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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT I COMMUNITY DEVELOPMENT Permit#: ELR2014-00029 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/20/2014 T t t;A C;L7 g Parcel: 2S103DD00800 Jurisdiction: Tigard Site address: 13815 SW PACIFIC HWY 90 Project: H&R Block Subdivision: MELROSE Lot: 7-8 Project Description: HVAC system. Contractor: AMERICAN HEATING INC Owner: D W SIVERS CO 1339 SE GIDEON ST 4730 SW MACADAM AVE#101 PORTLAND, OR 97202 PORTLAND, OR 97239 PHONE: 503-239-4600 PHONE: FAX: 503-239-7038 FEES Description Date Amount Specifics: Restricted Energy Permit 02/20/2014 $75.00 12%State Surcharge-Electrical 02/20/2014 $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 may obtain a copy• . .. . d i r e c t• questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: - _ _. 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 A llcat10I1 FOR OFFICE USE ONLY II or City of Tigard CEIVE i ;i' Permit No.. " • , _ se 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: T I G A R U Inspection Line: 503.639.4175 FEB 4 2014 Date Ready/By: B See Page 2 for Internet: www.tigard-or.gov pp Notified/Method: ,�j Supplemental Information 'rte. of rub rEGtlse�ilr• 1PLAPI REVIEW ❑New construction ®Addition/altBURMIGAVISION Please check all that apply(submit 1 sets of plans w/items checked below): ❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories. where the available fault current ❑Marinas and boatyards. CAGY 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 ®Commercialindustrial ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or .104 SITE om ❑Emergency system. larger separately derived system. ❑Addition of new motor load of ❑"A" "E","1-2","1-3» Job no.: Job site address: 13815 SW Pacific HWY IOOHP or more. occupancy. ❑Six or more residential units. ['Recreational vehicle parks. City/State/ZIP:Tigard OR 97234 ❑Health-care facilities. ❑Supply voltage for more than ,n ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.:90 Project name:f Rink-Park 1 IL f'`-© 'L.k.— ❑Service or feeder 600 amps or more. FEE SCHEDULE street/directions to job site: Description IIIEQt. I.E 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 1 Tax map/parcel no.: Limited energy,residential DESCRIPTION OP WORK (with above sq.ft.) 75.00 2 Limited energy,multi-family low voltage wiring residential(with above sq.ft.) 75.00 2 Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation ❑ lRo enrY owroot 1 0 T ANn 200 amps or less 100.70 2 1 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 Address: 601 amps to 1,000 amps 301.04 2 City/StateJZIP: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Phone:( ) Fax:( ) relocation . 200 amps or less 59.36 1 Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2 Owner signature: Date: Branch circuits—new,alteration,or extension,per panel cs APrI.ICAItrr I 0 CONTACT nom A.Fee for branch circuits with - above service or feeder fee, 7.42 2 Business name:American Heating Inc each branch circuit B.Fee for branch circuits without Contact name:Brad Manchester service or feeder fee,first 56.18 2 branch circuit Address:5035 SE 24th Ave Each add'I branch circuit 7.42 2 City/StatelZIP: Portland OR 97202 Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Phone:(503)239-4600 Fax::(503)239-7038 dwelling,service and/or feeder Reconnect only 67.84 '_ E-mail: Pump or irrigation circle 67.84 '_ CONTRACTOR Sign or outline lighting 67.84 2 Business name:American Heating Inc Signal circuit(s)or limited-energy I See 7 en panel,alteration,or extension. Page 2 2 Address:5035 SE 24a'Ave Each additional inspection over allowable in any of the above City/State/ZIP: Portland OR 97202 Additional inspection(1 hr min) 66.25/hr Investigation(1 hr min) 66.25/hr Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is �/hr Lic.: 33135 Electrical Lic.: 26 3CRE Su rv.Lic.: 2640LEB specifically listed eh hr min) ELECTRICAL PERMIT PUS Suprv.Electrician signature,required: Subtotal: 75,E Print name: T Steve Young Date: 2/3/14 Plan review(25%of permit fee): State surcharge(12%of permit fee): esd Authorized signature ,ii nG ,c TOTAL PERMIT FEE: ,T.co This permit application expires if a permit is not obtained within 180 Print name: Brad Manchester Date: 2/3/14 days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\Buildng\Permits\E1.C_PermitApp_EIR_ERE.doc Rev 05/21/2013 440.4615T(I1/05/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 13815 SW PACIFIC HWY 90, TIGARD, OR, 97223 Commercial - Electricial Limited Energy 199 Electrical ﬁnal 2014-03-14 00:00:00 ELR2014-00029 PASS - No C of O Violation Summary: Inspector Contractor