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Permit (18) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT IN IICOMMUNITY DEVELOPMENT Permit#: ELR2019-00192 T I O a\jt p 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2019 Parcel: 2S113AB00101 Jurisdiction: Tigard Site address: 16101 SW 72ND AVE 200 Project: RMLS Subdivision: None Lot: None Project Description: Limited energy for HVAC. Contractor: EXCEL HVAC INC Owner: PACIFIC REALTY ASSOCIATES LP PO BOX 1188 ATTN: N PIVEN CANBY, OR 97013 15350 SE SEQUOIA PKWY#300 PORTLAND, OR 97224 PHONE: 971-930-7194 PHONE: 503-624-6300 FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 10/07/2019 $75.00 12%State Surcharge-Electrical 10/07/2019 $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 per it will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Orego• :w requires u to "• ow the ,"s adopted by the Oregon Utility Notification Center. ••se rul-: r- et forth in OAR 952-001-0010 through 0. .01-0090. u may o• a cop�the rules or direct questions to OUNC by calling 503.232.1•: • :10.33;• WINO Issued By: / Permittee Signature: / OWNER INSTALLATION ONLY S 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 OFFICE USE ONLY City of Tigard Received /��. Ihi a 13125 SW Hall Blvd.,Tigard,OR 97223 OCT 7 2019 Plan Review, • Phone: 503.718.2439 Fax: 503.598.1960 Date/B : � ` igNIPMIMI Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: - S e Page 2 or TIGARD Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information TYPE OF WORK -t;::', .,, PLAN REVIEW ❑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 ❑Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEG 1,'Y OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ 1-and 2-family dwelling V Commercial/industrial 111Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family ❑Master builder ❑ Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION rV ❑Emergency system. larger separately derived 272."'' i ❑Addition of new motor load of system. Job 4: 70b Site address: f 00/ 51A/ AV 100HP or more. ❑«A» «E» «1_2» «1.3» City/State/ZIP: 7795 ,r) eVL� 0 ❑Six more facili . units. 0 Recreational 7.Z a ❑HeaIth-care facilities. vehicle parks. Suite/bldg./apt.#: +�,� Project name: j 0 Hazardous locations. 0 Supply voltage for more than 0.V ��L 600 volts nominal. ❑Service or feeder 600 amps or more. Cross street/directions to job site: ,../ ,5„ Ki; , FEE SCHEDULE Description I Qt, I Each I Total 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 WORK Limited energy,residential /// (with above sq.ft.) 75.00 2 l✓A 6 1 /T .Pv �y Limited energy,multi-family ` residential(with above sq.ft.) 75.00 2 Renewable Energy El See Page 2 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: pripe-0 J ipal. 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 0 APPLICANT 0 CONTACT PERSON �� , Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7.42 2 Contact name: y�9 � - O B.Fee for branch circuits without 1.r l�j service or feeder fee,first Address: .! "d�dl' branch circuit 56.18 2 City/State/ZIP: 1 Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 ;CONTRACTOR Pump or irrigation circle 67.84 2 Business name: G. -----A.-7.2...e7..... /LA r- ,t-. Sign or outline lighting 67.84 2 Sign circuit(s) lit -energy r Address: Jia rjj r j3 j /8 S panel,alteration,00r extension. p.See Page 2f 2 City/State/ZIP: •tl'iti *�/3 Each additional inspection over allowable in any of the above l Additional inspection(1 hr min) 66.25/hr Phone:(97e ) 93 0 _7/9 LJ Fax:( ) Investigation(1 hr min) 90.00/hr 7 Email: Industrial plant(1 hr min) 78.18/hr 7 / Inspections for which no fee is CCB Lic.: /q3 q S Electrical Lic.: ec/1.2Suprv.Lic.: 3f Lai specifically listed('/z hr min) 90.00/hr ""w ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: :�y0y Huiel Subtotal: Print name: J S F(, 4 5 Date: f C5 — 7—/c ❑Pian Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature: TOTAL PERMIT FEE: _ A This permit application expires if a permit is not obtained within 180 Print name: gti,t i �y1� -7— Date: r.y7/9 days after it has been accepted as complete. 777 E * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_E .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: RESID TIAL WORK©NLY:' /;:FEE SCHED> , ;,r,. , f'f tiG, oD Description I Qty. I Each I Total I �*�� Fee for all residential systems combined: $75.00 Renewable 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 Garage Door Opener* 50.01 to 100 kva 552.26 2 >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 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(A hr min) Z Ztf� iri%k t , CTRI„C4, J R 1IT1L �',//b' �n COM1yIERCIA WORK ONLY: Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): y * 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 Li Instrumentation ❑ Intercom and Paging Systems n Landscape Irrigation Control* Medical ❑ Nurse Calls n Outdoor Landscape Lighting* Protective Signaling ❑ Other: Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations I\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015