Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111: COMMUNITY DEVELOPMENT Permit#: ELR2020-00022
Date Issued: 02/10/2020
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S115AB01900
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY C
Project: Ace Hardware Subdivision: 1994-028 PARTITION PLAT Lot: 2
Project Description: HVAC system for RTU's.
Contractor: AMERICAN HEATING INC Owner: SN PROPERTIES PARTNERSHIP
5035 SE 24TH AVE 1121 SW SALMON ST
PORTLAND, OR 97202-4765 PORTLAND, OR 97205
PHONE: 503-239-4600 PHONE: 503-973-0205
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/10/2020 $75.00
12%State Surcharge-Electrical 02/10/2020 $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 $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
( -4'
Issued By: - Permittee Signature: .
OWNER INSTALLATION ONLY
The installation is being made on property I awn which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY'
Received 1,
City W Tigard ,,,� �"�EIVED Date/13 : .' / +rri Permit No.: ,o?co_ ,
II • 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review Other Permit: /
a' Phone: 503.718.2439 Fax: 503.59 1 60 qDateB
T I GA RD Inspection Line: 503.639.4175 O 20 ZQ Date Ready By: Id See Page 2 for
Intemet: www.tigard-or.gov ' Noti6ed/Method: Supplemental Information
TYPE OF. WO, ry e '$ Q 1,. 1.1 C .
;"-:-- '''. '''''''''''''''''''' - ' Please-check all that apply(submit a sets of plans w/items checked below):
❑New construction ®Addition/alteratio -,ent
■Service or feeder 400. El Building over three stories.
❑Demolition ❑ Other: where the available fault current ■Marinas and boatyards.
p •I:1 1 i i CATEGORY OF c `11WcTTOI�I v -, exceeds 10,000 amps at 150 volts or El Floating buildings.
•••••••••.,•••'"'-•:"••"• '• less to ground,or exceeds 14,000 El Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps other
❑Multi-family ❑Master builder 0 Other: • • '
■Emergency system. larger separately derived system.
ttr or more. . ...
Job no.: Job site address:16200 SW Pacific Hwy
• • "'City/State/ZIP:Tigard,OR 97224
■Hazardous locations. .tt volts nominal.
Suite/bldg./apt.no.:C Project name:Ace Hardware •Service or feeder 600 amps or more.
Cross street/directions to job site: Description Qtr. Fee. ram
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: Loot)sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.:
Limited energy,residential
n., 14 i l�as ..:� tj .a 75.00 2
' as DESCRIPTION OF WORK ('� � (with above sq.ft.)
--- Limited energy,multi-family 75.00 2
low voltage wiring and T-stats residential(with above sq.if)
Renewable Energy ❑ See Page 2r
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER 1 ❑ TENANT „ 200 amps or less 100.70 2
.. . .m -, .. .., 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
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 i
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
"s--. ;, APPLIC ANT w=� A.Feefor branch circuits with
above service or feeder fee, 7.42 2
Business name:American Heating Inc. each branch circuit
B.Fee for branch circuits without
Contact name:Amanda Bostic service or feeder fee,first 56.18 2
branch circuit
Address:5035 SE 24t'Ave. Each add'I branch circuit 7.42 2
City/State/ZIP:Portland,OR.,97202 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)239-4600 I Fax: :(503)239-7038 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:a.bostic@americanheating.net Pump or irrigation circle 67.84 2
«a t ^
I'N,tas�:V Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)orlimited-energy 1 See 1
panel,alteration,or extension. Page 2 2
Address:Amanda Bostic Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OR.,97202 Investigation(1 hr min) 66.25/hr
Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00!hr
CCB Lie.: 33135 Electrical Lic.: 26993CRE Suprv.Lie.: 2640LEB a.- ificall listed '/a hr min)
a. st Chi e i sas
cff
Suprv.Electrician signature,required: .75
Subtotal: ✓,
Plan review(25%of permit fee):
Print name: T Steve Young`� �,,_ ,,)R /�� Date: 2/10/2020 State surcharge(12%of permit fee): (,
Authorized signature:�C'i`�"ie'�/ `a" _' TOTAL PERMIT FEE: ,P6 a--
Print name: Amanda Bostic Date: 2/10/2020 This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:1Building\Permits\ELC_PerrnitApp_ELR_ERE.doe Rev 05/21/2013 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 for all residential systems combined $75.00 Description Qty. Fee Total •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01to15kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
ElBurglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
El H• eating,Ventilation and Air Conditioning OAR918-309-0040)
* Solar generation systems in excess of 25 kva:
System
Each additional kva over 25 7.42 3
❑ V• acuum Systems* >100 kva—no additional charge 0.0 3
El Other:
additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr I
Inspections for which no fee is 90.00/hr
C01IME 2C s it-wally listed(Y2 hr min)
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
❑ 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
1:\Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 05/21/2013