Permit a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II I= • COMMUNITY DEVELOPMENT Permit#: ELR2013-00228
Date Issued: 09/16/2013
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503.718.2439 Parcel: 2S101 BB01300
Jurisdiction: Tigard
Site address: 11950 SW GARDEN PL 100
Project: Vesta Subdivision: CROW PARK 217 Lot: 1
Project Description: HVAC system
Contractor: PROTEMP ASSOCIATES INC Owner: WALTON CWOR PARK BC 8 LLC
9788 SE 17TH AVE BY CTMT-WALTON RE TAX
PORTLAND, OR 97222 4678 WORLD PARKWAY CIR
ST LOUIS,MO 63134
PHONE 503-233-6911 PHONE
FAX. 503-238-9767
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/16/2013 $75.00
12%State Surcharge-Electrical 09/16/2013 $9 00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo 0 Boiler Controls. 0
CCTV 0 Clock Systems. 0
Data&Telecommunications 0 Fire Alarm: 0
HVAC: 1 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 I •-• •ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done accordance wit 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 TTENTION Oregon 'w requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-0 1-0010 through OAR 952-0e -10' iuu/may obtain a copy of the rules or direct questions to OUNC by calling 503 232 19 or 1 800 332 2344
Iss ed By: • / % /2 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.
Electrical Permit Application FOR OFFICE USE ONL
City of Tigard Received
DateB [ ( i1 Permit No.:
IN
n �. • .
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 DateB : Other Permits/3 U -
T1 G A.RD Inspection Line: 503.639.4175 Date Ready/By: r. See Page 2 for
•
Internet: www.tigard-or.gov 1 6 ,LZ13 Notified/Method: M Supplemental Information
TYPE OF WORK C�Q•'} tog) . . = PLAN REVIEW
v 4v' w`
❑New construction ®Addition/alteration/repl 'fjik �0,` Please check all that apply(submit 2 sets of plans w/items checked below):
�! ��S ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: CS‘i Iv� where the available fault current ❑Marinas and boatyards.
'
"I';:?-4:.C.,���.�r �;-'<'e � �,,CATEGORY'OFt CONS <`, ---' ,',, „ ' exceeds 10,000 amps at 150 volts or 0 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
0.JOB SITE INFORMATION=AND;LOCATION:', Emergency system, larger separately derived system.
❑Addition of new motor load of ❑"A" `E" "1-2" "1-3",
Job no.:3705 Job site address: 11950 SW Garden Place 10OHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard Or 97223 ❑Healthcare facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: 7 Q d Project name:Vesta ❑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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
_,_' ',it : ' DESCRIPTION'.OF WORK.' - (with above sq.ft.)
Relocate Thermostat&wire Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Services or feeders installation,alteration,and/or relocation _
200 amps or less 100.70 2
v4;" ;' I&1 PROPERTY OWNER ;,:•,_' TENANT,` '4. 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
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 -
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 I above service or feeder fee,
❑,CONTACT'PERSON each branch circuit 7.42 2
Business name: B.Fee for branch circuits without
service or feeder fee,first
56.18 2
Contact name: branch circuit
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
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
?-r.:,,;n;,-i_-2.;'-',,T-1-::,, ,"' ' CONTRACTOR
.-_-- � . � - Signal circuit(s)or limited-energy
Business name:Protemp Associates panel,alteration,or extension. 1 Page 2 75-1:- 2
Each additional inspection over allowable in any of the above
Address:9788 SE 17th Ave Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Milwaukie Oregon 97222 Investigation(1 hr min) 66.25/hr
Industrial plant(I hr min) 78.18/hr
Phone:(503)519-6199 Fax:(503)238-9767 Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
CCB Lic.: 38868 Electrical Lic.: 26-1063 Suprv.Lic.: 26131eb ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ ` . Subtotal: 7$i
, � Plan review(25%of permit fee):
Print name: Monty Schroeder Date: 9/16/13 State surcharge(12%of permit fee): G1,a'-"'
TOTAL PERMIT FEE: S Hs.�E.--Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Bruce Butner Date: 9/16/13 • days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB