Permit (58) III f
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
4. COMMUNITY DEVELOPMENT Permit#: ELR2018-00118
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2018
TIG.1 R Dg Parcel: 2S103DD01100
Jurisdiction: Tigard
Site address: 13939 SW PACIFIC HWY
Project: Walgreens Subdivision: None Lot: None
Project Description: Low Voltage for HVAC for TI.
Contractor: ARJAE SHEET METAL CO, INC. Owner: WALGREEN CO#5780
8545 SE MCLOUGHLIN BLVD. PO BOX 901
PORTLAND, OR 97222 DEERFIELD, IL 60015
PHONE: 503-231-7717 PHONE:
FAX: 503-230-4888
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/01/2018 $75.00
12%State Surcharge-Electrical 08/01/2018 $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 $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 o 1. 0.332.2344.
Issued By: Permittee Signature: /
>O
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•-Electrical Permit Application RECEIVE: FOR OFFICE tJSE ONLY
City of Tigard AUGReceived
h1 V p Date/B : /P /�/1/_I. 1 0 ��
111 . 13125 SW Hall Blvd.,Tigard,OR 97223 201$ Plan Review
Phone: 503.718.2439 Fax: 503.598.1960Date/B : Related Permit#:
Inspection Line: 503.639.4175 L 1 w r i' .:_.ii.',:FReady Date/By: Juris: El See Page 2 for
TIGARD: Internet: www.tigard-or.govBUILDING oiv;s' k otified/Method: Supplemental Information
T% OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY'OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
ngs.
❑Multi-family 0 Master builder 0 Other: ampsireforallother installations. but
0Fire pump. Installation❑ of 150 KVA or
JOB SITE INEORI ATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#:1171610 Job site address: 13939 SW PACIFIC HWY 100HP or more. ❑"A","E","1-2","t-3",
City/State/ZIP:TIGARD ❑Six or more residential units. occupancy.
['Health-care facilities. ❑Recreational vehicle parks.
Hazardous locations.
0 Supply voltage for more than
Suite/bldg./apt.#: Project name:WALGREENS ❑ 600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: PEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'1 500 sq.ft.or portion 33.92 1
DESCRIPTION OF'i WORK. Limited energy,residential 75.00 2
LOW VOLTAGE CONTROLS FOR HVAC (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
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
Owner signature: Date: 401 amps to 599 amps 168.54 2
t:®!APPLICANT ❑'CONTACT PL ON Branch circuits—new,alteration,or extension,Qer panel
A.Fee for branch circuits with
Business name:ARJAE HVAC SERVICES above service or feeder fee, 742 2
each branch circuit
Contact name:KEN KLUNDER B.Fee for branch circuits without
Address:8545 SE McLOUGHLIN BLVD service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:MILWAUKIE,OR 97222 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)231 7717 Fax: :(503)230 4888 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:KEN@ARJAE.COM Reconnect only 67.84 2
CONTRACTOR . ' Pump or irrigation circle 67.84 2
Business name:ARJAE HVAC SERVICES Sign or outline lighting 67.84 2
Address:8545 SE McLOUGHLIN BLVDSignal circuits)orlimited-energy 0 See Page 2 2
panel,alteration,or extension.
City/State/ZIP:MILWAUKIE,OR 97222 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)231 7717 Fax:(503)230 4888 Investigation(1 hr min) 90.00/hr
Email:KEN@ARJAE.COM Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 60835 Electrical Lic.: 26-1208C�,L,.,� Suprv.Lic.: 2617LEB specifically listed(V2 hr min)
ELECTRICAL PERMITFSS
Suprv.Electrician signature,required: X 4✓ Subtotal:
Print name: KEN KLUNDER Date: 7-30-18 0 Plan Review Required(25%of permit fee):
� State surcharge(12%of permit fee):
Authorized signature: r% \� 4(4.A TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: KEN KLUNDER k Date: 7-30-18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
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M
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY. FEE SE a TA
Descr *
Fee for all residential systems combined: $75.00 Renewable
Qty. Each I Total electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Az hr min)
COMMERCIAL WORKONLY:?Ii 1'LY: ELECTRICAL.PE tMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00
* Number of inspections allowed per permit.
(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
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