Permit CITY TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Ak DEVELOPMENT SERVICES PERMIT #: ELR2005 -00248
c � Ill 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/2/2005
PARCEL: 2S101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY 120 ZONING: MUE
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 002 JURISDICTION: TIG
Project Description: Thermostat.
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:
TIGARD TRIANGLE I LLC AMERICAN HEATING
4650 SW MACADAM AVE STE 220 1339 SW GIDEON ST
PORTLAND, OR 97201 PORTLAND, OR 97202
Phone: Phone: 239 - 4600
Reg #: LIC 33135
ELE 26- 993CRE
FEES SUP 2640LEP
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/2/2005 $75.00
[TAX] 8% State Surchari 9/2/2005 $6.00
Total $81.00
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 direct questions to OUNC at 503 - 246 -6699.
Issued By: ( "" Permittee Signature: , ,/7
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.
I
Electrical Ptrnit Application FOR OFFICE USE ONLY
�r , _ ,, r-r'
' City of Tigard ic , - -- 1 I(- I� Receive.
Date 6,c-g.,72„,,,, % O y'.
b B : 0 P Penni( No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Rev
Phone: 501639.4171 Fax: 503.598.1960 -I `
1n0. �/ +'a Date/B : Other Permit:
Inspection Line: 503.639.4175 U� l ,! �. `I Date Ready/By: Hinil El See Page 2 for
Internet: www.ci.tigard.or.us j Notified/Method: Supplemental Information
L t , ` -Y : ,. TYP1v'^d WO P '.• " `J E V - : .. ? ii h _ ...k:_,Y a t ra 1 AN.BEV'IEW
l ci o t . , r y tS)E ' - Please ceck all tht a 1 y=
❑New c onstruction �A�t- fior>�alter(aho replacement pp ,•;:.--:::`...::.-..".:‘,'
❑ Demolition ❑ Other ['Service over 225 amps, comm'l ['Hazardous location
�. - ,x 5 { _ uv �r ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
- * -" ^_ , i ; ^ Cy1TEG01, :. .Old ClJ1�fS - .∎ . C_ION, 4 ; « �T s � r -t.: - : of 1 - and 2 - family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Wommercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
/ } kY r r , r L a ['Occupant load over 99 persons ['Manufactured structures or
- ` JQB1 1"l'E ; INF - Q TZIITATF9. � . 00.4 O I - , yY s e y % { r ❑Egress/lighting plan RV park
❑Health -care facility ❑
Job no.: I Job site address: /3 (9,Q ) 611 ���."� , „/ abov
`""� Submit 2 sets of plans with any of the above.
City /State/ZIP: 77 Q Y J D 9iLL3 1 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: /�/e P roject name :Ei�/frt O' /h7 { :: ' . SEE { ;
(� DexAptloo l Qty. I Fee l Total I '*
Cross street/directions to job site: 0 I�V New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or le 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy,
+e r= r •: non - residential 75.00 2
, ` ; z .0tSCRI IQIl) l R ��'4'O ; 'r,':° " *'?'7 ' = Each manufactured or modular
1 _ � � dwelling, service and /or feeder 90.90 2
/ es-ro bc)4 Services or feeders installation, alteration, and/or relocation
•
200 amps or less 80.30 2
,r NI 4 u x , 4 -�'7 447.E ir. ' i., t a . . 201 amps to 400 amps 106.85 2
A t e r er C..,t. , -C .VYl s E ,. "' ::: t , 4 : -., o- v' -F- ..s` --,t ,-0- ; -,; ` .. • r t. - . _ i:- -r,
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I F ax: ( ) relocation
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
* f .., t " "'' u 4- e r nt A. Fee for branch circuits with
z, * P.ELI CIV k . t -r `xo1.ITAr 1�01r" t y. service or feeder fee, each 6.65 2
Business name` � �/,��#9ln/,a� ....0C, branch circuit
Contact name: B. Fee for branch circuits
s ,�! �,� � without service or feeder fee, 46.85 2
g /
each branch branch it
Address: ■33 9 se -
��� J � Ea ch add'1 branch circuit 6.65 2
City/State/ZIP: ‘0,....71/�� y 1 O2 �
9,2 Miscellaneous (service or feeder not included)
Phone: (
'' ) � tSt�� I Fax: : ( / .�, 2 5'- X' � Pump or irrigation circle 53.40 2
,3
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
t z , " cor tRA J ' qR - . = � s .r energy panel, alteration, or
extension. Describe: 1 Page 2 2
Business name: A� ( � ,4,• ...V
Address: J j3 p jC � j � h - Sl� Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: 'r} - /a p D ,7244.- Investigation per hour (1 hr min) 62.50
e
Phone: ) J Z31„ Fax :,93) 2.... 9_ 2 ' Industrial plant per hour 73.75
� 't a 1 ( L M EL G1 G 5 E ,. 4'1 ,It. C S _ , 5 r r 3S CCB Lic.:23' Electrical Li 1 4, 3 3 Suprv. Lic.:, ' / Q T Subtotal
46 Suprv. Electrician signature, require `� Plan review (25% of permit fee)
Print name: fTG tiiY rQ Gr Date A� State surcharge (8% of permit fee)
o TOTAL PERMIT FEE
Authorized signature: 41 / / 7 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name l 4 e Date: 9A/10
,/O Fee methodology set by Tri- County Building industry Service Board
Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12103 440- 4615T(10 /02/COM/WEB