Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00090
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2011
Parcel: 25101 DC00200
Jurisdiction: Tigard
Site address: 13535 SW 72ND AVE 165
Project: Workflow One Subdivision: 72ND AVE OFFICE BUILDING Lot: 0
Project Description: HVAC system.
Contractor: AMERICAN HEATING INC Owner: PNWP LLC #2
1339 SE GIDEON ST BY PACIFIC NW PROP LTD PTNSP
PORTLAND, OR 97202 PO BOX 2206
BEAVERTON, OR 97075
PHONE: 503 - 239 -4600 PHONE:
FAX: 503 - 239 -7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/15/2011 $75.00
12% State Surcharge - Electrical 04/15/2011 $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 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 -0090. You ma obtain a • . • .e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B ro / /1//-,-.
" � � ^ 'I e S 7 '
y Perm 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 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 I O R O I I I( I I I ()NI
City of Tigard ��� Received
L � � Permit No.: mot,.... , i/ —moo
• 13125 SW Hall Blvd,, Tigard, OR 972 Y
I Phone: 503.639.4171 Fax: 503.598. . 6 ` 1- Date/B new Other Permit: 6-2 /� - , , -
i' I G A R D Inspection Line: 503.639.4175 ,. . 11 6: e Ready/By: ® See Page 2 for
Internet: www tigard -ot gov Gp■- a .ed/Method: Supplemental Information
T'ltr. of WORk . - 15LAN R v c w ..! .
' ' - Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construct A Addition/alteration/re .: , .
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current ❑ Marinas and boatyards.
*� exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
tr'- 8 . _ s . `: . 3 - ' , -; , . - less to groun or excee 14,000 ❑ • Commerc -use • agricultural
❑ 1- and 2- family dwelling ■ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system.
❑ Multi-family ❑ Master bu larger separately derived system.
JOB SITE INfO*MATLON AND LOC;ATI(ON ❑ Addition of new motor load of ❑
1001W or more. occupancy.
Job no.: I Job site address: 1- 5 3 5 sto 7 (La H^ V `e ❑ Six or more residential units. ❑ Recreational vehicle parks.
� ��d ❑ Health -care ra ns es.
❑ Hazardous locatio ❑ Supply voltage for more than
City/ State/ZIP: 6 600 volts nominal.
Suite/bldg. /apt. no.: roject name: 1 �,_ Oftt ❑ Service or feeder 600 amps or more
3 _ t S CAIw ,-
Cross street/directions to job site: Des ripeloe I Otv. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I 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
l ar i ® (with above sq. ft.)
. . s . #1>
Limited energy, multi - family 7500 2
J _(J — ` " 2 14 ,, s C t' ( residential (with above sq. ft.)
l jN 11 3�f D i Services or feeders installation, alteration, and/or relocation
000 200 amps or less 100.70 2
v
2
1 4**:- O' t s .. ri ; g . _°., . , t "; ,.:. , . 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 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: relocation
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 40I amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
11 �N above service or feeder fee, 7.42 2
- 0CAI!1 , , .` , = -1 .. - - . each branch circuit
r B. Fee for branch circuits without
Business name: �P f � CVI 1 11 B t - (' service or feeder fee, first 56.18 2
Contact name: 6"G 0 S o s, branch circui
Each add'1 branch circuit 7.42 2
Address: (, 33 9 S GI t (JJ l) I 1 a, Miscellaneous (service or feeder not included)
/� n Each manufactured or modular 67 84 2
City/State /ZIP: p V {,0 I , ^ V A A 4 cil r�(`} O dwelling, service and/or feeder
` - 7 C1 Recon nect only 67.84 2
Phone: (583) r�� -�� 00 Fax: ( � ) l U� O Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
0011`1 to Q!Y3 Signal circuit(s) or limited- energy d:
Business name: n t p alteration, or extension. Page 2 75.. 2
( ca....tn +1 (t 1 1 nC Each additional inspection over allowable in any of the abov
Address: J Cl S E ok a ..eo y S t Additional inspection (1 hr min) 66.25/ hr
0 n (� Q Investigation (1 hr min) 66.25/ hr
�
City/ State/ZIP: o� ■ V i Industrial plant (1 hr min) 78.18/ hr
Phone: (1 f Fax: ( 63) ') ' -1 O' Inspections for which no fee is O/ hr
( V i J " l specifically listed CA hr min)
CCB Lic.: 3 (3 s Electrical Lic.: d 1001 (,g. Suprv. Lic.: /1'40 �Q(ti Etigc00I0AI7 T tT ~..PEES ' -
Subtotal: -75 . "—
;iuprv. Electrician signature, required: , P lan review (25% of permit fee
A L� :mac. // : ' ( P ): �7 -- .
Print name:
State surcharge - 1 `
A r -
t �(L �Q, 0 ( Date: 4 _ 1 ' � ( hrge (12% of permit fee): TOTAL PERMIT FEE: �2/, //(:J
Authorized signature: (k� ( Y� T his permit a pplication expires if a permit is not o , fined within 180
days after it has been accepted as complete.
Print name: 1 i ,�k An a (, j . (C4 a Date: L t._ I (4-
■ 1 • Number of inspections allowed per permit
I: \ Budding \Permits\ELC- PermitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB