Permit ill V CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' n ' COMMUNITY DEVELOPMENT Permit#: ELR2013-00204
TI(3ARL7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2013
Parcel: 2S 113AB00500
Jurisdiction: TIGARD
Site address: 16083 SW UPPER BOONES FERRY RD 310
Project: Sterling Bank Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Low voltage for HVAC.
Contractor: AMERICAN HEATING INC Owner: G&S FC LLC
1339 SE GIDEON ST 16083 SW UPPER BOONES FERRY RD,
PORTLAND,OR 97202 STE
TIGARD, OR 97224
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/19/2013 $75.00
12%State Surcharge-Electrical 08/19/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 1 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. 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 obta'• : .+•p∎ • . - es es or direct to OUNC by calling 503.232.1987 or 1.800.332,2344.
' r4 d /- I �tG4cs -lC/-
Issued By. 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.
Electrical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard �0��
Date/By: ' 11 1 13 9 Permit No.: a��/Rti, /3 „oU '-j
71
- ° 13125 SW Hall Blvd.,Tigard,OR 1 Z0 A Plan Review `w��rJ 3 l
Phone: 503.718.2439 Fax: 503.56'. 960 ���� DateB : Other Permit: tPanf3 _06/45--
T 1 GA RD Inspection Line: 503.639.4175 P� �� Date Ready/By: runs: ® See Page 2 for
Internet: www.tigard-or.gov O. <6% Notified/Method: v Supplemental Information
TYPE OF WORI�,-,S)� PLAN REVIEW
❑New construction ®Addition/alteration* cement Please check all that apply(submit sets of plans w/items checked below)•
vvv ❑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 E Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","l-2","l-3",
I OOHP or more. occupancy.
Job no.: Job site address: 16083 SW Upper Boones Ferry Ro �0 0 vehicle
❑Six or more residential units. parks.
City/State/ZIP:Tigard OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:Bldg B Project name:Sterling Bank ❑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'I 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
low voltage wiring t-stat residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( )
relocation
200 amps or less 59.36 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
Owner signature: Date: Branch circuits-new,alteration,or extension,peer panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:American Heating Inc each branch circuit
B.Fee for branch circuits without
Contact name: Brad Manchester service or feeder fee,first 56.18 2
branch circuit
Address:5035 SE 24th Ave Each add'I branch circuit 7.42 2
City/State/ZIP:Portland OR 97202 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)239-4600 Fax: :(503)239-7038 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:American Heating Inc Signal circuit(s)or limited-energy
I See
panel,alteration,or extension. Page 2 2
Address:5035 SE 24th Ave Each additional inspection over allowable in any of the above
City/State/ZIP:Portland OR 97202 Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 33135 Electrical Lie.: 26993CRE Suprv.Lie.: 2640LEB specifically listed(%hr min)
S ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required Subtotal: 75....:
Print name: T Steve Young Date: 8/19/2013 Plan review(25%of permit fee):
State surcharge(12%of permit fee): Q.CID
Authorized signature: a4'11..--.. TOTAL PERMIT FEE: .iry- ----
Print name: Brad Manchester Date: 8/19/2013 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
P\Buitding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46t5T(11/05/COM/WEB