Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00026
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/02/2011
Parcel: 2S102CB01802
Jurisdiction: Tigard
Site address: 13407 SW PACIFIC HWY
Project: AutoZone Subdivision: Lot: 0
Project Description: (2) HVAC systems.
Contractor: CENTURY HEATING & A/C INC. Owner: BAR -AM, LLC
PO BOX 544 BY GODFATHER'S PIZZA
GRESHAM, OR 97030 1416 THIRD AVE
SEATTLE WA, 98
PHONE: 503 - 656 -6707 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/02/2011 $150.00
12% State Surcharge - Electrical 02/02/2011 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
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 $168.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through 0 • : 952- 001 -0090. You_may ob • • • the rules or direct questions to OUNC by calling 50 987 or 1.800.332.2344.
Issued ByV Permittee Signature: ,� /.� ✓iL� %��
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application,
FOR OFFICE USE win'
Received ( -,
-.........4i , /
City of Tigard ,M > • �. a :n
n 13125 SW Hall Blvd., Tigard, OR 97223 t
Plan Review' Other Pernik: '
• a .. , Dattte/Bv: � _ . 411 1� . .■
Phone: n Line: 5 03 3 . 63 9 503598.19b0 L Date y ec ' age 2 for
T I G A R p
Internet l frt 5... No
A. pd eth FM SaPelemeettal Information
(nlerrr,et ww�.��gardar.go. �Ea
I PLAN REy1EW
TYPE OF WORK submit � sets of plaits wlitems checked below):
Please c$rcl a0 that apply
m Nun' construction ❑ tdUddlll0n/allCCat CptacC171CIIt ❑ Savior or feeder 400 maps or more ❑ Bedding over three stones.
❑ Demolition ❑ Other where the available fault parent ['Marinas and boatyards.
exceeds 10.000 amps at 150 volts or 13 Floating buildings.
CATEGORY OF CONSTRUCTION exceeds
to grouted, or exceeds 14.00D ['Commercial-use agricultural
❑ 1- and 2- family dwelling ® Commercial/indnshial 0 Accessory building amps for all other installations buildings.
One gyp ❑ Installation of 75 KVA or
❑ I _ y 0 Mast
er builder ❑ . ❑ Emerge etcy system. larger separately detived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", ' occupancy.
Job �i w d
r / 100HP or more.
[Job site address: J S pIuFr,4- Air Sir or more ❑ ❑ Recreational vehicle parks.
CltylStatP1ZIl': � f att� , facilities. e s . writs. ❑ Supply voltage Sr o more than
_ Project 7 ❑ 1ledtb tear fac CI Hamm locations. 600 volts nominal.
ect name: �� ❑ Service or feeder 600 amps or moat.
Suite/bldgJapt no.: l ttt7 La FEE SCHEDULE
�// L1 p� ' _ >>e>tarit�m I pt!- I Fee. I Total l .
Cross street/directions to job site: �i c L't 4f+� s G1 `_'� New residential single- or multi - family dwelling unit.
1 Includes attached garage.
1,000 sq. R or less 168.54 I 4
Subdivision: no.: 33.92 1
Ea. aeld'1 500 sq. P. or portion
Tax Imp /parcel no.: Limited energy, residential 75.00 2
(with above sq. it)
DESCRIPTION OF WORK Limited energy, multi-family .
ulti- family 7 5 06 2
-
residential (with above sq. ft.) l
Services or feeders installation, , alteration, and/or relocation ,
200 amps or less 100.70
z
201 amps to 400 amps 13336 2
PROPERTY OWNER ❑ TENANT 201 2
/7
h 401 amps to 600 amps
Name: c ��d wA + 601 amps to 1,000 amps 301.04 ` -
/a 3 eS ou.ne t ft R ST O ver 1,000 pat or volts 552.26 2
Address: e>aporaty services or feeders installation, alteration, and/or relocation
City/State/DP: iAl 'AA I rid 7A amps or less 5936 _ 1
Phone: ( ) Fax: ( ) 125.08 2
Owner installation: This installation is being made on property that I ovt�1 which is not 201 amps to 400 amps
401 amps to 599 amps 168.54 2 ,
• intended for sale, lase, ran, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits _new, alteration, or exterraion, Per panel
Date: A. Fec for branch circuits with -
Owner signature:
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
• each blanch circuit
B. Fee for branch circuits without
Busincs4 service or feeder Ice, East 56.18 2
branch circuit .
Contact name: ' Each add'l brands circuit 7 ( 2 '
Address: Miscellaneous (service or feeder not included)
Each manufacturcd ornmdular I 67.84 2
City/State/ZIP: dwelling, service andlor feeder
Reconnect only 67.84 2
Phone: ( ) Fax : ( ) Pomp or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuits) or limited-energy j Paw 2 • �2
r • _ panel. alteration. or maces-ion.
Business name: � � � 4./ �� Each additional inspection over isle In any of the above
r� r� Addifisoal moo (1 hr ::i11 i 66 hi' Address: O al Ste' �`�' r3-�x S 5/ hr
�'! 1 �e Investigation (1 hr min) _ i�L� ...a
City/Sttitc/ZlP: G,rez . t7' ., 9 j Za8 3 Industrial plant (1 br , �1W
/ ��
I for which n• , is V 1111 , i• .11% c t 1 ltr
Ph C...% (v 46 (0`7' F ) (.a 4 G -- 4 - 7 g apecificalt q listed la : ;,. )C 4l. ! rl •
,, ► ' >�Es
CCB Lic.: 4 2/ (ev Flechrica / ,., . R S uprv, Lic.: ri ;Z: l}L�� ■
Suprv. Electrician signature, nee ,A J� — Plan review (25° orpermrt fee):
— .J i Date: ` State surcharge (12°.'° of permit fee): 65%00
Print na1>le ` ed!'� I 4 TOTAL PERMIT FEE: /63 - . LI O
Authorized signature: / This permit application expires if a pit is net obtained wtthla 180
Ct J daps after It has been accepted as complete.
Print name:
Dale: a /, Ire 1 a Ntmberof inspections ellowedper permit.
� y 1 41 ,, „.
4:o-M,15T(l uosrcoww>:g
I ,,.y7d y.... I.C-PeQailAPpdx 07/0.1/10
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Electrical Permit Application - City of Tigard Protective Signaling
Page 2 - Supplemental Information Other
LIMITED ENERGY PERMIT FEES: Total number of commercial systems:
RESIDENTIAL WORK ONLY: No licenses are required. Licenses are requires
Fee for all residential systems
$75.00 for all other installations
combined........
Check Type of Work Involved:
Audio and Stereo Systems`
Burglar Alarm
I } Garage Door Opener*
Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
( Other:
COMMERCIAL WORK ONLY: $75.00
Fee for each commercial
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
Audio and Stereo Systems
k 1 Boiler Controls
n Clock Systems
I Data Telecommunication Installation
ri Fire Alarm Installation
HVAC
E l Instrumentation
Intercom and Paging Systems
E Landscape Irrigation Control'
Medical
Nurse Calls
Outdoor Landscape Lighting
1: EuildurgermLWELC -Pc mitAPp.dec 0■01'10
Z'd 68L9 999 seLU1oH iGe0 d6t7:Z L L L W qad