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Permit (176) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT II Permit#: ELR2017-00143 Date Issued: 08/01/2017 T( a.r RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102CC00500 Jurisdiction: Tigard Site address: 13500 SW PACIFIC HWY 70 Project: Bi-Mart Subdivision: None Lot: None Project Description: Low voltage for HVAC Contractor: HVAC INC Owner: MERCER INVESTMENTS LLC 5188 SE INTERNATIONAL WAY 629 NW SEAN CT MILWAUKIE, OR 97222 BEND, OR 97703 PHONE: 503-462-4822 PHONE: FAX: 503-462-6555 FEES Description Date Amount Specifics: Restricted Energy Permit 07/25/2017 $75.00 12%State Surcharge-Electrical 07/25/2017 $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. Tho rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Su may obtain a co of the rules or direct questions to OUNC by calling 503.232.19i7i r .800 2344. Issued By: ti ZLL� 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 ApplicRKEIVE/) FOR OFFICE USE ONLY Received ' City of Tigard Date/By: t' /7 „,it._ = Permit No.: E"44,49017-t16 143 1111111 ill q 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Phone: 503.718.2439 Fax: 503 J N9 f2 8 2017 Date/By: Other Permit: f 1 Ci A RD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for Internet. www.tigard-or.gov Notified/Method: �ffl Supplemental Information IT' OF TIGARD■irk ,� ”' rT y4 -14-141' �f ' '+ ddills ',<4111.)1,—;,;,-17' v i i-vP' r' it f�i �: 1 . a "` ,. r t D I N E" � �'i ed a ❑New construction El A n/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below): 0 Service or feeder 400 amps or more 0 Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. -''''41'''':1' �`t-1R F :044©I+` , r -'+ -44 exceeds 10,000 amps at 150 volts or 0 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 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 75 KVA or � P� z , ❑Emergency system. larger separately derived system. M1 JOB'4'44'414 4/4/1"' -`oT' RM1I4�N ')VD - CATIQI'I kq ai D Addition of new motor load of ❑"A","E","1-2","1-3", Job no.: Job site address: 13500 SW Pacific Hwy#70 10011P or more. occupancy. 0 Six or more residential units. 0 Recreational vehicle parks. City/State/ZIP:Tigard,OR 97223 0 Health-care facilities. 0 Supply voltage for more than o Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.:#70 1 Project name:Bi-Mart 0 Service or feeder 600 amps or more. ileo, FE 5 Iii111E Cross street/directions to job site: Description I Qty. I Fee. I Total 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.: ,itLimited energy,residential I< a j -" '. DD S'=RIP' 'ION; F WO. ,�'4 is i (with above sq.ft.) 75.00 2 Limited energy,multi-family low voltage controls for new units 75.00 2 g residential(with above sq.ft.) Services or feeders installation,alteration,and/or relocation 200 amps or less 100.70 2 0 P RT O .; �` tt-', r',PIIIIti fi -„ 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation,alteration,and/or relocation Phone:( ) 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 168.54 2 Branch circuits—new,alteration,or extension,per panel Owner signature: Date: A.Fee for branch circuits with et�t �1 '._.��� ax A 'PLtCAA T �$ r rt(CT a'ERBU j i# above serch circuit feeder fee, 7.42 2 each branch circuit 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'l branch circuit 7.42 2 Address:5188 SE International Way Miscellaneous(service or feeder not included) City/State/ZIP:Milwaukee,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 ,�i�� �� r Sign or outline lighting 67.84 2 '41N%1'KAC 1I �I °` ii 1 41- Signal circuit(s)or limited-energy Business name:HVAC,Inc. panel,alteration,or extension. 1 Page 2 7<j a> 2 Each additional inspection over allowable in any of the above Address:same as above Additional inspection(1 hr min) 66.25/hr City/State/ZIP: 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(%hr min) CCB Lic.: 50897 Electrical Lic.: 26-571CLE Suprv.Lic.: 3796LEB ". '=,SLE(,'t')-4-41 ETt gr EE r�;i;„� ;' Subtotal: ' 3 Suprv.Electrician signature,required: T5 Plan review(25%of permit fee): Print name: Mike SchmidpllDate: 6/28/17 State surcharge(12%of permit fee): 9.c t:' TOTAL PERMIT FEE: �'L/ ,LXX Authorized signature: 1 This permit application expires if a permit is not obtained within 180 r days after it has been accepted as complete Print name: Jody DePew)'-' Date: 6/28/17 * Number of inspections allowed per permit. I:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(11/05/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: Fee for all residential systems combined ... $75.00 Check Type KA Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating,Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COM C} '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 ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC-PermitApp.doc 07/01/10