Permit ,t CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELR2015-00043
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/08/2015
TIGARD Parcel: 2S112AB02000
Jurisdiction: Tigard
Site address: 14344 SW MILTON CT
Project: Bonita Water Pump Station Subdivision: BONITA INDUSTRIAL PARK Lot: 2
Project Description: Low voltage for HVAC system.
Contractor: ROBERT LLOYD SHEET METAL INC Owner: CITY OF TIGARD
4485 INDEPENDENCE HWY 13125 SW HALL BLVD
INDEPENDENCE, OR 97351 TIGARD, OR 97223
PHONE: 503-838-3863 PHONE: 503-639-4171
FAX: 503-838-3964
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/18/2015 $75.00
12%State Surcharge-Electrical 02/18/2015 $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 t •opted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy• direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: — Permittee Signature: `v
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
Clay of Tigard • `vED Received IA ,
13125 5W Hall Blvd.,Tigard,OR 9 Plan Review e
111 LEM
_ - Phone: 503.718.2439 Fax: 503.59 1 Date./0 : OtherPermic �a� !7l'
TI GARD
Inspection Line: 503.639.4175 FEB A r)015 Date Ready/By: 65 See Page 2 for
Internet: www.tigard-or.gov GD fl L Notified/Method: Supplemental Information
TYPE_OF W'YO... :_lam . .i O PLAN REJEW :!
®New construction ❑Addilion/alte 1 �(r O(NISI Please check all that apply(submit 2 sets of plans whims checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATLGORY 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 150 KVA or
' m crgcn m. larger separately derive system.
em.
JO SITE IFORMAIO ND LOCATION: ❑Addition o f new
motor load of ❑"A"
Job no.: 14-020 Job site address: 14344 SW Milton Court Six or or more. Recreation
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR,967224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Bonita Pump Station ❑Service or fader 600 amps or more.
:, TEE SCIIEDULI!,,,, , . : ' :
I . I Fee. I Total I
Cross street/directions to job ob site:North of Bonita Drive Description •
New residential single-ur multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.fl.or portion 33.92 1
Tax map/parcel no.:
Limited energy,residential 7500 2 •
i1 DESCRIPTI•N.OF:;WORK (with above sq.R.)
Limited energy,multi-family 75.00 2
Installtion of new HVAC system controls. residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROP1✓R .Y OWNL12 ❑ TENANT.j 200 amps or less 100.70 2
201 amps In 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: 7'emporary 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,per panel
:. •;, APPLICANT „ 0 CONTAC''1' PERSON feeder fee,
Fee for branch circuits with
above service or feed ee 7 42 2
Business name:Robert Lloyd Sheet Metal Inc. each branch circuit
B.Fee for branch circuits without
Contact name: Kyle Hanson service or feeder fee,first 56.18 2
branch circuit
Address:4485 Independence Hwy Each add'l branch circuit 7.42 2
City/State/ZIP:Independence,OR,97351 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)838-3863 Fax: :(503)838-3964 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:kylelt @rlsm.net Pump or irrigation circle 67.84 2
,:,;,CON *ACTOR;:
:i. Sign or outline lighting 67.84 2
Business name:Robert Lloyd Sheet Metal Inc. Signal circuit(s)or limited-energy i See -fds
panel,alteration,or extension. Page 2 , 7s• 2
Address:4485 Independence Hwy Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP:Independence,OR,97351 Investigation(I hr min) 66.25/hr
Phone:(503)838-3863 Fax:(503)838-3964 Industrial plant(I hr min) 78.18/hr .
Inspections for which no fee is 90.00/hr
CCB Lic.: 62476 Electrical Lie.: C1074 Suprv.Lie.: 3951LEB specifically listed(h hr min)
'•, ._LLECPRICAL..PERMIT FIES`:
Suprv.Electrician signature, quired:
Subtotal: $75
Print name: John Lloyd Date: 2/5/2015 Plan review(25%of permit fee):
State surcharge(12%of permit fee): $9
Authorized signature: TOTAL PERMIT FEE: $84
Print name: John Lloyd Date: 2/5/2015 This permit application expires if a permit is not obtained within 180
Y daps after it has been accepted as complete.
. Number of inspections allowed per permit.
1:11luildingTermits\El.0 PermitApp ELR ERE.doc Rev 05/21/2013 440-46157(11/05/COM/WEI3
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: i`; :. .. EEE ScIIEIX E .
Fee for all residential systems combined $75.00 Description I Qtr_ I Pee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 55226 Z
El Heating,Ventilation and Air Conditioning OAR918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
111 Other: additional inspection over allowable in any of the above:
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr mm)
Inspections for which no fee is 90.00/hr
specifically listed(Y,hr min)
COMMERCIAL WORK ONLY: .ELECTRICAL PERMIT FEES"
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
nA• udio and Stereo Systems days after it has been accepted as complete.
' Number of inspections allowed per permit.
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ F• ire Alarm Installation
• HVAC
n Instrumentation
n Intercom and Paging Systems
n L• andscape Irrigation Control*
n M• edical
n N• urse Calls
n O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
I:\Buildina\PermiisTLC PermilApp ELR_GRE.dor Roy OS/2112013
ii
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14344 SW MILTON CT, TIGARD, OR, 97224
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00043
Jeff Grove
Violation Summary:
Inspector Contractor