Permit (87) `• CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
l j � DEVELOPMENT SERVICES PERMIT #: ELR2005 -00052
, I ° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/14/2005
PARCEL: 2S115BA -02500
SITE ADDRESS: 16200 SW PACIFIC HWY W ZONING: C -G
SUBDIVISION: TIGARD TOWNE SQUARE LOT: 001 JURISDICTION: TIG
Project Description: Relocate thermostat.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SN INVESTMENT PROPERTIES WILLAMETTE HVAC
1121 SW SALMON STE 400 27655 SW LEPLEY LN
PORTLAND, OR 97205 HILLSBORO, OR 97123
Phone: 503 242 - 2900 Phone: 628 - 6841 XPIRE
Reg #: LIC 56951 as 1
ELE 34- 346CRE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[TAX] 8% State Surchari 3/14/2005 $6.00
[ELPRMT] ELR Permit 3/14/2005 $75.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to fol adopted by the Oregon Utility Notification Center. Those rules are set forth in O ' 952 - 001 -0010
throug OAR 952 -0 1 -' r II. 'ou may obtain copies of these rules or direct questions to OUNC . 03- 246 -6699.
Issued y: /i r P ermittee Signature y ;!2�/- " -if
P
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'N DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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
Date/B : ,..At ' .1 '
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ,45414 ' A
Date/B : Other Permit:
. i rl
Inspection Line: 503.639.4175 Date Ready/By: Mil PI See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: - Supplemental Information
,
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ID New construction Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
0 Demolition Other: SO ervice over 320 amps - rating 0Buildng over 10,000 sq. ft.,
d OF 'ail•igkktieiloO - . *-4 of 1- and 2-family dwellings 4 or more new residential
2-'''': l', :: r -`•-:::" :',. lei. - -:_-. ... s-- ,•••• , ,-: ....•,-..',.!,„ - - `'' =g_:,...
0 1 and 2 dwelling Commercial/industrial 0 Accessory building OSystem over 600 volts nominal units in one structure
['Building over three stories OFeeders, 400 amps or more
o Multi Li Master builder 0 Other:
DOccupant load over 99 persons ['Manufactured structures or
,, , .. , _„ ,. ,,, . „ , . ,. • • •- ••,„ • .. .. ,• , .
7,..:-.,'■c; iOI3: :::;'-;-,;,-,-_:%':; •:•,:`, •:,.., I:Egress/lighting plan RV. park .
0Health-care facility El Other:
Job no.: Job site address:/C) z ) 7 c ,4-, be
Submit 2 sets of plans with any of the above.
7
City/State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: VI Project name: V.\.)c)1-- ..:::: i :. - • --
"
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.: .
Limited energy, non-residential 75.00 • 2
. •WcW , .T-A Y - --' -'t.'''" .!. t! :, Each manufactured or modular
dwelling, service and/or feeder 90.90 2
c- /Or". ckk•- -- c....i...-. o S7 Services or feeders installation, alteration, and/or relocation
200 amps or less _ 80.30 2
. ' 'fl:•4 isr ' •',"-.':.'-- ,',.'",.-•••..•:,
-, 7.; .,-;-'-:..:' .:' ,•• • ;, , ',.. - 1.; -.'' . • -;:•-• ' -'.; :- "..',--`, fi'?S!k,-i• ." (7 , ,, - .12 , - 2°1 amPs t° 4°° s 106.85 2
amP
401 amps to 600 amps 160.60 2
Name: '. /t ) hi Lltf77 ii',4 Pcin ts _......
601 amps to 1,000 amps 240.60 2
Address: // P/L 5 e arl/I. - P*0U V (74r) Over 1,000 amps or volts 454.65 2
Reconnect only - 66.85 2
City/State/ZIP: V7 Cr) 04- F-7.9e) Temporary services or feeders installation, alteration, and/or
Phone: 5b 24 d ”10 4 0a I Fax: ( ) relocation
200 amps or less , 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
;- :::; tr r 'I.: .:,-. A. Fee for branch circuits with
service or feeder fee, each -
6.65 . 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
46.85 2
each branch circuit
Address: Each addl branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 . 2
Phone: ( ) I Fax: : ( ) Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
1.'''';.1,-Y '# '•.,;,,'--'' ''.:toNAkAcitilt- ,,, ' , 'I.,„;,:- „ - :`,4A,i.•„1:,:'• , " , ;V! . , : z4 , ,.: y t',..1.e energy panel, alteration, or
ra
extension.Aeok Page 2 7••• 2
Business name: ...A‘41
Each additional inspection over allowable in any of the above
Address: . /. .c, .23 .,t( f ."7 3 " (-e/ Per inspection 62.50
City/State/DP:?lakk/41-"e CA.,- 4 ? ?c2 Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax ( ) Industrial plant per hour 73.75
': .-:,-. "4 -- '-: :ELKTRCC:4;:kgRMIttEa*,-.E:25p
CCB Lic.: S'g .1 0- •
1 Electrical Lic.: Suprv. ic.: %O s--ZS..:j Subtotal 7)
Suprv. Electrician signature, required: ‘ • _ Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: / af4h. el ,57,c...ekzeol Date:
TOTAL PERMIT FEE 8/ .,e)C)
Authorized Signature: . This permit application expires If a permit Is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board
•* Number of inspections per permit allowed.
i:\Building\Permits\ELC-PerrnitApp.doc 12/03 440
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
SIREN L W01t 0N :E775.57:
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:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
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\ELGPermitApp .doe 04/03