Permit INy �� CITY OF TIGARD .�� ELECTRICAL RESTRICTED ENERGY PERMIT
. COMMUNITY DEVELOPMENT Permit#: ELR2015-00085
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/30/2015
Parcel: 2S101AA00100
Jurisdiction: Tigard
Site address: 12300 SW 68TH AVE
Project: Landmark Ford Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: HVAC system. 4/6/15,reprinted to correct address and parcel number.
Contractor: AMERICAN HEATING INC Owner: CORLISS, JAMES L&CORA K
5035 SE 24TH AVE LEASE TO: FORD LEASING
PORTLAND, OR 97202-4765 DEVELOPMENT COMPANY
PO BOX 23970
TIGARD, OR 97281
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics:. Restricted Energy Permit 03/30/2015 $75.00
12%State Surcharge-Electrical 03/30/2015 $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. ATTENTI . rego aw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 rough OAR 952- 1-0 u obtain a copy of the rules or direct questions to OUNC by callin 7 or 1.800.332.2344.
Issued B � _ Permittee Signature: �'(7 L-4--e--C�
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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
3 COMMUNITY DEVELOPMENT Permit#: ELR2015 00085
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/30/2015
Parcel: 2S101AA00101
Jurisdiction: Tigard
Site address: 12000 SW 66TH AVE
Project: Landmark Ford Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: HVAC system.
Contractor: AMERICAN HEATING INC Owner: CORLISS, JAMES L&CORA K
5035 SE 24TH AVE LEASE TO: FORD LEASING
PORTLAND, OR 97202-4765 DEVELOPMENT COMPANY
PO BOX 23970
TIGARD, OR 97281
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/30/2015 $75.00
12%State Surcharge-Electrical 03/30/2015 $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
952-001-0010th 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. -
Issued B 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 Application FOR OFFICE USE ON E.=
City of Tigard n��'`E,v IP Eew Permit No . 0
1,1 - .. 13125 SW Hall Blvd. Tigard,OR 97223 V Phone: 503.718.2439 Fax: 503.598.19 DateBy: Omit:1 � c�ois�vo[s-(
T[G A RD Inspection Line: 503.639.4175 ►1 AR i 3 Date Ready/By: Ions: l See Page 2 for
Internet: www.tigard-or.gov .1�1�� / tifed/Method: Supplemental Information
TYPE OF WORK CI` , NG O v ION
PLAN REY.EW
❑New construction ®Addition/alteratior � 9ment
Please check all that apply(submit 1 sets of plans w/items checked below):
❑Service or feeder 400 amps or more Cl 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 [1 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 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of
Job no.:315137 Job site address: 12395 SW 69th Ave 100lIP or more. occupancy.
❑Six or more residential units. []Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 ❑Health-care facilities. []Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Landmark For Replace AC ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Uescriptio. . I Fee. I 7bw 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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
(with above ft.) 75.00 2
DESCRIPTION OF WORK ( sq. ) ____
Limited energy,multi-family
75.00 2
low volt wiring residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
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
Over 1,000 amps or volts 552.26 2
City/State/ZIP: 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
® APPLICANT ® CONTACT PERSON 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:Brandon Hutchinson service or feeder fee,first 56.18 2
branch circuit
Address:5035 SE 24th Ave. Each add'I branch circuit 7.42 2
City/State/ZIP: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 2
E-mail:b.hutchinson @americanheating.net Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)or limited-energy 1 See
panel,alteration,or extension. Page 2 2
Address:Brandon Hutchinson Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OR.,97202
Investigation(1 hr min) 6625/hr
Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lic.: 33135 Electrical Lic.: 26993CRE Suprv.Lic.: 2640LEB specifically listed(V2 hr min)
"'
Suprv.Electrician signature,required: !f / ELECTRICAL PERMIT FEES Subtotal
Print name: T Steve Young Date: O 'iS Plan review(25%of permit fee).
State surcharge(12%of permit fee):
Authorized signature: ///e4k/ TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Brandon Hutchinson Date: ./• 0•/. days after it has been accepted as complete.
• Number of inspections allowed per permit.
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•
•Electrical Permit Application—City of Tigard
Page 2—Supplemental I nformation
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. Fee I Tet•' I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.O1 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to
25 kva 200.34 2
nBurglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
n Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with
552.26 2
Ti Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
Ti Each additional inspection over allowable in any of the above:
Other: Each additional inspection is
66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is
specifically listed(Y hr min) 90.00 hr
COMM ERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 subtotal:
(SEE OAR 91 8-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
n Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
Fire Alarm Installation
AC
Ti Instrumentation
n Intercom and Paging Systems
Ti Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
Ti Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
L\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013