Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11111 .7
COMMUNITY DEVELOPMENT Permit#: ELR2018-00001
TtGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/02/2018
Parcel: 1 S 136AD04100
Jurisdiction: Tigard
Site address: 11501 SW PACIFIC HWY 201
Project: Barnett Firm Subdivision: VILLA RIDGE Lot: 2
Project Description: HVAC system.
Contractor: AMERICAN HEATING INC Owner: CJAM LLC
5035 SE 24TH AVE 10200 SW GREENBURG RD STE 340
PORTLAND, OR 97202-4765 PORTLAND, OR 97223
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/02/2018 $75.00
Type of Use: COM 12%State Surcharge-Electrical 01/02/2018 $9.00
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 0 A' 952-001-0090. You may obtain a c•• -s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �
- Permittee Signature: /ffff `
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 ONLY
City of Tigard � Received
.11 M' 13125 SW Hall Blvd.,Tigard,OR 97223,,---, „ f -^ r PlanDate/BR : �� ", ,37,.._ PermitNo.: �+1 +��wl (/�_� V:{�i
S Phone: 503.718.2439 Fax: 503.598.1960 Plan RevieN 9�D�(.' J L<✓�V
t Date/By: Other Permit: y i 7-.0:487
Ins
Inspection Line: 503.639.4175 - r
GARD
Internet: www.tigard-or.gov p1 Date Juris
S See Page 2 for
I1
upplemental Information
PISA ;REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0Building over three stories.
El Demolition 0 Other:
where the available fault current
0 Marinas and boatyards.
k ,„ ccitt rtii*o*iii I0t1N ' 0 A; -- ' exceeds 10,000 amps at 150 volts or
', .. "" >" 0 Floating buildings.
❑ 1-and 2-familydwellingless to Bound,or exceeds 14,000 0 Commercial-use a
®Commercial/industrial ❑Accessory building amps for all other installations. buildings. agricultural
0 Multi-family ❑Master builder
0 Other: 0 Fire pump. 0 Installation of 150 KVA or
SI' � D 0 Emergency system. larger separately derived system.
>, 4 p .� . ❑Addition of new motor load of ❑"A","E","1-2","l-3",
Job no.: J Job site address: 11501 SW Pacific HWY 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 0 Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:201 Project name:Barnett Firm ❑Service or feeder 600 amps or more.
" S
Cross street/directions to job site: 4. EHL3I:l . . - " i,,
Description I Qty, I Fee. I Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
1,000 sq.ft or less 168.54 4
Subdivision: Lot no.:
Tax map/parcel no.: Ea.add'1500 sq.ft.or portion 33.92 1
�e Limited energy,residential
DESORiI'Tlolsf Ql`Wold d - (with above sq.ft.) 75.00 2
If .
low voltage wiring and T-stats Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy " ! El See Page 2
Services or feeders installation,alteration,and/or relocation
i 1 1. d PR0P6T'' 6- E1Nor, / 200 amps or less 100.70
Name: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
401 amps to 599 amps 168.54 2
Owner signature: Date:
Branch circuits—new,alteration,or extension,per panel
0PI,I AI!J'I ' 0,. '!a itCd*84 ji SO* :ii, T A.Fee for branch circuits with
above service or feeder fee,
Business name:American Heating Inc. each branch circuit 7.42 2
Contact name:Brad Manchester B.Fee for branch circuits without
service or feeder fee,first
Address:5035 SE 24th Ave.
branch circuit 56.18 2
Each add'1 branch circuit 7.42 2
City/State/ZIP:Portland,OR.,97202 Miscellaneous(service or feeder not included)
Each manufactured or modular
Phone:(503)239-4600 Fax::(503)239-7038 dwelling service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail:brad@americanheating.net
1Co 1 Rt1CflR� Pump or irrigation circle 67.84
w _. c Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)or limited-energySee
panel,alteration,or extension. 1 Page 2 I . 2
Address:Brad Manchester 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
CCB Lic.: 33135 Electrical Lic.: 4.993CRE Su try.Lic.: 2640LEB specifically listed(/hr min) 90.00/hr
Suprv.Electrician signature,req fired: ET E IRI ALPI RMIT "PEES
tiP Subtotal
Print name: T Steve Young Date: 12-8-17 Plan review(25%of permit fee):
Authorized signature:
/ A,7c k State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Print name: Brad Manchester Date: 12-8-17 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
I_\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB