Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a : COMMUNITY DEVELOPMENT Permit #: ELR2012 -00103
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2012
Parcel: 2S113AA01000
Jurisdiction: Tigard
Site address: 16578 SW 72ND AVE B9
Project: Gingerbread Tradition Subdivision: ROSEWOOD ACRE TRACTS Lot: PTS C,C
Project Description: (1) 3 ton gas pack thermostat, (1) 2 ton gas pack thermostat
Contractor: OREGON HEATING & AIR CONDITIONING Owner: PACIFIC REALTY ASSOCIATES
PO BOX 241 ATTN: N PIVEN
DUNDEE, OR 97115 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 691 -9699 PHONE:
FAX: 503 - 691 -8556
FEES
Description Date Amount
Specifics: 12% State Surcharge - Electrical 05/22/2012 $18.00
Type of Use: COM Restricted Energy Permit 05/22/2012 $150.00
Class of Work: ALT
Total Number of Systems: 2
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 $168.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law, All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 52- 001 -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
T7 /� /'
Issued By: & py Permittee Signature: O IV A .8 P I s / 1 1Mt
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project
Approved plans are required on the Job site at the time of each inspection.
05/21/2012 11:33 503 - 691 -6556 OREGON HEATING PAGE 01/03 �'
frD I�
Electrical Permit A licati . ; ` 4-, P, Q • OFFICE ('SE ONLY � �
Permit T'
City of Tigard i L� �► z - 00 1 03
li
n 13125 SW Hall Blvd., Tigard, OR 9722 T • Plan Review
Phone: 503.639 x171 Fax: 503.598. AY 21 2012
i)stelter: Other Permit:
T I G AR D Inspection Line: 503.639,4175 n eth
Dale ReadyReady/By: Jurir la See Page 2 for
Internet www.tigard- or.gov CITY OF TIGAi 1D Notified/Mod: � G - Supplemental Informalioa
TYPE ol$liONG DJVISION PLAN REVIEW
❑ New construction 01 Addition /alteration /replacement Please cheek all that apply (submit a sets of plans wine= checked below):
❑ Service or feeder 400 amps or more • El saucing over three stories. .
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEG9RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Commercial -use mintier-at
❑ I- and 2- family dwelling t oCommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family 1:1 Master builder ❑ Other: ❑ fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
A
❑ Addition Of new motor load of oocup
•
Job no., .0033 Job site address: /�vj/Q t 7/. /t,. 10011P or �m �y
Q G,J [i CI or moore residential units. ❑ Reueationet vehicle parks.
City /Stale /ZIP: ❑ Health-care facilities. 0 Supply voltage for mom than
lA . � //� �� �7��1 ❑ 1lamrdous locations. 600 volts nominal.
Suite/btdg. /apt no.: Project name: n { _ � �a�� ❑ Sern s m oe or feeder 600 em more.
U FEE SCHEDULE
Cross street/directions to job site: tkyeriptten I Qty I Fee. J 'rotas 1 •
- 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'1 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi-family 75.00 2
/ 2 — a 411/4014/31214- residential (with abo sq. ft.)
a.7 r� Services or feeders installation, alteration, and/or relocation
1, 2;51" t ` /2040 200 amps or less 100.70 • 2
❑ PROPER OWMR I I] TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 . 2
Name: • 1 601 amps to 1,000 amps 301.04 2
Address: . Over 1,000 amps or volts 552.26 2
relocation services or feeders installation, alteration, and/or
City /State/ZIP: e�
Phone: ( ) I Fax: ( ) . 200 amps or lees 5936 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 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, per panel
Owner signature: _ Date: A. Fee for branch circuits with
❑ APPLICANT J le CONTACT PERSON above service or theder the, 7.42 2
� each branch circuit
Business name: �ly� /,T�� Q Q(" / B. Fee for branch circuits rsirl+our
( Service or feeder fee, first
36.18' 2
Contact name: each
circuit
-- Each add'l branch circuit • 7.42 2
Address: i U ( 5 ay / Miscellaneous (service or feeder not included)
tY �jo ( 9 7 / d el ing, servic a or r feeder 67.84 2
City/State/21P: /Sta /21;?: ! dwelling, service anNor feeder
Phone: 16 ( A g( Fax: (Q9/ .11,515-.6 Pump or irrigation circle 67.84 2
E'rnai 11AA 1 6" ' e it/ 4 ./ /_f - Sign or outline lighting 67.84 2 •
C t ' ' • CTOR Signal circuit(s) or limited-energy
Business name; panel, alteration, or extension. Page 2 2
. Each additional inspection over allowab a art a above
Address: - Additional inspection (1 hr min) 66.25! hr
City/StateJZiP: Investigation (I hr min) 66,25/ hr
Industrial plant (1 ht m 78.r
Phone: ( ) tikkv " 1 Fax: ( t�u� D ��\ � o 0\4' 18/ h
inspections for which no the is 90.00 1 hr
•t V specifir�r listed (% hr min)
CCB Lic. :J" ta,,� au? Electrical Lic.: y0 Suprv. Lic. :)798/ iN • ELECTRICAL PEST FEES
Suprv. Electrician signature, required: o Subtotal: /$a
_ Plan review (25 /o of permit fee);
Print name: n r «a ruL Date: rl State surcharge (12% of permit fee): /8-1
C r TOTAL PERMIT FEE: / to 5 1 ,
• Authorized signature � j p' permit 18 nor obtained within 150
'� ;, �, _ _�� T h is permit application expires if a
Print name: /� f ' Date ^/ days after it has been accepted as complete.
(� , • Number of inspections allowed per permit.
r \a..i,A'mo19.,,ni,.,F,.r- Dermi, Ann Anc 07/01/10 440 44157(r I /O /COM/WEB
05/21/2012 11:33 503 - 691 -8556 OREGON HEATING PAGE 02/03
Electrical Permit A.pplicatioL. 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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 91 &309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems •
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems;
*No licenses are required. Licenses arelrequired
for all other installations