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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT IN a COMMUNITY DEVELOPMENT Permit #: ELR2013 -00310 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2013 T [ [;;� It D g Parcel: 1S135BD00100 Jurisdiction: Tigard Site address: 9600 SW OAK ST Project: Plaza West Subdivision: ASHBROOK FARM Lot: PTS 5 & Project Description: Low voltage for replacement HVAC units #5 & #8. Contractor: HUNTER DAVISSON INC Owner: SUN LIFE ASSURANCE CO OF CANADA 1800 SW PERSHING ST BY NORRIS BEGGS & SIMPSON PORTLAND, OR 97202 121 SW MORRISON ST #200 PORTLAND, OR 97204 PHONE: 503 - 542 -3628 PHONE: 503 - 273 -0381 FAX: 503 - 542 -3654 FEES Description Date Amount Specifics: Restricted Energy Permit 12/10/2013 $150.00 12% State Surcharge - Electrical 12/10/2013 $18.00 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 $168.00 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 spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. T ose s are set forth in OAR 952- 001 -0010 through OAR • . - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 • 1 ;00. 4 / 344. Issued By: t 9 , � r / Permittee Signature: a it 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 ONLY City of Tigard Deate/BVyy /a e/ /...3 PermitNo.: Eu 1 3'1, - )03/6 114 a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: - T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction U 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 ❑ 1- and 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations. buildings. El Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. A ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job no.: 13291Q Job site address: cre eep CIA) 5.4...s 100HP or more. occupancy. p ❑ Six or more residential units. ❑ Recreational vehicle parks. El City/State /ZIP: _ t � ` a — 2"L'� ❑ Health -care facilities. ❑ Supply voltage for more than Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: c) ---..,, ,, Project name: AeA W Raicaiiii ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site i � � . �� Description I Qty. I Fee. I Total I " New residential single- or multi - family dwelling unit. - S ' ©3 -S Includes attached garage. Subdivision: l Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 V.pttic.)2,rne ,s S ■ Limited energy, (with above s multi-family 75.00 2 ` \ � residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 I, PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 lip Name: / ` I .� S (�f 401 amps to 600 amps 160.60 2 `��, ""'^`""' "` ��, t rti l 1 601 amps to 1,000 amps 240.60 2 Address: 12( t 0 C SOO J ?CO Over 1,000 amps or volts 454.65 2 City/State/ZIP:'C # DC / 111710 c4. Temporary services or feeders installation, alteration, and /or relocation Phone: (503) l -73-0 t l Fax: (, 3) 7 —02 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 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, 6.65 2 each branch circuit Business name: ii "( D'It eLf1(l� . 1,(1C-. B. Fee for branch circuits Contact name: Zak without without service or feeder fee, 15 2 n - - first branch circuit Address: `S p % � s �)-t- Each add'( branch circuit I 6.65 I 12 `�"^^`��' Miscellaneous (service or feeder not included) City/ State/ZIP: ' C) 1 07- Each manufactured or modular �t7� v Y 7 l W L n _ 90.90 2 1 1 dwelling, service and/or feeder Phone: (w3) Z -r Fax: : ( ) 59 1., -, 54 Reconnect only 66.85 2 E- mail: 'Z +� ` Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: --( .r� �C�✓ � ;�� ( e p a ne i,(a) er or t o n, or n al, alteration, or a Address: C 5�� /� extension. Describe: 'l Page 2 /6 2 City/ State/ZIP: j- l -1 if,Z Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (5j) . 2_3 — 04 I Fax: (5) 547... - 3651.1 Investigation per hour (1 hr min) 62.50 CCB Lic.: ! G /2 Electrical Lie.: -. ej Suprv. L' .: Industrial plant per hour 73.75 ` ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: ` -3 / 4- Print name: /1 I,, i Date: �Z Plan review (25% of permit fee): ----- l �ll 65 * �, Z State surcharge (8% of permit fee): / . CO Authorized signature: f ft. TOTAL PERMIT FEE: `" od This permit application expires if a permit is not obtained w 180 Print name: • Date: (� �3 days after it has been accepted as complete. ' Number of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 05t23/06 440.4615T(I1/05 /COM/WEB