Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s • COMMUNITY DEVELOPMENT Permit#: ELR2013 00197
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503.718.2439 Date Issued: 09/17!2013
Parcel: 26 101 BCO2401
Jurisdiction: Tigard
Site address:-12650 SW HALL BLVD
Project: Snyder Roofing Subdivision: TIGARDIA TERRACE Lot: 3
Project Description: Low voltage for HVAC
Contractor: AMERICAN HEATING INC Owner: JFK PROPERTIES OREGON LLC
1339 SE GIDEON ST 12650 SW HALL BLVD
PORTLAND,OR 97202 TIGARD,OR 97223
PHONE. 503-239-4600 PHONE
FAX. 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/17/2013 $75 00
12%State Surcharge-Electrical 09/17/2013 $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 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 ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090 You mu obtain a co.y of the rules or direct questions to OUNC by calling 503 232.1987 or 1 800 332 344
Issued By: _ — Permittee Signature: �r� C/ 4^GNUS -, k"
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.
111?
Electrical Permit Application FOR OFFICE I SE ONE)
t g is . City of Tigard Received ,..,
13125 SW Hall BlycL,Tigard,OR 9 ns,
-4'..ki - ib tL
- Phone: 503.639.4171 Fax 5O3.59: 7'■ ,s.,, : Other Pemut Al C4'. , .....dip .. ,
■
Inspection Line: 503.639.4175 121 See Page2 or
T:Ign R D 0 .e s,sc e 1 FEE r2 ,1 u r i s:
1 .-4) Supplemental Information
Internet www.tigard-or.gov
V:`,.*--..`x-.6",■;.Z Tri"-.1.4;'1:0:'ViIiietiViiiiiiiie":5Y'-,v:2: , .- ....,:-!;;;,cAr-• ;"•;i!-, ;(-:;i.2"! '..;,. .,-,:,-'','.:'-:",'',-,::•-,;:;-':..,'.;:,4, 41.4V* : :1,:,:;..:"..-y,--.!],l,
-(, 4.4;.,:.- , ,7.. ..-`41.- •-..;,;. ::,(',','..1='7:%''''..."--!1.V7;4', .:'.t:,7! ...-•‘ . '','-' ' '' '-3- ": -'-''-'
Please check all that apply(submit 1 sets of plans w/items checked below):
0 New construction p Addition/alteration/ -;rSrent
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: .'
where the available fault current 0 Marinas and boatyards.
,47:,,L,q;‘,:::-;:::;---;';;',, -?r,',-,'..,. .,`;;'c::-f:: exceeds
10,000 amps at 150 volts or 0 Floating buildings.
'' -'-'-:''' ".".'''''' '''''''"`-'-'-''''-'-''''-:':''-‘4%-------'''''''''•"' less to ground,or exceeds 14,000 El Commercial-toe agricultural
D l-and 2-family dwelling ria CommercialTmdustrial 0 Accessory building amps for all other installations. buildings.
O Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
,._- .., 0 Emergency system. larger separately derived system.
46,,-:;ATE i,Wiigkiiiiiiiiblivaato : ,..):, -:..-t-,-,:-..,,...,.,-_,,t El Addition of new=TOT load of 0"A","E","1-2","1-3",
Job no.: Job site address: 1 Aco 50 sk) 1, Ica( 61 vci 100HP or more. occupancy.
0 SiX OT more residential units. _ 0 Recreational vehicle parks.
aty/State./ZIP: .-I--\
I ,T-ra ,0 e-- 0 Health-care facilities.
