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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT t q COMMUNITY DEVELOPMENT Permit #: ELR2009 -00198 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/22/2009 Parcel: 2S115BA02600 Jurisdiction: Tigard Site address: 16230 SW PACIFIC HWY 120 Subdivision: Lot: 0 Project: Little Caesars Pizza Project Description: Install restricted energy for HVAC. Owner: FEES SN PROPERTIES PARTNERSHIP Description Date Amount 1121 SW SALMON ST Restricted Energy Permit 07/22/2009 $75.00 PORTLAND, OR 97205 12% State Surcharge - Electrical 07/22/2009 $9.00 PHONE: Contractor: OHAC INC PO BOX 241 DUNDEE, OR 97115 PHONE: 503 - 538 -2953 FAX: 503- 691 -8556 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 Total $84.00 Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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 thr ugh 0 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: CIA iNQ ,'\4) Permittee Signature: Q 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 an inspection that business day. 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. o r Electrical Permit ApplicationR EC EIVEDimmozzimmem City of Tigard JUL 2 0 2009 Received il h ,-- patens: t�� J� Permit Na.. 1. ( POOQ ' 6°1 Q g 13125 SW Half Blvd.. Tigard, OR 97223 Plan Review �ii� ( 1 Phone: 503.639.4171 Fax: 503.+98.1 CITY OF TIGARD 1Da Re CkherPermtt: 2�` Qq� Tit , >, Inspect,on e 503 639.4175 pate Ready/9y: lures p 2 for l m Internet wsvw ngard or gov BUILDING DIVISION Not" ed/ t 1 ibd: '_) C' SnpPlemental Information 1 , ,I ll 1 1 1 'e121 irk it i fyi il s ''I _ I 1 1 1 1 ❑ New onon ction Addition/alteration/replacement t ;i .;, - �, Please check all that apply (submit , ` Other: ,� � r • pp y ( limit 2 4Ct8 of plans wlitem! checked helew); � © + }k Q 1:1 Service or feeder 400 amps or more ❑ Building over three stories, Y1l�ll {1 1 j�' � #1 a I� ti, " k t^ J.a(a4 r; i;l d �° , ,t , cr va. m l °;i'`:,yl ; r�" y t t',}: tiI "ill kli 1 , ,Mt , y where the available fault Currant ❑ Marinas and boatyards. X1 tt)lllfl ill {r ' }, ub gltJl u,9d, }i tc ,, "n 1 ' 1 F, �Wl r iTi: exceeds 10,000 amps at 150 volts or 0Floatingbuildin s. El I - and 2- family dwelling ta Commercial/industrial lma l e needs 1a,000 pConincrciai- tuea ❑ Accessory bulldnlg amps foraliotherinstal buildings, Fire um lathons. nt ❑ Multi family ❑ Master builder , T 1 Pl,l , r v 1 rr < IN ,, 2 , , tt Ifj KI ILIA 11,', :ether I r ' , ,, I 13 Em Emergency System. ❑ larger t i separately 75 KVA or ,,, 1 „, 1 ., ;- , .. 11 Joh no.: 09 -0272 Job site address: 16230 SW Pacific Iiwy I00HP or more ystein e . „,,,,,1,: .. : , !!,,, ,. ❑ nddilion of new motor low of E""1- . occupancy. Ci /Statel2[P: ❑ Six or more residential units. ❑ Recreational vehicle parks. tY Tigard OR 97224 ❑ Health-care facilities. El Supply valtago for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: 120 Project name: Little Caesar's ❑ Service or feeder 600ampsormore. ;. I.