Permit 1, CITY OF TIGARD ELECTRICAL PERMIT
IN 1 . COMMUNITY DEVELOPMENT Permit #: ELC2011 -00223
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/28/2011
Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 203
Project: Aesthetic Medicine Subdivision: TIGARD MEDICAL MALL Lot:
Project Description: Reconnect split system condenser.
Contractor: WILLAMETTE HVAC Owner: MCFADDEN, ARTHUR L
3075 SW 234TH AVE. #206 BY SKLARZ, ERIC
HILLSBORO, OR 97123 621 SW MORRISON ST, STE 800
PORTLAND, OR 97205
PHONE: 503 - 628 -6841 PHONE:
FAX: 503 - 848 -2597
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 04/28/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/28/2011 $6.74
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This perm' s issued subject to th- egulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don: in accordance with approved •Ia, .. T is 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 requi . you to :How the rules adopted by the Oregon Utility Notification Center. Those files are set forth in OAR
952-1)1-0010 thro gh OAR 952-001-00'0 o ` de a copy of the rules or direct questions to OUNC by calling 503.232.1917 or :00.3 2344.
I
Iss d 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 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 A licati CEIVED FOR OFFICE USE ONLY
7111 Tigard
of Ti Ci Received _ /ir� 1 `dd �� 2
ty ` r �j / Permit No g �t / ✓
•J g Date/3 a� p ti/4G
• 13125 SW Hall Blvd., Tigard, OR 97 R 2 8 1 Plan Review
m Phone: 503.7182439 Fax: 503.598.1960
Date/By: Other Permit:
T I Ci A R D Inspection Line: 503.639 Date Ready/By: Juris: El See Page 2 for
Internet: www.tigard - or.gov CITY RD Notified/Method: Supplemental Information
BUILDING ING DIV1 DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction EI Addition/alteration/replacement 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.
❑ Demol ition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
. • ❑ Emergency system. larger separately derived system.
( sat INFORMATION l LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 9735 SW Shady Ln looiiP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 203 Project name: Aesthetic Medicine ❑ Service or feeder 600 snips or more.
� Di n
c . =
Cross street/directions to job site: Description ' I Qty. I Fee. I Total I *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 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 (with above sq. ft)
Limited energy, multi- family 75.00 2
Reconnect split system condenser residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 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
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, per panel
Owner signature: Date: A. Fee for branch circuits with
C:1 APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42
each branch circuit
Business name: same as below B. Fee for branch circuits without /
service or feeder fee, first 1 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: -
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) F ax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Willamette HVAC, LLC panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: 3075 SW 234th ave Suite 206 Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
ity/State /ZIP: Hillsboro OR 97123
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 628.6841 Fax: (503) 597 Inspections for which no fee is 90.00 / hr
specifically listed (% hr min)
CCB Lie.: 56951 Electrical Lie.: 3434 CRE Suprv. Lie.: 4025LEB ELECTRICAL PERMIT S I JP u ,
Suprv. Electrician signature, required: Subtotal: .
Plan review (25% of permit fee): -
Print name: Mike sicard Date: 4/27/11 State surcharge (12% of permit fee): Ce •7¢
TOTAL PERMIT FEE: � df ' l .0
Authorized signature: (9 � 1 This permit application expires if a permit is not obt n d within 180
Print name: Michael Malstrom Date: 4/27/11 *
days bo allowed has been accepted as complete.
Number of inspections allowed d per permit.
I:\ BuildingWermits \ELC- PermitApp.doc 07/01 /10 440- 4615T(ii /05 /COM/WEB