.: Job site address: 16570 SW 72nd ave IOOHP 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.: Project name: Stay'N Power ❑ 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') 500 sq. ft or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75 00 2
Limited energy, multi - family 75.00 2
relocate thermostats as necessary for new office layout residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
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 I
- 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7 42 2
each branch circuit
Business name: same as below B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each dwelling, ng, service manufactured
City /State /ZIP: 67.84 2
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 i °
Business name: Willamette hvac LLC panel, alteration, or extension. I 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 ('/A hr min)
CCB Lie.: 56951 Electrical Lie.: 34346CRE Su rv. Lic.: 4025LEB ELECTRICAL PERMIT FEES _
-'
�jj T73
Suprv. Electrician signature, required: 2,4 ? ` Subtotal.
Plan review (25% of permit fee): '--
Print name: mike sicard Date: 7/26/13 State surcharge (12% of permit fee): e) •
^ n / TOTAL PERMIT FEE: ?./ - �
Authorized signature: rye � (_ 42 //0 7r� cs�
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Michael Malstrom Date: 7/26/13
* Number of inspections allowed per permit.
I '\ Bui !ding \ Permit s\ELC- PermitApp doe 07/01/10 440- 46t5T(it/05 /COM/WEB