Permit •.f
a CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00176
T [ G A R to 13125 SW Hall Blvd., Tigard OR 97223 503 639.4171 Date Issued: 04/22/2009
Parcel: 1 S 136AD04000 •
//537 Jurisdiction: Tigard
Site address: SSW PACIFIC.HWY
Subdivision: Lot: 0
Project: Pacific Terrace •
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Project Description: (4) branch circuits for RTU replacements.
Owner: FEES
PACIFIC TERRACE COMMERCIAL LLC Quantity Description Date Amount
BY EDITA M SMITH, 833 NW 170TH DR 4 crt Branch Circuits 04/22/2009 $66 80
BEAVERTON, OR 97006 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/22/2009 $8.02 .
Contractor: Electrical
WILLAMETTE HVAC
3075 SW 234TH AVE. #206
HILLSBORO, OR 97123 .
PHONE: 503 - 628 -6841
FAX: 503 - 848 -2597
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
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Total $74.82
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 .d work is suspended for more the
180 days. ENTION "gon - requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-0* -0010 through OAR 95 • 101-0100. o may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 1 80 32.2344 R
Iss ed By: % / � � . �/ Permittee Signature: Y rn , "��
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 INST • LLATION ONLY
SIGNATURE OF SUPR. ELEC'N 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 eaih inspection.
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' Electrical Permit Application • FOR OFFICE USE ONLY
� Rece
City o f Ti �� DateBy / / � d Permit No E(� eV/70
°. 13125 SW Hall Blvd., Tigard, OR �llg: Plan Review '
0 ' Phone: 503.639.4171 Fax: 503.598.1960 , ' n Date/By Other Permit
P A PR
Inspection Line: 503 639.4175 009 Date Read /B 3 RI Sce•Page 2 for
• TIGARD
Internet: www.tigard or.gov N oti fi ed/Method /C Supplemental
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... ..T .:: x:,..,... ' " =t '`PtiAN. REVIEW:: , �; .:
. IVIS1 M of ed
New construction Please check all that apply (submit 2 sets of plans w/items checked below)
❑' ®Atiditiol>/a�! ettt
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
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'r •4 ' • k . .r . CATEGORY. ,.. `` ..., "a114 .,. ;1! exceeds 10,000 amps at 150 volts or ❑ Floating buildings
:�:': ": C OF:. CONSTRUCTION =:�:�: ;:: "
e.... t
• less to ground, or exceeds 14,00 0 ❑ Commercial-use use agncu tira l
❑ 1- and 2- family dwelling ® Com mercial /industrial ❑ Accessory building amps for all other installations buildings
•❑ Multi- family ❑ Master builder ❑ Other: 0 Fire Installation of KVA or
•,., :. :.. ... :.. ,,.: .:: .
Y Emergency ❑ y system. larger separately derived system
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;:_ ,'- .. ; � ;' .. r B SITE, INFORMATION AND LOCATION - ur - 0 Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I - ",
• Job no.: Job site address: 11505 SW Pacific Hwy Six or or more occupancy.
• ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: Tigard OR ❑ Health -care facilities ❑ Supply voltage for more than
_ ❑Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: t ❑ Service or feeder 600 amps or more.
�.� FEE'�SCHEllULE <
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 145.15 4
- - Ea. add'l 500 sq..ft or portion 33.40 1 • •
Tax map /parcel no.: l,irnited energy, residential •
>' i.: - -;..:
. :. =: '' DESCRIPTIO\ OF WORK • • i •' : w + (with above sq ft )
�.. �'" is
Reconnect 4 RTU's Limited energy, multi - family 75.00 2
residential (with -above sq ft)
Services or feeders installation, alteration, and /or relocation
.: x - $ , .. : .... . ❑ is
200. amps or less 80.30 2
-:: :.,:� PROPERTY }VNER :' 's;;.: . : "'; _''H' - TENANT .. . �.,�, F 201 amps to.400 amps 106.85 2
Name: 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: 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 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 ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner si nature: Date: Branch circuits — new, alteration, or extension, per panel
g A Fee for branch circuits with
`..• :APPLICANT`;,s ` feeder � a: : °iel :0: CONTACT • PERSQN' : ?:::':g above service or feed fee, 6.65 2
each branch circuit
Business name: Same B. Fee for branch circuits // G�
Contact name: wrthbut service or feeder fee, fa 46 ft!' o'' 2
first branch circuit Q
Address: Each add'l branch circuit _ 6 65 // •95 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90 90 2
dwellihg, service and /or feeder
Phone: ( ) Fax: : ( ) • Reconnect"only. 66.85 2
E -mail: Pump or irrigation circle 53.40 2 .
+', R „:': . ::.:,:.:� ..: Sign or otitline•lighting 53.40 2
CONTRALTO '
Business name: Willamette HVAC e n e r g y p a n el , a) or. t on, o r
energy panel, alteration, or
Address: 3075 SW 234 Ave Ste 206 extension. Describe Page 2 2
City /State /ZIP: Hillsboro OR 97123 . Each additional inspection over allowable in any of the above
Per inspection 62.50
• Phone: (503) 628.6841 Fax: (503) 848.2597 Investigation per hour(I hr min) 62.50
CCB Lie.: 56951 Electrical Lie.: 34346CRE Suprv. Lie.: 4025LEB Industrial plant per hour 73.75
,. ..: -. ELECTRICAL.: PERMIT ;FEE5.1p � .:• .:
Suprv. Electrician signature;;required: • Subtotal: (.p(p , 30
Print:name: Mike Sicard Date: 4/21/09 Plan review (25% of permit fee)
• . State surcharge (12% of permit fee). 8' . 6
Authorized.signature; TOTAL PERMIT FEE . 7q . a
Erint name: MikeSicard Date: 4/21/09 This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete. .
* Number of inspections allowed per permit
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• ; I \IiuitdmgTermus\ELC- PcrmitApp doe 05/23/06 440- 4615T(I I /05 /COM/VEB