Permit (165) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
7,1
COMMUNITY DEVELOPMENT
Permit#: ELR2019-00062
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/29/2019
Cf+�aIRZ Parcel: 2S112DC00100
Jurisdiction: Tigard
Site address: 15605 SW 72ND AVE
Project: Consumer Cellular Subdivision:HERN PACIFIC TIGARD INDUSTRIAL Lot: 1-2
Project Description: HVAC for new RTU's
Contractor: WILLAMETTE HVAC LLC Owner: PACIFIC REALTY ASSOCIATES
3075 SW 234TH AVE.#206 ATTN: N PIVEN
HILLSBORO, OR 97123 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-259-3200
PHONE: 503-624-6300
FAX: 503-848-2597
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/17/2019 $75.00
12%State Surcharge-Electrical 04/17/2019 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
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 503.232.198 1.:J0.332.2 -
n n
Issued By: 1°P 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 ONLY
Cityg of Tigard DECEIVED Received
"'rV �L/�Permit No.: /9---t),061
III il Date/B : 7.� �sr
13125 SW Hall Blvd.,Tigard,OR 97 3 Plan Review
O Phone: 503.718.2439 Fax: 503.598'1960A
03.598.1960 - Date/B : Other Permit:
TIGARD
Inspection Line: 503.639.4175 APR 2 2019 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
7,`,-,t'; TYPE*W DING DIV S10 RI
El 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 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
"°. CATEGORY OF CONSTRUCTION : ,N„ _�°
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
^"" less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 75 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION; 0 Addition of new motor load of 0"A","E","1-2","1-3",
Job no.: Job site address: 15605 SW 72nd Ave 1 OOHP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard OR 97224 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Consumer Cellular Project 0 Service or feeder 600 amps or more.
FEE SCHEDULE ''
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.: Limited energy,residential 75.00 2
,,
i DESCRIPTION OF WOIt�� s k (with above sq.ft.)
Limited energy,multi-family
2 new thermostats residential(with above sq.ft.)_ 75.00 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
0 PROPERTY 0 V1 ,R 0 TENANT 201 amps to 400 amps _ 133.56 2
401 amps to 600 amps 200.34 2
Name:
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
above service or feeder fee,
t APPLICANT 0 CONTACT PERSON 7.42 2
each branch circuit _
Business name:same as below B.Fee for branch circuits without
service or feeder fee,first Atif56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
€ax '.,y `" ,,i t c z 0" 1> "; x7777, iw„#;r ' , 4” , -;.7..-
- ' ...
Signal circuit(s)or limited-energy Y
Business name:Willamette HVAC LLC panel,alteration,or extension. __ Page 2 2
Each additional inspection over allowable in any of the above
Address:3075 SE Century Blvd Suite 206 Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Hillsboro,OR 97123 Investigation(1 hr min) 66.25/hr
Industrial plant(I hr min) 78.18/hr
Phone:(503)259.3200 Fax:(503)848.2597 Inspections for which no fee is 90.00/hr
/ I specifically listed(''A hr min)
CCB Lic.: 56951 1 Z I Electrical Lic.: 34346CRE S' ..' ,e,:„Juprv.Lic.: 4025LEB ELECTRICAL,PERMIT PEES
al
Suprv.Electrician signature,required:
Plan review(25 %of permitSubtotfee):: 75.
et
Print name: mike sicard Date: 4/1/19 State surcharge(12%of permit fee): 5 t c
TOTAL PERMIT FEE: I i Ct
Authorized signature: / )1.N.ticittrh,
This permit application expires if a permit is not obtained within 180
Printdays after it has been accepted as complete.
name: Michael Malstrom Date: 4/1/19
* Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp.doc 07/01/10 440-4615T(1 I/05/COM/WEB
Electrical Permit Application - City of Tigard n Other
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES: *No licenses are required. Licenses are require
for all other installations
REgipEtmiktorwoittelhatyr, N.•
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
❑ Audio and Stereo Systems"
❑ Burglar Alarm
nGarage Door Opener"
❑ Heating,Ventilation and Air Conditioning
System's
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
nClock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
® HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control"
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting'
❑ Protective Signaling
I:\Building\Permits\ELC-PermitApp.doc 07/01/10
L