Permit (117) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1'1 COMMUNITY DEVELOPMENT Permit#: ELR2019-00162
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/27/2019
TIGARD Parcel: 1 S 134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE PB
Project: Saibri Cooper Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 3
Project Description: Duct modifications and relocating existing fan.
Contractor: HVAC INC Owner: DIETRICH, NANCY BISHOP
5188 SE INTERNATIONAL WAY ROBINSON, JERRY CHRISTOPHER TRUST
MILWAUKIE, OR 97222 ROBINSON, LYNN ET AL
9701 SE MCLOUGHLIN BLVD
MILWAUKIE, OR 97222
PHONE: 503-462-4822 PHONE: 503-245-7100
FAX: 503-462-6555
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/27/2019 $75.00
12%State Surcharge-Electrical 08/27/2019 $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 Cen- 'ose rules are set forth in OAR
952-00170010 throw h OAR 9527001-0090. Y• '•- •, -in a coL.•myipmj=c - direct questions to OUNC by calling_503.232 leo. 2.2344.
Issued By:�- iiC ---a -- 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 RECEIVED FOR c)FFICF FSI. O\El
City of Tigard AUG 2 7 2019 Received
t) �`,1 Permit#: (r. o t'•f IA,
"III 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGARD Plan R : Related Permit#. 0= - i`1_gat cr
Inspection Line: 503.639.4175 BUILDING DIVISION
ReadyDateBy: RI See Page 2for
TIGARD MOM
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
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 exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: r' ` ^A �A y �Q ❑Addition of new motor load of system.
110 ,V iA �r �l ��M. 100HP or more. ❑«A„ «E„ «1 2„«1 3„
City/State/ZIP: 1 i r i "yak C'l1 ) -)/-3 ❑Six or more residential units. occupancy.
V t'� / ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:)C- I JY_ l.tl�' 1,/!/ 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more.
600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description J 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WO Limited energy,residential
l,, ' ( 'L (, \ / (with above sq.ft.) 75.00 2
V�/ v \ �l C \1���"\V U '• l� Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
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 0CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
0A.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
Address:5188 SE International Wayervice or feeder fee,first 56.18 2
bbranch 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
Email:jodyd@hvacincorp.com dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Signal circuit(s)or limited-energy _t 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 Lie.: 50897 Electrical Lie.: 26-571CL Suprv.Lie.: 3796LEB specifically listed(V hr mm)
,-, ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:��(�- l, / _.-' Subtotal: .75 `'
Print name: Mike Schmidgall t 1 Date: 08/27/19 0 Plan Review Required(25%of permit fee):
\b,7- State surcharge(12%of permit fee):Authorized signature: TOTAL PERMIT FEE:I.(�,�
This permit application expires if a permit is not o tamed within 180
Print name: Jody Deli Date: 8/27/19 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitAppELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB