Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I s ` -n COMMUNITY DEVELOPMENT Permit# ELR2011 -00228
Date Issued 10/26/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439
Parcel 23113AB00300
Jurisdiction Tigard
Site address 16037 SW UPPER BOONES FERRY RD 200
Project Oregon State Bar Subdivision FANNO CREEK ACRE TRACTS Lot 38
Project Description HVAC system
Contractor BEST ELECTRICAL Owner OREGON STATE BAR, THE
13533 SE 123RD 16037 SW UPPER BOONES FERRY RD
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE 503- 319 -4169 PHONE 503 - 620 -0222
FAX
FEES
Description Date Amount
Specifics. Restricted Energy Permit 10/26/2011 $75 00
12% State Surcharge - Electrical 10/26/2011 $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 $84 00
Other Desc Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 - 001 -0010 through OAR 95 - 101-0090 You may obtain a co. of the rules or direct questions to CUNC by calling 503 232 1967 or 1 800 332 2344
Issued By mutes- Signal - -
®� OWNER INSTALLATION LY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE Date
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR ELEC' Date
LICENSE NO
Call 503 639 4175 by 7 00 a m for the next available inspection date
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection
Electrical Permit Application �.� FOR OFFICE USE ONI.I
City of Tigard Received Date /B t o ,
`J g Permit No - J I I ,�� `ice • 13125 SW I lall Blvd ,Tigard, OR 9722 e Plan Review
'' t7 Phone 503 718 2439 Fax 503 598 i yyyfff r m Q 1 Date/By Other Permit G/1-.,1 } _ (�4 t 3
"IiIGARD Inspection Line 503 639 4175}2, 0 CO A Q (_,Date Ready /By tuns c"' EJ See Page 2 for
Internet www ligard -or gov �`"'�� r .( . c . ? � [ 4!� Notified/Method _cumin
Supplemental Information
TYPE OF WORK rk ':at * " PLAN REVIEW
El New construction 14 Addition /alterattorqeplacement Please check all that apply (submit 2 sets of plans whtems checked below)
Lr 'J ❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition El Other aJ• where the available fault current ❑ Marinas and boatyards
y'-' CATEGORY OF COY$'GRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
El 1- and 2- family dwelling ® Commercial /Industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other 0 Fire pump ❑ Installation of75 KVA or
❑ Emergency system larger separately denved system
JOB SftE INFORMATION AND LOCATION ❑ Addition of new motor load of
Job no • I Job site address 1E o37 U PP1k 8 Ocit FEP /A // Six or or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
City/State/ZIP /i 0 0',Q ❑ Health -care facilities s
tion ❑ Supply voltage for more than
r ` ❑Hazardous locations 600 volts nominal
Sutte/bldg /apt no C Project name o 5.46 ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site Description I Ott 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
Tax map /parcel no Ea add'I 500 sq ft or portion 33 92 1
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi -family 75 00 2
C-
L V4C 1, �, ad/ Pc QC. 5 residential (with above sq ft)
f 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
Name. 401 amps to 600 amps 200 34 2
601 amps to 1 000 amps 301 04 2
Address Over 1,000 amps or volts 552 26 2
City /State /ZIP Temporary services or feeders installation, alteration, and /or
relocation
Phone ( ) Fax ( ) 200 amps or less 59 36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 os 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, 'Cr panel
Owner signature Date A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name 8,657 6 an p/c /IL B Fee for branch circuits ivrtlmm
service or feeder fee, first 56 18 2
Contact name LA ks. BES r branch circuit
1 / Each add branch circuit 7 42 2
- 2 r
Address / 7 - 5 % 3 SF /2 3c� -4 E Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP C (...../k ,e ' / ��}},,��
/b✓i 5 0 /. 9 - 1a) S dwelling, service and/or feeder 67 84 2
Phone ( ) Fax ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E
Sign or outline lighting 67 84 2
CONTRACTOR _ Signal circuit(s) or limited- energy -7
Business name 66:67 W E 6 7 VI , c /I C. panel, alteration, or extension I Page 2 / 5' 2
//'� Each additional inspection over allowable in any of the above
Address / 35 3 3 5 /0/3 g" ✓E- Additional inspection (I hr min) 66 25/ hr
City /State /ZIP or/lc lA - 970/ S Investigation (1 hr min) 6625/hr
Industrial plant (I hr mm) 78 18/ hr
Phone (S''c 319' - y(6 9 Fax ( ) Inspections for which no fee is 90 00/ hr
specifically listed ('b hr min)
CCB Lie i�U ! Electrical Tic (563 Supry Lie 55'6 5 _ ELECTRICAL PERMIT FEES
r ' ( / /jry _ ;,, } ii( : ^, fee) `75,
Supry Electrician s eian gnature, required a / - —� 2 Plan review (25 %of permit rmit fee)
Print name jr 77 / 6 "5'z; - ' Date I o/; 6 A J State surcharge (12% of permit fee) q,
Authorized signature L � ✓ , TOTAL PERMIT FEE f' t�
,
I his permit application expires if a permit is not obtained within 180
Punt name Date days after it has been accepted as complete
e Number of inspections allowed per permit
I \9mldmg\Permns\ELGPesmdApp doe 07/01/10 440- 4615T(i I /05 /COM/WE9
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
n G • arage Door Opener*
n H • eating, Ventilation and Air Conditioning System*
n V • acuum Systems*
El Other
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n line Alarm Installation
HVAC
!!!❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
1 Tudding\ermusLLI C- PermuApp doc 07/01/10