Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2010 00225
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2010
Parcel: 2S110DCO2300
Jurisdiction: Tigard
Site address: 11525 SW DURHAM RD D -7
Subdivision: Lot: 0
Project: Willowbrook
Project Description: HVAC system.
FEES
Owner:
HIP WILLOWBROOK LLC Description Date Amount
BY TAX DEPARTMENT, PO BOX 2708 Restricted Energy Permit 10/22/2010 $75.00
PORTLAND, OR 97208 12% State Surcharge - Electrical 10/22/2010 $9.00
PHONE:
Contractor:
REITMEIER MECHANICAL
19570 SW 90TH CT
TUALATIN, OR 97062
PHONE: 503 - 603 -0205
FAX: 503 - 603 -0150
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 2- 001 -0100. You may • of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 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 1.(m t o r r c l : ti: u. l . \
City of Tigard �ED / Permit No.
:� • 13125 SW Hall Blvd., Tigard, OR 97� Pin By. n /e��70 /g7Tr : .�[)L@ O
Phone: 503.639.4171 Fax: 503.598 Date/By: Other Pe1mit:
i , R n Inspection Line: 503.639.4175 Date Ready /By: lure: See Page 2 for
Internet: ww,r.tigard OC1 2 2 2 M Notified/Method: '-=r I ® SupplementalInformatior
TYPE OF WORK >� PLAN REVIEW
❑ New construction ® Addition/altera c . P '' IS10N Please check all that apply (submit 3 sets of places w /items checked below;
1 i 0 Service or feeder 400 amps or more 0 Building over three stories.
13 Demolition ❑Other BV where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 votes or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other. 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATTnut AND LOCATION O Emergency system larger separately derived sys
❑ Addition of new motor load of 0 "A", "E" "1-2", "1-3".
Job no.: Job sit address:' 11525- f) p r L., )2d 100HP or more. aaRCn•
❑ Six or more residential units. 0 Recreational vehicle parks.
City /State/ZIP: T, r f O 8 722 3 o Health-care facilities. 0 Supply voltage for more shat
Ti 0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: D...7 Project name: 44) f / A rco ji 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: tkralptloa I qty. I Fee. 1 Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00
. � • Limited energy, multi - family 75.00
t / c.w VD /tQlG eon it Y0 a w r[ n residential (with above sq. ft.)
Services or feeders installation alteration, and/or relocation
200 amps or less 100.70
ge PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56
Name: LL J 1 401 amps to 600 amps 200.34
LL r.5c •,�hve s f ine k 7 Pr er I le 5 601 amps to 1,000 amps 301.04
Address: N30 Sot /3r oJfo a Over 1,000 amps or volts 552.26
City /State/ZIP: ?0 f �r� a � Q 1 Temporary services or feeders installation, alteration, audio relocadon
Phone: ( ) I Fax: ( ) 200 amps or less 59.36
Owner Installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
jai APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42
each branch circuit
-
Business name: G rt Mef / B. Fee for branch circuits without
PX' ✓"t Lt Yt tc ct service or feeder fee, first
Contact name: 4 ' i 5 branch circuit 56.18
.J !! •
�r Each add'1 branch circuit 7.42
Address: iq S7 . q f , f ' Miscellaneous (service or feeder not Included)
Ci City/State/ZIP: Each manufactured or modular
tY L A.14 in , OE q 7 0 2 dwelling, service and/or feeder 67.84
Phone: ( 3 ) ‘ - 0,2GS I Fax: : (5o3) 6o 3 - 0/50 Reconnect only 67.84
, Pump or irrigation circle 67.84
E-mail:,,-j/, r - er 5 ( n6 their Aant cc,N
Sign or outline lighting 67.84
CONTRACTOR Signal circuit(s) or limited-energy
�j / 1 panel, alteration, or extension. I _ Page 2 �
s
Business name:
Rey tmeter /"leGf�Q Yf / Each additional inspection over aUowable in any of the abo■
Address: icK70 31 go ); Lam.. r`( Additional inspection (1 hr min) 66.25/ hr
j ` Q O / �7 Investigation (1 hr min) 66.25/ hr
City /State/ZIP: -r, tnLl lA / oR / 7 l; 4 Industrial plant (1 hr min) 78.18 / hr
Phone: ax: Inspections for which no fee is
( S r tJ'J ) 603' C32D S Fax: (5�3) 603 - U SD d hr min) 90.00/ hr
specifically listed ('Vs
CCB Lic.: 153 7 7C) 1 Electrical Lic.: 3C /- 6jackel Suprv. Lic.: )/ Q' 5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 9 o Subtotal: 75; e�
7 Plan review (25 /o of permit fee):
Print name: 1. jr.i5e PI Date:10 /2 2f / d State surcharge (12% of permit fee): ' v1
Authorized signature: TOTAL PERMIT FEE: t le/
y � 4 r ���L This permit applkadon expires If a permit to not Ob ned within 181
Print name: �(I� �J ew /� vf� C � s I Date: 104 �7 / 0 R after at bas been accepted as complete.
N um b er o lions allowed per permit.
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