Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 COMMUNITY DEVELOPMENT Permit #: ELR2013 00087
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2013
Parcel: 1 S 136CC00100
Jurisdiction: TIGARD
Site address: 8200 SW PFAFFLE ST
Project: Westside Christian High School Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: (1) low voltage for HVAC
Contractor: HVAC INC Owner: WESTSIDE CHRISTIAN HIGH SCHOOL
5188 SE INTERNATIONAL WAY 4565 CARMEN DRIVE
MILWAUKIE, OR 97222 LAKE OSWEGO, OR 97035
PHONE: 503 - 462 -4822 PHONE: 503 - 697 -4711
FAX: 503 -462 -6555
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/06/2013 $75.00
12% State Surcharge - Electrical 05/06/2013 $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 ION: Ore!: law re.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 10 through OAR 9 ' 00 s u may obtain a copy of the rules or direct questions to OUNC by calling 503.232 1987 or 1.800.332.23
Issu d By: /i L// ALA Permittee Signature:
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.
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. F�. .
Electrical Permit ApplicationRECEIVE FOR OFFICE USE ONLY
City of Tigard tY Received g APR 18 2 013 Date/By: qh 3 Permit No: i JO( 3 - Oo0 8
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
/3 .
Phone: 503.718.2439 Other Permit
439 Fax: 503.598.1960 Date/B ; d(� 3 '000
l' 1 G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: Ju / El See Page 2 for
Internet: www.tigard - or.gov BUD B[VG DIVISION Notified/Method: I(0 Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction , 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
"Z6--a n �l r ( ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l -3 ",
Job no.: Job site address: 'c)11 SV IJ
k) �l1 L 4f C'' Six or more occupancy.
❑
/� l Vl TTT ❑ Si or more n sidential units. Recreational vehicle parks.
City /State /ZIP: 1\ f hl /J �j ❑ Healthcare facilities. ❑ Supply voltage for more than
/` ` ' 1 WY I = r ' n �r y ❑ Hazardous 0 or feedet locations. 600 volts nominal.
Suite/bldg./apt. / ap 9 t. no.: Pro j t ect name : , A 1� � �� 1 CV r� V t r 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: V v l 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
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
`11 kW `l i i l . VO -Q le c AV\ 1 A1W1 residential (with above sq. ft.)
75.00 2
v Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
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 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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 I CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: 14 v ( t / B. Fee for branch circuits tvirhour
111/f.,1 service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'1 branch circuit 7.42 2
Address: S S ��4Q /( n V 6 �,IM,/
� v _ Miscellaneous (service or feeder not included)
City/State/ZIP: 1 VA) �A K q��- Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (S1)3) l/t — ` t s-n -- Fax: : -3 ( 65 -7" Reconnect only 67.84 2
E -mail: ' I () ('� 11 r a U)�n t (.,
Pump r irrigation leig r 67.84 2
t�l 1 � V C t T 0 Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: \:_ v AL- ..1/1(...-- panel, alteration, or extension. I Page 2 2
Each additional inspection over allowable in any of the above
Address: UL G �/L.� �p e ^ C 1)� Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP :(� � ' J ( V Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
specifically listed (%2 hr min) 90.00 / hr
CCB Lic.: (-- -3 - 0"3 0 1 -- ) Electrical Lic.:2b -'S I Suprv. Lic.:3 / qt LE ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required / / /1n/j,� Subtotal:
/ 1A C -��v t' t ` � Plan review (25% of permit fee):
Print name: M .‘11.1e, S l.�V l V� Date: i 113 State surcharge (12% of permit fee):
•1 TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180 a ys a
days it has been accepted as complete.
Print name: d Date: � 1 1 1� • Number of inspections allowed per pennit.
I : Building \Permits\ELC- PermitApp 1/10 440 46I5T(1 I /05 /COM/WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
8200 SW PFAFFLE ST, TIGARD, OR, 97223 2013 - 12 - 03 00:00:00
Record Type: Record ID:
Commercial - Electricial Limited Energy ELR2013 - 00087
Inspection Type: Result:
199 Electrical final PASS - No C of 0
Comments:
Violation Summary:
Inspector Contractor