Permit (159) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' II COMMUNITY DEVELOPMENT Permit#: ELR2019-00088
T I[;A l<.F) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/09/2019
Parcel: 2S102DB00100
Jurisdiction: Tigard
Site address: 8840 SW BURNHAM ST
Project: Frontier Subdivision: None Lot: None
Project Description: Low voltage control wiring for new mechanical unit.
Contractor: HVAC INC Owner: FRONTIER COMMUNICATIONS NORTHWES
5188 SE INTERNATIONAL WAY PO BOX 152206
MILWAUKIE, OR 97222 IRVING, TX 75015
PHONE: 503-462-4822 PHONE:
FAX: 503-462-6555
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/09/2019 $75.00
12%State Surcharge-Electrical 05/09/2019 $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.rThos- rules are set forth in OAR
952-001-0010 through OAR 9 -001-0090. Yo ay obt— a cop of the rules or direct questions to OUNC by calling 503.232.19:. or .:10. : . 344
Issued By: ♦ : /ir ' 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 .rjEQ FOR OFFICE I SE()NEN
City of Tigard DateRece/B d /! 6' P. t
w 13125 SW Hall Blvd.,Tigard,OR 97223 v PlanReview ( ��� , '
i m Phone: 503.718.2439 Fax: 503.598.1960MNI �o�� Date/B : s- /,_SII
Inspection Line: 503.639.4175pap Ready Date/By: Suns: El See Page 2 for
T I G A R D Internet: www.tigard-or.gov GVl'‘(OCF T�+R v'S'®NI Notified/Method: Supplemental Information
TYPE OF W �LDINPLAN RENEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑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 CONSTRUCI'ION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:8840 SW Burnham St. 100HP or more. ❑"A","E",`°t-2",`1-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Frontier Tigard 0 Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE 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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK - Limited energy,residential 75.00 2
low voltage control wiring for new mech unit (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 0 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
®®< APPLICANT El`.CONTt#CT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:HVAC,Inc. above service or feeder fee,
7.42 2
each branch circuit
Contact name:Jody DePew B.Fee for branch circuits without
service or feeder fee,first
Address:5188 SE International Way56.18 2
branch circuit
City/State/ZIP:Milwaukie,OR 97222 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503-)462-4822 Fax: :(503)462-6555 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:jodyd@hvacincorp.com Reconnect only 67.84 2
_ , . CONTRACTOR Pump or irrigation circle 67.84 2
Business name:HVAC,Inc. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ® See Page 2 2
Address:5188 SE International Way panel,alteration,or extension.
City/State/ZIP:same Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 50897 Electrical Lic.: 26-571 CL{j Suprv.Lie.: 3796LEB specifically listed('14 hr min)
i� ELECTRICAL PUMA' 1?EES ..
Suprv.Electrician signature,required:t ►� X'Wiv,,,,' ���1 Subtotal:
Print name: Mike Schmidgall Date: 5/9/19 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
J This permit application expires if a permit is not obtained within 180
— Print name: Jody DePew —_... --_nate• 5/9119_ . days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
"Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description
Fee for all residential systems combined: $75.00 Renewable I Qty. I Each I Total
3' 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 552.26 2
with OAR 918-309-0040)
❑ 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%1 hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY:
Fee for each commercial system:• $75.00 Subtotal per permnter t.oPage 1):
3' ' Number of inspections allowed permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
• HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
I:\Building\Permits\ELC PermitApp ELR_ERE.doc Rev 06/17/2015