Permit y u CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�' COMMUNITY DEVELOPMENT Permit #: ELR201300146
T1GATM 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/27/2013
Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 115
Project: Davidson Benefits Planning Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Low voltage for HVAC
Contractor: WILLAMETTE HVAC LLC Owner: PORTLAND SW CENTER LLC
3075 SW 234TH AVE. #206 BY FELTON PROPERTIES INC
HILLSBORO, OR 97123 ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: 503 - 259 -3200 PHONE:
FAX: 503 - 848 -2597
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/27/2013 $75.00
Type of Use: COM 12% State Surcharge - Electrical 06/27/2013 $9.00
Class of Work: ALT
Total Number of Systems: 0
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTEN • : Oregon .w re, ires you to follow the rules adopted by the Oregon Utility Notification Center. Those ru - are set forth in OAR
952 - 001 -00 r through OAR 952 -0 1091 ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.8 4.
/ ./ r
Issue. By: L 4 Permlttee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
r
Electrical Permit Applicatio CE IVED FOR OFFICE USE ONLY
City of Tigard Received / 2 t permit No.' a� ?�� /
� g U N 1 Date/By: (o c 7 / ✓ _ / cL.4, t7 f0
13125 SW Hall Blvd., Ti gard, O 9722 2 013 Plan Review
' ° ' Phone: 503.718.2439 Fax: 503.5}$ 0 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 I'OFTIGARD Date Ready/By: Juris: ® See Page 2for
Internet: www.tigard or.gov BUI Notified/Method: 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: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 7632 SW Durham Rd tOOHP 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.:(y Project name: Davidson Benefits ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
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 168.54 4
Ea. add'l 500 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
relocate thermostats as necessary for new office layout residential (with above sq. ft.)
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 1
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 ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: same as below B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: P: Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 .
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy I (!).
Business name: Willamette hvac LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 3075 SW 234 Ave Suite 206 Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Hillsboro, OR 97123 Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 259.3200 Fax: (503) 848.2597 Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: 56951 Electrical Lic.: 34346CRE Suprv. Lic.: 4025LEB ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 711?.er, o Subtotal: 76 Plan review (25 /o of permit fee)
Print name: mike sicard Date: 6/27/13 State surcharge (12% of permit fee): 9
co
TOTAL PERMIT FEE: r
Authorized signature: 7,4f This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Michael Malstrom Date: 6/27/13
• N umber of inspections allowed per permit.
I:\Building \Permits \ELC- PermitApp.doc 07/01/10 440 4615T(II/05/COM /WEB
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7632 SW DURHAM RD 115, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
135 Low voltage
06/28/2013 00:00
ELR2013-00146
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7632 SW DURHAM RD 115, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
135 Low voltage
06/28/2013 00:00
ELR2013-00146
PASS
Violation Summary:
Inspector Contractor