Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II 2 . COMMUNITY DEVELOPMENT Permit#: ELR2014-00210
T[G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/17/2014
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11101 SW GREENBURG RD
Project: Computer Solutions Tech Subdivision: HILLSBORO Lot: PTS 1-2
Project Description: Low voltage for HVAC
Contractor: ARROW MECHANICAL Owner: GREENBURG SPACE CENTER LLC
10330 SW TUALATIN RD PO BOX 91305
TUALATIN, OR 97062 PORTLAND,OR 97291
PHONE: 503-692-1565 PHONE:
FAX: 503-691-1879
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/17/2014 $75.00
12%State Surcharge-Electrical 09/17/2014 $9.00
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 $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 a -• •ance .•proved 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' TION: Oregon la, requir,.- •u to follow the rules adopted by the Oregon Utility Notification Ce Those rule are set forth in OAR
952-001-1110 through OAR 952-001—'0-• • ma 4.btain a copy of the rules or direct questions to OUNC by calling 503.23 : 0.332. 4 4.
I //
Issue. By: I)� i / Permittee Signature: i ,� _
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 ONLN
Received �D
City of Tigard CINI.:1.) Dat eive �'/7 / ,�1; Permit No.: )/ 02/()111111 0 '� 13125 SW Hall Blvd.,Tigazd,OR 93 1*1 `1�1� Plan Review Other Permit: ?((� �/��-e� j
Phone: 503.718.2439 Fax: 503.598iJ1 r� Date/By:
TIGARD Inspection Line: 503.639.4175 �,(` y Date Ready/By: saris ® See Page 2 for
Internet: www.tigard-or.gov .e Vt"eg)‘ Notified/Method: Supplemental Information
TYPE OF •',∎,;1 9%`. �) PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked below):
{New construction ❑Addition/altera on/replacement El Service or feeder 400 amps or more El Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATECoRY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ID floating buildings.
u( 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
❑Emergency system. larger separately derived system.
JOB SITE INFO N AND LOCATION ❑Addition of new motor load of ❑"A", E","l-2","1-3",
yr t�N aV ,/, I• I Six or or more. occupancy.
Job no.: 43� Job site ad 7GA
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ilmjd 64 l ri3 ❑Health-care facilities.
cat ons. ❑Supply voltage for more than
C� ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: C'Lo�,a,�,pvTt 57iJ'T1�S / ,�. ❑Service or feeder 600 amps or more.
/ FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I TOW 1 •
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
75.00 2
DESCRIPTION OF WORK (with above sq. )
ft.
J) Limited energy,multi-family 7500 2
�,0'.„/ V,i T/1l,ft T# •t r"►.e, '.1.47" f!i i residential(with above sq.ft.)
IT vi-- Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
IROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Tit 401 amps to 600 amps 200.34 2
Name: ` FA die i U 7 601 amps to 1,000 amps 301.04 2
Address: z i 3‘,p Ml M O tC t,,,,,Al") pt, Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: ll &i_o eNc 17 ' l relocation
Phone:(9,3 );Li ,5— 63 5 7 , 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 168.54 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
® APPLICANT I to CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name:Arrow Mechanical B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Contact name: D i I G ,A� A/1( branch circuit
ff Each add'l branch circuit 7.42 2
Address: 10330 SW Tualatin Rd Miscellaneous(service or feeder not included)
Each manufactured or modular 67 84 2
City/State/ZIP:Tualatin OR 97062 dwelling,service and/or feeder
Phone:(503)692-1565 Fax: :(503)691-1879 Reconnect only 67.84 2
- Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Arrow Mechanical panel,alteration,or extension. Page 2 " ' 2
Each additional inspection over allowable in any of the above
Address: 10330 SW Tualatin Rd Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
City/State/ZIP:Tualatin OR 97062 Industrial plant(1 hr min) 78.18/hr
Phone:(503)692-1565 Fax:(503)691-1879 Inspections for which no fee is
90.00/hr
specifically listed(V2 hr min)
CCB Lie.: 5193 Electrical Lic.: 34-47CLE Suprv.Lie.: 4647LEB ELECTRICAL PERMIT FEES
Subtotal: -75", aaV
Suprv. Electrician signature,required: i Plan review(25%of permit fee)
Print name: John Chamberlain Date: q/,s/i Y State surcharge(12%of permit fee): 9,0 d
•
TOTAL PERMIT FEE .r..),
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Mott Mine Date: CIAO // • Number of inspectionsallowed per permit.