Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'a ' COMMUNITY DEVELOPMENT Permit#: ELR2020-00100
Date Issued: 8/21/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S134BC00100
Jurisdiction: Tigard
Site address: 12100 SW SCHOLLS FERRY RD
Project: Chase Bank Subdivision: None Lot: None
Project Description: HVAC
Contractor: HUNTER DAVISSON INC Owner: ATLAS GREENWAY LLC
1800 SE PERSHING ST 808 SW ALDER ST STE 200
PORTLAND, OR 97202 PORTLAND, OR 97205
PHONE: 503-542-3628 PHONE:
FAX: 503-542-3654
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/21/2020 $75.00
12%State Surcharge-Electrical 08/21/2020 $9.00
Type of Use: COM
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: 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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
7 � �
1.ti �� .ems �.✓ /944
Issued By!�.� ) Permittee Signature: C �O
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 RECEIVE r FOR OFFICE USE ONLY
City of Tigard J U L 2 $ 2020 �atemBvy �l�/ 4/0 Permit#EL,R. -00
• III
et 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 CITY OF TIGARD Date/By: Related Permit#:
Inspection Line: 503.639.4175 RI ill fING DIVISION ReadyDate/By: Juris: H SeePage2for
T I GA R U Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction 17a Addition/alteration/replacement Please check all that apply(submit 2 sets of plans a/items checked):
0 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 0 Floating buildings.
[II '1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family D Master builder ❑ Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
system.
❑Addition of new motor load of
(66 rarvp S i x.l,ol(s cerry fc1
Job#: Job site address: tooHPoc more. ❑"
❑Six or more residential units. occupancy.
City/State/ZIP: ❑Recreational vehicle parks.
�� OR 1'7o2a,3 El facilities.
Suite/bld /a t.#: Project name: 6(' �1l ❑Hazardous locations 0 Supply voltage for more than
g' p J "' �"�� Y7b�►N "eC ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ChuSe- e41 k ,i :s - FEE SCHEDULE
Description I QIy. I Each I Iolsi
New residential single-or multi-family dwelling unit.
Subdivision: - I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 I
DESCRIPTION OF }VORI' Limited energy,residential 75.00 2
i-yl- J ,I{, 1 n (with above sq.ft.)
L6,a V U�I G /l V�G c re, I74 Limited energy,multi-family 75.00 2
(�C'/2�Gt�Q 1 •
` residential(with above sq.ft.)
f�21� -� (1 O N f�or T /D (�NIt/1 Renewable Energy ❑ See Page 2
i alPROPERTY OWNER f ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name 6 A, P!) t jc�J emetj 200 amps or less 100.70 2
�^ 1^1 201 amps to 400 amps 133.56 2
Address: easy ,,,r(^/ r �f2PJ Tie. �O 401 amps to 600 amps 200.34 2
/ 1 ( d p T70205. p ,000 a
City/State/ZIP: or 4tf �/� 601 amps to 1,000 amps 301 04 2
Phone:(Sca3) '7,5 '-8•o/S Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
l ( APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension, er panel
'iA.Fee for branch circuits with
NIn� v above service or feeder fee,
Business name: 2r— .?;v4,50/4 /-id G - 7.42 2
f each branch circuit
Contact name: R "N /' of j''J B.Fee for branch circuits without
�� c� #('. ''f.rJ 9 Sf�e2+� service or feeder fee,first 56.18 2
Address: O p J branch circuit
City/State/ZIP: �`fa/jd se / /aa Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: .7 !/ �8r Fax: : Each manufactured or modular
( > .�7�- ( ) 67.84 2
-ty f dwelling,service and/or feeder
Email:rpn-f-¢efOa _AANQrodailiSSaN-e OlM Reconnect only 67.84 2
f ,< ,:cONTIIACTOR : Pump or irrigation circle 67.84 2
Business name:NhN j''''-� ws..S- lrl,, Sign or outline lighting 67.84 2
1 ,�/ Signal circuit(s)or limited-energy -�- See Page 2 2
Address: /�6 0 .� [, j g J RQQ� panel,alteration,or extension.
�../ J O Each additional inspection over allowab e m an of -e a)or
City/State/ZIP:i f„N of O� L�a.� Additional inspection(l hr min) 66.25/hr
Phone:(Sp 3 ) 5'9,2-26acr I Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is 90.00/hr
CCB Lic./‘!a I Electrical Li i :a4.1 •aCc� Suprv.Lic.:60 O L8 specifically listed(v,hr min)
,,ELEC17t[CAL PERMIT FEES
Suprv.Electrician signature,required: , Subtotal: -s.
Print name:TM P v,i -(N Date:C-� 0 Plan Review Required(25%of permit fee):
` State surcharge(12%of permit fee): 9.41
�/n TOTAL PERMIT FEE: Ft ,er
Authorized signature: OC 2 4 - „t
This permit application expires if a permit is not obtained within 180
Print name: GlN r iela,e—i- Date:6/'a5''o2O days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:1 Building\Permits\EL _PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(I1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description Qty. Each Total
an 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:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in an of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90 00/hr
specifically listed(Y,hr min)
COMMERCIAL WORK ONLY: . ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 :Number of inspections allowed per permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
``4 HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: /
*No licenses are required. Licenses are required for all
other installations
118uildinglPermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
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