Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT I ' Permit #: ELR2010 -00139
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718. A 39 / Date Issued: 07/29/2010
® Parcel: 2S102AA01100
Jurisdiction: Tigard
Site address: 12035 SW PACIFIC HWY A
Project: Tigard Auto Stop - Spec Space Subdivision: Lot: 0
Project Description: Limited energy for HVAC. 1/21/11, reprinted to correct project name.
Contractor: OREGON HEATING & AC Owner: TIGARD AUTO STOP PARTNERS
PO BOX 241 2829 RUCKER AVE STE #100
DUNDEE, OR 97115 EVERETT, WA 98201
PHONE: 503 - 691 -9699 PHONE: 503 - 796 -2887
FAX: 503 -691 -8556
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/29/2010 $75.00
12% State Surcharge - Electrical 07/29/2010 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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 don n accordance wiftr- •proved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day ATTENTION: Oregon la r =:.1 :s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 - 001 -0010 through OAR 952 -0' 1090. u may obtain a copy of the rules or direct questions to OUNC by . 987 or 1.800.332.2344.
Issued By: � /�t..� Permittee ‘ature:
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 the next available inspection date.
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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1p
® COMMUNITY DEVELOPMENT Permit #: ELR2010 00139
I Date Issued: 07/29/2010
T I �� R 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102AA01100
Jurisdiction: Tigard
Site address: 12035 SW PACIFIC HWY A
Subdivision: Lot: 0
Project: Tigard Auto Stop - Brake Team
Project Description: Limited energy for HVAC
Owner: FEES
TIGARD AUTO STOP PARTNERS Description Date Amount
2829 RUCKER AVE STE #100 Restricted Energy Permit 07/29/2010 $75.00
EVERETT, WA 98201 12% State Surcharge - Electrical 07/29/2010 $9.00
PHONE: 503 - 796 -2887
Contractor:
OREGON HEATING & AC
PO BOX 241
DUNDEE, OR 97115
PHONE: 503 -691 -9699
FAX: 503 -691 -8556
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 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 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 OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: M ^ kJ Perrnittee Signature: J L A p p7„ c ...:� %—/
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.
CaII 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 Applicati r , %; E,C.EIVE c1I, O I i sr oN1'l
- City of Tigard Receive
1 3 125 SW Hall Blvd., Tigard, OR 97223 2 $ ' L C10 Date/BY YiiY1">L
Pi
l 0 U. Plan Resew Other Permit'
: , ax: 503. 598.196
: - Phone: 503.639,1171 F0 Date/By: B N 2.GK1 — -
T. G ARD Inspection Line: 503.639.4175 OF fIG/\RD hate Ready/By: huts: See Page for
- (1
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Internet: www.ti drd - ov C I Dl Notified/Method: Supplemental Information
V iSt'J�
1171 OF PLAN REVIEW
❑ New construction XAddition /alteration/replacemerlt 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 El Other: velure the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
lest to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1 • and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for an other installations. buildings.
❑ Multi- family ❑ Master builder ❑' Other: ❑ rite pump.
I=1 Installation of 75 KVA or
• ❑ Emergency system. larger separately derived system,
JOB ST[ E TNPORMATION AND LOCATION ❑Addition of new motor load of ❑ "A "E ", `1 - ". "1 -
^ lob no.: . 3 Job site address: 12035 1 flu „ Six or o r rest occupancy. o r e .
V El Six or more residential units. 0 Recreational vehicle parks,
CirylSiflte /ZIP: t' Q—jo 3 ❑ Health -care facilities. in Supply voltage for more than
• `� v ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
— - - FEE SCHEDULE
Cross street/directions to job site: Dewiptlon ae. 1 total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 r 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (wit1 above sq. ft..
•
7 Limited energy, multi-family 75.00 2
- {,�► residential (with above l ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 1 2
BI PROPERTY OWNER E TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 , 2
Name: r, .�
,�x�v� � � 60l amps to 1 ,040 amps 301.04 2 •
AddreSS: I' " �� ' LAD r *� Over 1,000 amps or volts 552,26 2
� "" Temporary services or feeders installation, alteration, and /ar
City/State /ZIP: ` 7 i J` . 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, r panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT ❑ CONTACT PERSON above service or seeder 18e 7 42 2
(� each branch circuit
C -.T `
Business name: V r ar ! ' v `I 4. p / B. Fee for branch circuits without
service feeder fee, first 56.18 2
Contact name; f , Yv1 k �^r^ b branranch h ci sir an
'�� ] 4/ � V` Each add'1 brunch circuit 7 42 2
Address: '<— • v _ 110 A Qt-t , Miscellaneous (service or fteder not included)
Each manufactured or modular
City/State /ZIP: i.a. / .. �1 t (, 5 I - dwelline and/or feeder 67.84 2
Phone: ) .o Lt a 1 eg Fax: : 513) LSG(� p t O 5Sj W Reconnect only 67.84 2
Pump 2
p or ,gation circle 67,$4 2
E-mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: 6 c _panel. alteration, or extension. Page 2 2
� /� f !v Each additional inspection over allowable in any ("film above
Address: _ G. S { . M. " Additional inspection (1 hr min) 66.25/ hr
y /StHie /SIP. y Investigation (1 hr min) 66.25/hr
Cit
Yt� �� industrial plant (1 hr min) 78.18/ hr MOM
Phone: ) I q it Z ci Fax:e6 ) A I 35ste Inspections for which no fee is 90.00/ hr .
specifically listed (' /a hr min)
CCB Lic,: la.1 'aif? Electrical Lic.: • f L/0 Suprv. Lic.:) • r, b. ELECTRICAL PERMIT FEES
fir. Subtotal:
Suprv. Electrician signature, required: - -" .
Plan review (25% of permit fee):
•
Print name: GE, , a a ,,� Date: State surcharge (12% of permit fee): q
4 TOTAL. PERMIT FEE: � � • tO
f` Authorized Signature: .� f 1 This permit eppliattiun expires lr a permit is not obtained within I10
days after it has been accepted as complete.
/[/ r
Print name: / /� 1. / Date: a e Number or inspections anowed.per permit.
IABuiidi, Permits \ELC- PermitApp.doc 07/01,10 440.46157(11/05/COM /WEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY
Fee for all residential systems combined $75.06
Check Type of Work Involved:
I I Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
• Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee fot each commercial $7
•
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
•
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
j 1 HVAC
❑ Instrumentation
.❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape T righting*
❑ Protective Signaling
❑ Other
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: alildi4g ∎Permits\ELC- PermitAPDgdoc 07/01/10
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