Permit
g CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00011
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/22/2010
Parcel: 1 S136DD05300
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 100
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: Spec Space
Project Description: Low voltage for HVAC wiring.
FEES
Owner:
PNWP LLC#2 & Description Date Amount
PNWP LLC, 6600 SW 105TH AVE #175 Restricted Energy Permit 01/22/2010 $67.84
BEAVERTON, OR 97008 12% State Surcharge - Electrical 01/22/2010 $8.14
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N Total $75.98
Intercom/Paging: N Landscape/Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 actor ce`th 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. ATT ION: Ore b law requires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 0 through OAR 952'0 00. Y u may obtain a copy of the rules or direct questions to OUNC by calling 503 or 1,800.332.2144.
/
Issued _ y: 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 an inspection that business day.
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 OFFICE FOR ONL'Y
Received
City of Tigard Date/B //'o Permit No.: p?O D" 1(
13125 SW Hall Blvd., Tigard, OR 9722
B
N E Plan Review
EGE
C Phone: 503.639.4171 Fax: 503.598. 1 Date/B : Other Permit:
Inspection Line: 503.639.4175 2 2 9 010 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov JAN . L Notified/Method: Supplemental Information
TYPE OF WOR F TIGAR PLAN REVIEW
❑ New construction ddition/alterati Ep IDIVI r Please check all that apply (submit 2 sets of plans w/items checked below):
1r ~y ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEG RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ I - and 2-family dwelling ommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A", "E", "1-2", "1-3",
Job no.: Job site address: 11650 sue/ f J e 1001-11' or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Ttr A~V ZZ 3 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 0 0 Project name: q r ! CI ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description t . Fee. Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF ' WORK with above s q. ft. 67.84 2
O 1 A, 1 /O/~~ e ~ r f^ Limited energy, multi-family 67.84 2
V V 1+ lei .5 residential (with above sq. ft.
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 20034 2
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
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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits ivrrh
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: A Merl C a? He/,* ' f i i ,7-,-i c- B. Fee for branch circuits
without service or Contact name: Cl r-0 C1 Mom ! om G `j e 5 ,c first branch circuitfeeder fee, 56.18 2
Address: /33 'SE G jdC p n Each add'I branch circuit 7.42 2
Miscellaneous service or feeder not included
City/State/ZIP: Q r /qh Cl OR %ZZ 02 Each manufactured or modular
67.84 2
dwelling, service and/or feeder
I
Phone: (503) 2 3 - y~po 0 Fax:: (s03) 2 3 9 - 7v3 S Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Signal circuit(s) or limited-
/'Y)er-/CG~! I° rl r7 C- energy panel, alteration, or
Address: extension. Describe: Paget 2
City/State/ZIP: o r~' /Ga/t c 09 / -7-7 ,L, Each additional inspection over allowable in an of the above
Phone: (503) 23 / y~p00 Fax: (503 )?-3-7-7703 g Per inspection 66.25
Investigation per hour (I hr min) 66.25
CCB Lic.: 3J 3 5 Electrical Lic.: 2!0993 CRE Suprv. Lic.: 2l0VO r.EB Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, require ct~~ Subtotal:
Print name: T S- f ve Q IJ,l Date: z I 10 Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: -;Fie TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: rp~ Date: Z days after it has been accepted as complete.
• Number of inspections allowed per permit.
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