Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111111 q III COMMUNITY DEVELOPMENT Permit#: ELR2014 00058
Date Issued: 03119/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S101AD03500
Jurisdiction: Tigard
Site address: 6600 SW HAMPTON ST
Project: Pacific Parkway Center Subdivision: WEST PORTLAND HEIGHTS Lot:
Project Description: (9)RTU's for TI
Contractor: HVAC INC Owner: PACIFIC REALTY ASSOCIATES
5188 SE INTERNATIONAL WAY ATTN: N RIVEN
MILWAUKIE, OR 97222 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE 503-462-4822 PHONE
FAX 503-462-6555
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/19/2014 S75 00
12%State Surcharge- Electrical 03/19/2014 59 09
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 arid Reports(Conditions)
This permit is ass ed-nublect 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 cordance 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 ATT NTION Oregon law •-res you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 10 th •ugh OAR 952-•• -0090 may obtain a copy of the rules or direct questions to OUNCrby call 2 1987 or 1.800.332 44
�.� '
Issued . Permittee Signatsul3: clflyCCJt..__
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' Uate:
LICENSE NO
Call 503.539.4175 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 ``�� VO FOR OFFICE t Sh: t1.1.1
11111 City of Tigard `V DatelB
• 13125 SW Hall Blvd.,Tigard •• ''2 Plan Review - 1 tiro IZEMNIMINSI
a Phone: 503.718.2439 F. I I . 9.. .I ,L41� DaleB Other Permit— _ p
TI G A R U Inspection Line: 503.639., 1 O 6 Date Ready/By: 0 See Page 2 for
Internet: www.tigard-or.gov �P% `\ �a�_`t, Notified/Metbod: Supplemental Information
TYPE OF R'O�R�(Q�{ \N� `` PLAN REVIEW
❑New construction ® Addition/alteratlaltj end Please check all that apply(submit j sets of plans writems checked below):
❑ Demolition ❑Other: ` �\��11 ❑Service or feeder 400 amps or more ❑Building over three stories.
QV- where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSPRUCITON 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 ® Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑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","1-2","1-3",
Job no.: Job site address:6600 SW Hampton St. IOOHPor more occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Portland,OR 97224 ❑Health-care Facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Pacific Parkway Center ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ' Description I Qty. I Fee. I Taal 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 75.00 2
DESCRIPTION OF WORK (with above s4 ft.)
Limited energy,multi-family 75 00 2
Low voltage control wiring for HVAC equipment residential(with above sq.ft.)
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER f ❑ TENANT 1 201 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:( ) l 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 168.50 2-
Branch circuits–new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
❑ APPLICANT 1 above service or feeder fee,
0 PERSON each branch circuit 7 42 2
Business name: HVAC,Inc. B.Fee for branch circuits without
service or feeder fee,first
56.18 2
Contact name:Jody DePew branch circuit
Each add'I branch circuit 7 42 2
Address:5188 SE International Way Miscellaneous(service or feeder not included)
City/State/ZIP:Milwaukie,OR 97222 Each manufactured or modular 67.84 2
dwelling.service and/or feeder
Phone:(503)462-4822 Fax: :(503)462-6555 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:jodyd @hvacincorp.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy•
Business name: HVAC,Inc. panel alteration,or extension I Page 2 2
Each additional inspection over allowable in any of the above _
Address:Same as above Additional inspection(t hr min) 66.25/hr
City/State/Z1P: Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:( ) Fax:( ) Inspections for which no fee is 90.00/hr
specifically listed(i hr min)
CCB Lic.: 50897 Electrical Lie.: 26-571CLG Suprv.Lie.: 3796LEB ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: '\/ ,�,' CI't t,� .-V Subtotal:
' Y Ur'� /" Plan review(25%of permit fee):
Print name: Mike Schmidgall Date: 3/6/14 Slate surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature: This permit application expires If a permit is not obtained within 180
Print name: Jody DePe Date: 3/6/14 ' days after It has been accepted as complete.
Number of mspections allowed per permit
1.tBuilding1Permite\ELC-PttmitApp doe 07/01/10 440-401 STf I I/05/00 4W EB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
• Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
® I IVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
1.113uilding\Permits\ELC•PermitApp.doc 0 7/01/10