Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
` COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00302
TIGARa 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/23/2008
PARCEL: 2S 102C B -03200
SITE ADDRESS: 09975 SW FREWING ST 1020 ZONING: C -G
SUBDIVISION: MASSIH OFFICE BLDG LOT: 021 JURISDICTION: TIG
PROJECT: VISION WORLD
Project Description: Install low voltage for HVAC.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: X PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
MASSIH LLC JET INDUSTRIES INC
PO BOX 108 PO BOX 7362
BEAVERTON, OR 97075 SALEM, OR 97303
Phone: Contact #: PRI 503- 363 -2334
FAX 503- 363 -2622
FEES Reg #: ELE 24- 277CRE
LIC 3944
Description Date Amount SUP 339LEB
[ELPRMT] ELR Permit 10/23/200€ $75.00
[TAX] 12% State Surch 10/23/200€ $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or dir que "ons to NC at 503.246.6699 or 1.800.332.2344.
Issued Permittee Signature: �L 2 7 �G
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'N: 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.
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Electrical Permit Application „v fit o FI SEION LY ”' i,.1 � , �
k '''A''' " r „'.. City of Tigard Date /B : � rlrb ♦ Permit No : r� 1 /�, , Il /. Z
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• 1 " Phone: 503.639.4171 Fax 503.598.1960 DateB : Other Permit:
' " I
1-30' nspect L 503.639.4175 Date Ready /By:
T IGAR ®See Page 2 for
ea:4 +.0 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 below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
J O B SITE INFORMATION AND. LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ",' 1 -2 "I -3 ",
Job no.: Job site addressetiQl 165 f t"Y•Q.1N ✓i 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 1 ; °//r ,gyp( y I�i "' ❑ Health -care facilities. ❑ Supply voltage for more than
vOw s s .� 3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 15 ISYI Y\1 O Y t
❑ Service or feeder 600 amps or more.
FEE SCHEDULE •
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
. DESCRIPTION OF WORK . , (with above sq. ft.)
1 u , Limited energy, multi- family 75.00 2
`JI �� u U `j.-� residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ ' PROPERTY OWNER MTENANT 201 amps to 400 amps 106.85 2
l�� ,\ 401 amps to 600 amps 160.60 2
`I -
Name: 1 f V
�` l� 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
(APPLICANT • ❑ CONTACT PERSON above service or feeder fee, 6.65 2
`r1K\n ^ each branch circuit
i
Business name: - _.N— 1 `) B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: � � � i E C Pump or irrigation circle 53.40 2
RACE R Sign or outl' a lighting 53.40 2
Business name: A t I Ln Si ctr i, alteration, or limited -
- -»11xx -« l.Y/`/ energy panel, alteeration, or --{.-0 Address: p st - -k 1 ��a, exten i• � fscr�'be: / Page 2 7�- 2
City /State /ZIP: �. Gl ] t). Each a • ditional inspection over allowable in any of the above
^� Per inspection 62.50
1 e: 3193. 2 Fax: qt
. 2.1p2 Investigation per hour (1 hr min) 62.50
Lic. : : E lectrical Lic.411,, a-n Suprv. Lic..:A9 Industrial plant per hour 73.75
+�) ELECTRICAL PERMIT. FEES
3 St4 . Electric s�r f��equired: c ar 7 /ill / Subtotal: e'.0 0
Print name 0` Date: /0 --(C . de
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: c� _e J TOTAL PERMIT FEE: Qo
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(1I /05 /COM/WEB