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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00160 T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/30/2012 Parcel: 2S113AC00101 Jurisdiction: TIGARD Site address: 16655 SW 72ND AVE 400 Project: Microlnterconnects Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 37 Project Description: Install thermostat (1) HVAC Contractor: OREGON HEATING & AIR CONDITIONING Owner: PACIFIC REALTY ASSOCIATES LP 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:, Restricted Energy Permit 07/30/2012 $75.00 12% State Surcharge - Electrical 07/30/2012 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 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 952- 001 -0090. You may l obbttain � a / coopyy of the rules or direct questions to OUNC by calling 503.232.1987or 800.332.2344. l� Issued By: J Lc-.t[/t Pelnttittee Signature: D # ' 7Dm.• 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. 07/26/2012 11:24 503 - 691 -9556 OREGON HEATING PAGE 01/03 Electrical Permit Application REC : FOR OFFICE USE ONLY JUL 2 6 R eceived 7 �-1o11 Z - ao« CO/ 100 City of Tigard • Permit No.: ° 13125 SW Hall Blvd., Tigard, OR 97223 Z r P lan Re Ira Phone: 503,639.4171 Fax: 503.598.1960 Dste/By: Other Permit: Q/ 42061_0043 Inspection Line: 503.639.4175 CiTY OFTIGAR pate Ready /By. r /_ 1 ldSeePage2for P. T 1 G A D Interact: www.tigard-or.gov B UILDING Y - S u der. o v DIVIS'' r fed/Method: Supplemental Inforraadon TYPE OF WORK PLAN REVIEW • i ii O New construction ddition /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 H Other: where the available fault current ❑ Marinas 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 0 I - and 2- family dwelling [commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family 0 Master builder ❑ Other:, 0 Fire pump. ❑ instaliation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑Amergen system. larger " -2 " derived system. ❑ Addition o of new motor load of ❑ "AA - , , "EF'. . "1-2". "14", Job no.: J /7— Q(f Job site address: /4,6456_41 9,9,„„(41,, n or more. occupancy. ❑ 0 Six x or r more reresidential l traits. Recreational vehicle parks. City /State /ZTP: �'' • ❑ Health -care facilities. ❑ Supply voltage for more than ❑Hazardous locations. 600 volts nominal. �i7 67/ / ,., Suite/bldg. /apt. no.: #00 Project name: t . ! ..„, ) ❑service or feeder 600 amps or more. Cross street/directions to job site: 1 . VV Description FEE S SCHEDULE E ry. I j Q Fee. ] Total J • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1 sq. ft. or less 168:54 4 Tax map/parcel n0.: Ea. add'l 500 sq. ft or portion 33.92 1 Limited energy, residential DESCRIPTION OF •WORK (with above sq. ft.) 75.00 2 9 � C / ��� /f � e`,( j Limited energy, multi-family a e sq. // , (.5Y—E? residential (with above sq. ft.) 75,00 2 Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER I d TENANT 201 amps to 400 a nps 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 • C /State /Z1P: Temporary services or feeders installation, alteration, and /o relocation Phone: ( ) Fax: ( ) . 200 amps or less 1 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 © APPLICANT I - EONTAt "T PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: p / 1 / Not-liftal OL ,Q t B. Fee for branch circuits wititote service or feeder fee, fi 56.18 2 Contact name: ` ; branch circuit f/ t acv add') branch circuit 7,42 _ _ 2 Address: P (/ a �` / Miscellaneous (service or feeder not iocluded) City/State /ZIP: /1, G3 -2 !/ J Each manufactured or modular 67.84 2 ` dwelling, service and/or feeder Phone: ( .96 Q9 Fax: : 6)3 ea / - 6376, Reconnect only 67.84 2 E -mail: / L _' ` �i1 / / �i i / //' . / / . Pump or irrigation circle 67.84 2 _ O �• OR Signal or outline lighting 67.84 2 Signal circui(s) orlimited energy is .- i Business name: panel, alteration, or extension. Page 2 2 Each additional inspection over allowable in any of the above • Address: 13 _- Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: • Investigation (I hr min) 66.25/ hr industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr / specifically listed (A hr min) XCB Lic. :)" (a.4 a CP electrical Lic.: y0 �iprv. Lt4.:47g5 4 i. ELECTRICAL PERMIT FEES • Suprv. Electrician signature, required: Subtotal: W�► . Plan review (25% of permit fee): ' Print flame; ; ft , • . rUL._ Date: (2-0 Stare surcharge (12% of permit fee): MU Authorized signature: �� �f / �^'� TOTAL PERMIT FEE: Wolff . e-e , '� J� Tess permit applkanen <Atka if a permit is net obtab , w•i ■ In 180 Print name: J [date: f A ! / .1 .9 , . / days after it ha accepted as complete. ' N • Al.. � L umber of at inspections allvvred.per perndl. rrry■ ■■• tttr t: 18 ufdtng \Permlte\ELC- PennitApp.doc 07101.10 4111 4411 ae15T(11/07 /GOM/wFa 07/26/2012 11:24 503 - 691 -8556 OREGON HEATING PAGE 02/03 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* ❑ burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* [ Vacuum Systems* ❑ Other: COIERCIAL 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 ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation [ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations t: \guadlogWumits\ELC -per .dx 07101110