Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 00219
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/15/2010
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 13221 SW 68TH PKWY 100
Subdivision: WASHINGTON SQUARE MALL Lot: 0
Project: Lincoln Heritage
Project Description: HVAC system.
FEES
Owner:
PPR WASHINGTON SQUARE LLC Description Date Amount
2235 FARADAY AVE STE #O Restricted Energy Permit 10/15/2010 $75.00
CARLSBAD, CA 92008 12% State Surcharge - Electrical 10/15/2010 $9.00
PHONE:
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202
PHONE: 503 - 239 -4600
FAX: 503 - 239 -7038
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 $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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 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 OA; 952-001-0100. You ma obtain a es or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
h Issued B• Permittee Signature: ra)GI fv1i e s4e
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.
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Electrical Permit Application I t/IZ 01:1- It I: l SE 0 \ I 1
City of Tigard
. -- • 13125 SW Hall Blvd., Tigard, OR 972
IN /r _ ,. .4
: 1 Phone: 503.639.4171 Fax: 503.598.191 \ -* „ .,c4fiffil Mel. permit eit jet ---()() ,
1 . 1 c A i n Inspection Line: 503.639.4175 \) (_, ..‘,\,,,,.‘ ‘;.., ii%, Ready/By: Juris: El See Page 2 for
- Internet: www.tigard-or.gov e)\ aciZs‘., \ " Notified/Method: 77 Supplemental Information
-..
Li
"1 N ew construct
-I".. ion Addition/alteration/rep i n ent ' ' Please check all that apply (submit a sets of plans w/items checked below):
Ei]
EI Service or feeder 400 amps or more 0 Building oeci three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and bcatYards.
#.04.COKON.::141.4.#00.#:Zige.61-.T.:E?;:.t.;...-;:.'4::&.,e'. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
01- and 2-fiunily dwelling in Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 13 File pump. 0 Installation of 75 KVA or
larger separately derived system.
'tJ'i 6 '':-' ''---=. '''''''' 0 Addition of new motor load of 0 "A", "E", "1-2",
Job no.: Job site address: 1Z 0.a 1 3 ui (02' Paitway 100HP or more.
0 Six or more residential units. occupancy.
0 Recreational vehicle parks.
City/State/ZIP: -1- L,( , ott C lia .3 0 Health-care facilities.
ID Hazardous locations. 0 Suppllts y voltage for more than
600 vonominal.
Suite/bldg./apt no.: % 0 0 I Project name: i ..; ir o,t, i i s k ire l cec , a 0 Service or feeder 600 amps or more.
1 ,R.T 2 '1 ,. l.,? - =`? .. , 1: :::4**r Wi 010.6C
Cross street/directions to job site: . arnt.effi neariptio. i criy. I pee. I Total 1 •
New residential single- or muld-family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 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 75.00 2
4qk2,:t-,11;;;:j.?.;,?,74.i2i;.;;Alki:r•Nifi*frke,0:0if,0,10**.Iti4:74.Liii3O+.q:IAfiR".''.0;,'''.'''.;,:ef!':, (with above sq. ft.)
Luuited energy, multi-family 75.00 2
ifijkC residential (with above sq. ft.)
Services or feeders installadon, alteration, and/or relocation
200 amps or less 100.70 2
05k#01....Ottfe004*:%.44VZIAVI4-"ii‘a.':::>Z..'K, 201 amps to 403 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps W 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocadon
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
tbsodyvittsissi,i.,N above serviceur feeder fee,
R ~
T'g6k L .W. , - ;..1,..L'.' ,',..,:..;-...,.., :;.; each branch circuit 742 2
, Fee for branch
Business name: n _
B. circuits without
1--omPf Clio 4eal a 0 t "ti(te . service or feeder fee, first 56.18 2
Contact name: D ko... mp.-4- branch circuit
Each add'l branch circuit 7.42 2
Address: 1 '53 et SE . c,4 -€-- Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: e l) 0 v 1/4, ( ..t a rvi fi en ao dwelling, service and/or feeder 67.84 2
Phone: ( 563) abci....ttk, l 00 Fax: : (63 ) .a.31 -1 63.8 Reconnect only 67.84 2
Pump or irrigation circle
E-mail: Sign or outline lighting 67.84 2
'.-4. -./.' ,' g, -- ■: , :-‘0 - ,:'/:::.:'-.= ,, :%,,,, '.....„..1. /* ::._ ,
t4.m <g:4-;. .: ,:,.' : -,. , .. 0., .:. .:!! `.. , ',:i :::: Signal circuiffs) or limited-energy a 7 2
panel, alteration, or extension. I Page 2
Business name: Non ev c _ o _ n “ A A j -; „ ,
Each additional inspecdon over allowable in any of the above
' ."- t " --L- "
Address: 1, et se 6Ciaton St Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: 1D-V1/4“&rk 04 4/ -.() a
Industial plant (1 hr min) 78.18/hr
k
Phone: ( •61 ,..'?jCi if( Fax: ( 56j _ _103 Inspections for which no fee is
specificaRy listed 04 hr min) 90.00/ hr
CCB Lic.: 2 4 S - Electrical Lic.: d( CaESuprv. Lic.: .2.4Ltott .::::J..F. -.::: -,:;,.! AtA0I0H
Subtotal: 75 &-
Suprv. Electrician signature, required.
. ( /'it.... ,/ Plan review (25% of permit fee):
z ______
Print name: - 3A ,i- 0 (.4)0 i ka ( TDate: i MO State surcharge .
02% of permit fee). c
TOTAL PERMIT FEE:
Authorized signature: , This permit application expires ff a permit is not obtained within 180
' days after it has been accepted as complete.
Print name: ( ()A Aik 0, I aa ( t,.0y\ Date: ( 0 - (5- I 0 • Number of inspections allowed per pemiit.
1: \ Building 1 Permits \ ELC-PerraitApp.doc 07/01/10 440-4615T(11/05/COMAVES