Permit • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11111 - COMMUNITY DEVELOPMENT `:_'`f : Permit #: ELR2011 -00230
TIGARD : AR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2011
Parcel: 25101 DA01500
Jurisdiction: Tigard
Site address: 7150 SW FIR LP 100
Project: Halstead International Subdivision: 72ND BUSINESS CENTER Lot: 5
Project Description: Low voltage for HVAC. 12/2/11, reprinted to correct description of work.
Contractor: AMERICAN HEATING INC Owner: DHS LLC
1339 SE GIDEON ST 15 OAKWOOD AVE
PORTLAND, OR 97202 NORWALK, CT 06850
PHONE: 503 - 239 -4600 PHONE:
FAX: 503 - 239 -7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/08/2011 $75.00
12% State Surcharge - Electrical 11/08/2011 $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. ATT •1: c -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -r 110 through OAR ° 2 -e: 00' • You may obtain a copy of the rules or direct questions to OUNC by calling 13 :232 987 or 1.800. 32.2344.
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Issue. By: I ` �, .1.4 - a Permittee Signature: ' Z
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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
v Permit #: ELR2011 -00230
COMMUNITY DEVELOPMENT
.��
TIG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2011
Parcel: 25101 DA01500
Jurisdiction: Tigard
Site address: 7150 SW FIR LP 100
Project: Halstead International Subdivision: 72ND BUSINESS CENTER Lot: 5
Project Description: Replace (1) 3 ton a/c ground mounted unit and associated supply /return air duct.
Contractor: AMERICAN HEATING INC Owner: DHS LLC
1339 SE GIDEON ST 15 OAKWOOD AVE
PORTLAND, OR 97202 NORWALK, CT 06850
PHONE: 503 - 239 -4600 PHONE:
•
FAX: 503 - 239 -7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/08/2011 $75.00
12% State Surcharge - Electrical 11/08/2011 $9.00
Type of Use:
Class of Work:
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N 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 ...roved 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. ATTENT a Oregon law r- y•u t• follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 % throu• OAR 952-001-01% I. You - obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or 1.800.332.234 .
Issued :y: t • . .� Permittee Signature: no a
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. 1. ESE ONLY. - : . , - ..
City of Tigard Received H d! Permit No.: e�e40 ?JQ' .A, j
1 14 13125 SW Hall Blvd., Tigard OR 97223 Plan Review Other Permit: C P hone: 503.639.4171 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page2 for
T I G A R O
--- — - Internet: www.tigard or.gov Notified/Method: Supplemental Information
', - l ''''''3''44' '° '° - :x PLAN«It)r Vfli W
T3 "VPORK v,.. F n
❑ New construction Hail 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.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
4,., • s ; :Z exceeds 10,000 amps at 150 volts or ❑ floating buildings,
CA TEGORY, OF CONS:1liLZCTIO�i - . - less to ground, or exceeds 14,000 ❑ Commerci -sSe 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
❑ mergency system larger separately env system.
x . JOB SIT_ Ei:IN,FO)f2I . TON - LOCA`T'ION ❑ Addition of new motor load of . ❑ «A > 1- ,
100HP or more. occupancy.
Job no.: Job site address: 1 15 0 S() �i ( 1.,(9-0 ? ❑ Six or more residential units.
0 Recreational vehicle parks.
❑ Health-care facilities.
0 locations. ❑ Supply voltage for more than
City/State/ZIP: G 600 volts nominal.
�' `I (�y
Suite/bldg. /apt. no.: Project name: ( T-- 1 ❑ Service or feeder 600 amps or more.
a C ,\ FEE S CH1 D4JLE' ' nl
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
,.��,: - - >•
: - -if
- above .ft.
= °t ° .; ,;._ ,.��;" (with abo
Limited energy, multi- family
,1_ V ° l XJ r I 41 1 r� 75.00 2 ft.) i n 9 feeders above sq. ti
T � O ' �Vl / residential Services or fee installatian, alteration, and/or relocation
200 amps or less 100.70 2
_.s 133.5
�; - amps to 400 amps - 201
�. ps
:z ®RROPERT S r U y ER . - .... `'M :... t. ,z . C7 TENANT.. .. - , .
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
401 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
- __: ;a ; �,• e.n,.. =_ t,, a serv or feeder fee 7
�_ - `.� - .42 2
- � / + PER�ON,...�,-
Y'�`� ^` `^�' t .. i�,iF t�J , 'Zr�Y., V'l"/k4� .
s,.�tstiA: -. �E , . - 3 :. -_ :� , � a ... . w..,, ,-.. - ._ ,.., - ,:.�..a ,,�,..._,�,� _. _ ..; h'- , each branch circuit
Business name:
' - aj .._ w , ,_ • .:, Ysf : "'£i 4Yi i a, �`
B. Fee for branch circuits without
(�, (((((y 1 i l �1 service or feeder fee, fast 56.18 2
Contact name: J l win t j/ �U branch circuit
t "� J - / Each add' I branch circuit 7.42 2
Address: 1, 33 9 S L 61 CLO-Y1 3 Miscellaneous (service or feeder not included)
^� en `1 Each manufactured or modular 67.84 2
City /State /ZIP: 1 0 l+V X Q •� vl� aV dwelling service and/or feeder
(
Phone: ( 565) a, - LtU 03 Fax: : (63) '- 1 (OZ Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
a tl R * , ? ,� - ,, . r' 4eON'1*ACTOR _ 2 , < t„ -a_ .,,.. t „ , .., , _- Signal circuit (s) or limited-energy
� ` , I _ _II -- panel, alteration, or extension. Page 2 2
Business name:
„ p Y , ( U N ( t .L(\C , Each additional inspection over allowable in any of the above
Address: ''''b GL k(,\ QO S 1I J A dditional inspection (1 hr min) 66.25/hr Investigation (1 hr min) 66.25/ hr
City /State /ZIP: f "6
- p o v, ( V /] 1 O � 1 _
r Industrial plant (1 hr min) 78,18/ hr
Phone: (t5 "' a' - L - �) Fax: (� , )_3G �- V� Inspections for which no fee is 90.00 / hr
v (J specifically listed (%z hr m :i � i . n : � )
/' / < 140A trtt t ?FEF,S ' >."' :`s; . 4 ;7;:
CCB Lic.: "� � � Electrical Lic.: � � ' � i Supry Lic.: � I li EIsE� lv ,. , , .
p required: 7 f /� I / f ' 4 9/11 al — Subtotal.
Su rv. Electrician signature, r u 1 f , 1 a., // ¢> Plan review (25% of permit fee):
Prier_ name: t r e k r Q f' Yet (7 , Date: ( ` — (( State surcharge (12% of permit fee): —_
-- TOTAL PERMIT FEE:
Auth signature: _OL(n d ((( This permit application expires if a permit is not obtained within 180
d after it has been accepted as complete.
Print name: �-� (A a a6 d Date: i (— 'i 1 • Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11/05 /COM/WEB