„ lb Cross street/directions to job Site: �, a 1 6., ,. I s Lll I ; ku elf 7 i „i lly D eserip hot Ow. Fee Total New residential single- or multi- family dwelling unit, Includes attached garage. Subdivision: Lot no.: 1,000 sq, ft, or less 145.15 4 Tax map /parcel no.: Fa. aAd'l 500 sq. ft. or portion 33.40 I Li i tcd y m energy residential re ential .. , ,L {Il,;r IIa ' ' 1 k ,r t 1 ,1 It ...t .,,.,.1t''" s;.i . ta„ r',i. h r "'''' , ; 10. .I., „1..1. k hL I∎c,I.la,,,. {i. I 11,'",11;,7,,'.,I; ' ' with above 2 1i t 75. Limited energy, multi - family 75.00 2 residential (with above sp, ft.) , Services or feeders installation, alteration, and/or relocation it 4 li l ,1 { } ',!'7,i'',''',' 1 p ,1 ''.1`,;7'4"',‘ I 11 ` t 1 I . r. 200 amps or less 80.30 2 ,I, , • •a t1 I __.•,h;:, H,,,e ?:C,, _ciibi;;; Lii;: ui,... . iLstiU. : . ..r , 1.i ",: 111 e , ,., alrv' ,1I, a a, . l � .,. 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 Address: 601 amps to 1,000 amps 240.60 al 2 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 1 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 OILS 447, 449, 670• and 701. 401 amps to 599 amps 133.75 2 _ Owner signature: D ate: Branch circuits - new, alteration, or extension, r r panel y ° t1r r e { u n , , . Pee far branch circuits with ' { 1, IIItil {�i n v " .,,... ,, n i ll 'I r 0 11 l � r 1`1' iIl' , gIL h i , '''` ,; L1 A 1 1 , Si #. ,f,,, ,, , :'!.' .( , . ,,,,. � ,,,..�,;, ',,,, t 'k1 .1. 1 i - 'A., i,21.::,..'‘:'..0".!, r.. .�, Is.,,,,,i.1 ' I above Seriice 0r feeder fee 6.65 2 Business name: each branch circuit H. Fee for branch circuits - Contact name: without service or feeder fee. 46.85 2 f branch circuit Address: Each add'I branch circuit -I 6.65 2 City/State/ZIP: Miscellaneous (service or fader not included) w Each manufactured or modular 90.90 2 Phone: dwelling„ service and/or feeder ( ) fax ( ) Reconnect only 66.85 2 mail ,. TM. p i, r 1r , *� Pump Or tmgauon circle 53.40 2 .,se. C a sxh .:i.il r ...v Iri y sH+,.;7 1 i R451 llri,lEr `, t< '' 1 Zt, IIIII'N. Sign $ t ng 53.40 2 �•.w:,. S or ou tline li h r Business name: Oregon Heating & AC Signal circuit(s) or limited energy panel, alteration, or Address: P 0 Box 241 extension, Describe: I Page 2 75 2 limited energy' City/State /LIP: Dundee OR 97115 Each additional inspection over allowable in any of the above Phone: (503) 53S-2353 FAX: (503 -) 537 -2172 Per inspection 62.50 Investigation per hour (I hr min) 62.50 CCB. Lie.; 172126 Electrical Lie.: LRR40 Suprv, Lie.: 179$LEB Industrial plant per hour 7335 1 t rl1.1 Ihl1� r •4' 1 - . }I� I' tell �' 'Z', f y.. d nle„ x:, / , 11 ,' 1 1 ... .. ,� ,_1.1,_, 1 1 /11,,.sn uii,. onJh, y , u,. ,l c a...; w.ww71:' 1 1t,.x:_.�1..1'. .c 1i;c,u If Suprv. Electrician signature, required: l -� SU htntal: 75. Print name: Greg Boone Date: 07/20/09 Plan review (25% of permit fee): +0� State surcharge (12% of permit fee): 9.00 Authorized signature �m _ . �, TOTAL PERMIT FEE: 84.00 Print name: Teresa Stupor Date: 07/20/09 this p ermit application expires if a permit is not obtained within ISO days lifter it has been accepted as complete. • Number of inspections allowed per permit I inn \Permin \ELC- PermitApp.006 05/23/06 4404slS7(11 /05 /COM/WE3 E0 /10 3E ONI1ti3H N003NO 9958- 169 -E09 TT:9T 600Z/0Z/L0