Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00204
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Date Issued: 09/14/2011
Parcel: 2S101DC04602
Jurisdiction: Tigard
Site address: 7291 SW TECH CENTER DR
Project: Pacific Recreational Products Subdivision: Lot:
Project Description: Low voltage for HVAC
Contractor: HVAC INC Owner: MCCORMACK PROPERTIES LP
5188 SE INTERNATIONAL WAY 7190 SW SANDBURG ST
MILWAUKIE, OR 97222 TIGARD, OR 97223
PHONE: 503 - 462 -4822 PHONE.
FAX* 503 - 462 -6555
FEES
Description Date Amount
Specifics: , Restricted Energy Permit 09/14/2011 $75 00
12% State Surcharge - Electrical 09/14/2011 $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 cordance itt� approved plans This permit will expire if work is not started within 180 days of issuance, or if war is suspended for more the 180
days A ENTION Oregon ••'res you to follow the rules adopted by the Oregon Utility Notification Cen Th.'s: rules are set forth in OAR
952 -00 0010 through OAR 9% - 01-0 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 k- :7 r 1 814 3% , 2344
Iss ed 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 App i .. ` . '0 FOR OFFICE USE ONLY
City of Tigard C' 4 2011 Received 9��� Permit No � '(�. � �j
II Ai
e ° 1 SW Hall Blvd., Tigard OR 97223 Plan Revie '
' Phone 503.639 4171 Fax 503.598 1960 Date/B : Other Permit
T i GARD Inspection Line. 503.639 4175 CITY OF TIGA D Date Ready/By runs 0 See Page 2 for
Internet: www.tigard or gov RI',LUNG DIVISION Notified/Method• Supplemental Information
TYPE OF WORK DIVISION
PLAN REVIEW
❑ New construction JI Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below)
El Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Mannas 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
❑ I- 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "t -3 ",
Job no.: — 11 Job site address: 1 R 1 SW ` e C) 1 1 CJ V, Otis Six or more more occupancy
❑ Six or more residential units. ❑ Recreational vehicle parks
City /State /ZIP: q ❑ Health-care facilities 0 Supply voltage for more than
1 1 � / , El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: p c-U ci u u U11� t tV 1 ❑ Service or feeder 600 amps or more
1 FEE SCHEDULE - .
Cross street/directions to job site: Descnption I Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq ft. or portion 33 40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft )
Limited energy, multi - family
\ /Ow V . V "VC (A) 1 1 1AA�/' residential (with above sq. ft.)
75.00 2
V 11 Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66 85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT - ❑ CONTACT PERSON above service or feeder fee, 6.65 2
J l_ / /IAA r h branch circuit
Business name: l.% Fee b B Fee for branch ch cia rcuits
Contact name: . , ' • , without service or feeder fee, 46 85 2
� ,Ar I I first branch circuit
Address: 5 I' % S °I ZN _ ' 0 11t r Wv f �,\ J / Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: I Y \ 1 \A1 �� \ \ a--1.--Y1(r-Q*--'' Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: -7 )) b u % " J /J �/ I Fax: : (S 3) 4 �� 1o �, Reconnect only 66.85 2
E -mail: I (� &.\ � (j v\V �.�\ (� r uo Pump or irrigation circle 53.40 2
•1 f , CONTRACTOR Sign or outline lighting 53 40 2
� ! 'L V, � panel, Signal circuit(s) limited -
Business name: ►`,L, V (i energy panel, alterer ation, or �
Address: S-1$1 S� �v� V 0\A extension Describe: I Paget 7 5' 2
City /State /ZIP: ■ � , Each additional inspection over allowable in any of the above
i v - Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lie.: ��� --) ,
I Electrical Lie.:' ( �'�`i uprv. Lic.:' j 7 n \ L kt , Industrial plant per hour 73.75
' �� �/� ELECTRICAL PERMIT FEES
c
Suprv. Electrician signature, required: - /WN J'1 V ., f Subtotal: 7 •
Print name: ` O (J vW /3,' ' a, Date: q 1 Plan review (25 %of permit fee
aL State surcharge (12% of permit fee): 9 , co
Authorized signature: f ' 1,�4,r 1 This permit application TOTAL PERMIT FEE gC DD
Print name: ^^VV 11
Xil �. `� . Date: C( I / [31 1 I expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit
I \Building \Permits\ELC PermaApp doc 05/23/06 440- 4615TO I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r`RESIDENTIAL WORK.ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
.COMMERCIAL WORK ONLY:.
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
tXt HVAC
n I • nstrumentation
n Intercom and Paging Systems
n L • andscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \Budding \Permos\ELC- PermitApp doc 03/23/06