0 Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
Suite/bldglapt no.: f project name:S ifhiapir 1C4.0 CA 1 0 Service or feeder 600 amps or more
;,:t*-. 4: '-.':::::';':;',',,,if --i'`...f..014$04E:litit*-='1:.;':'-:';itc-=';:::.4.70..", ,
Cross street/directions to job site: netion 1 Oty. 1 Pot. j Total I •
New residential single-or multi-family dwelling unit
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq.ft or less 168.54 4
Ea.add'l 500 sq.ft or portion 33.92 1
Tax map/parcel no.: _ Limited energy,residential 75.00 2
:-.'7,;-,-,,:fe,,,,_..z,-:-n,c1.--r.:V.,,;,:_tv.„,;,:e..-:.z;1,1,::-•,?,!..,.-:1-4-14- 161,4-14:Arciikr-r'-,...4r.-:-.?-;.1-,:q..f.- (with above sq ft)
5~;-'',--,-'-':-:'F,'--,,-=':'.',1-•,'-,--",-:',-,'`,'_ •=•-:.-4,--er,-.'- ..,,,',.,..- ' -,..--.....,:.4,-.,,.2,-N,;'....."...t- ...,,,':,,,_•;-1,F.,-.
Limited energy,multi-family 75.00 2
Link) ■fi)14-0..5e esnev-vo\ (.,13',(%,,ri_ residential(with above sq.ft) _
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
akikilfifirt7,§1Eit:!fi5-1;*-;:;:4::: 1g. ,-,V. 5 .-;0.07: ::T.:4.?.fi:=f --27 201 amps to 400 amps 13156 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/ZEP: relocation
Phone:( ) I 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 16854 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
%!-,,,;;;;A; Z;g:=:-.11(AVAIWNIA:s-3 -41:4-:=e-:•1"21::;:fig613500.-Viiiedfit.2if,?-::-::::: above service or feeder fee,
742 2
B.Fee for branch circuits without
Business name: 14.01eil civil Ocea-;a a NI( • service or feeder fee,first
J t circuit
56.18 2
Contact name: privi1/411 Wale_ branch
Each add'l branch circuit 7.42 2
Address: 1,33 ciJ3c5 (91cLp_al -e, Miscellaneous(service or feeder not included)
Each manufactured or modular
City/State/ZIP: fi?( Of_ dwelling,service and/or feeder 67.84 2
Phone:(563) NbC1-(41(0 DO I Fax .663) .a. 1--1 08
k 1 . Reconnect only
Pump or irrigation circle 67.84
67.84 2
2
Sign or outline lighting 67 84 2
A: 12,-,0$44.: OttiVi-17';:i.1:=-R .P.,:^ : ...:',-k.',§.. -', 5,.;;.'f:-P,.."7-i'A'Z', Signal circuit(s)or limited-energy I
Business name: 1\v",exl 444V l ltti or extension over a.lL o wablPage a y I of 7 th1e 7 a"bove
2
Address: 1,-5b C G 6u ä' -On St . Additional inspection(1 hr min) 6625/hr
hwestigation(1 hr rain) 6625/hr
City/State/DR 1-0\i\kfaj4 A 0 V CM ' -() D-
Industrial plant(1 hr min) 78.18/hr
l
Phone:( 0 roCt, itkaYO I Fax:( lb 1)-3q-7 0-3 asivctions for which no fee is
specifically listed(A br min) 90.00/hr
CCB Lic.:.-o--5 1, 6s- Electrical Lic.: d6Piq CAE-Suprv.Lic.: g..6 iti5a-76 mixfomatmiti.:j,tiow.,.,..-; f_...-,..-N-•:::-;:,
Subtotal:
Suprv.Electrician signature,required: 4.01:-% / ._. 4E—ii :' '.__. Plan review(25%of permit fee):
( 1_ 7
Print name: 7, 3Ae a.o •.ro IAA(7, Date: -7.471 13 State surcharge(12%of permit fee):
-- TOTAL PERMIT FEE:
Authorized signature: ).-. ..K114.--r% This permit application expires if a permit is not obtained within 180
Print name: t- -ktYllYlA S a (°lc n Date:1— n -13 * N of days after it has been accepted as complete.
umber inspections allowed per permit
I:\linurhus\Permirsua.c-Permaappstoe 07/01/10 440-4615T(11/05/COM/WEB
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
12650 SW HALL BLVD, TIGARD, OR, 97223
Commercial - Electricial Limited Energy
199 Electrical final
2014-01-08 00:00:00
ELR2013-00197
PASS - No C of O
Violation Summary:
Inspector Contractor