Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111
COMMUNITY DEVELOPMENT Permit#: ELR2022-00053
Date Issued: 5/4/2022
'1 E(3 MM 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135A603400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 650
Project: Majoris Health Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Access control system.
Contractor: BLUE HORIZONS TECHNICAL SOLUTIONS INC Owner: LINCOLN CENTER LLC
1982 NE 25TH AVENUE SUITE 14 BY SHORENSTEIN PROPERTIES LLC
HILLSBORO, OR 97124 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-939-3633 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/04/2022 $75.00
12%State Surcharge-Electrical 05/04/2022 $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: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 1 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 0 . 00.332.2344.
Issued By: 'JI—R--� Permittee Signature: rel5Or
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'N 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
IPII City of Tigardll ���E' N ateived
��sate/B : , . �I i_
13125 SW Hall Blvd.,Tigard,OR 97223 RECEIVE Plan Review
Ill Phone: 503.718.2439 Date/B : Related Permit#: f '- )5
Email: TigardBuildingPetmits@Tigard-or.gov M P"t 4 2022 Ready Date/By: :. See Page 2 for
1 I C,A R D Inspection Line: 503.639.4175 Internet: www.tigard-or.gov Notified/Method: �� Supplemental Information
TYPE OF WORK ,i l- tat' i,lv 411•
F''.1 ,,t nInlr ,r`1 lie..1 NI PLAN REVIEW
❑New construction rA Addition/alterationifelAacement Please check all that apply(submit 2 sets of plans w/items checked):
O 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.
❑ 1-and 2-family dwelling V Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: i10240 Si.) G•iruyb�1,� kC m El Addition new motor load of system.
100HP or more. ❑"A" "E" "1-2" "1-3'>
❑Six or more residential units. occupancy.
City/State/ZIP: fi,ar� M 0Recreational vehicle parks.
J t ❑Health-care facilities.
Suite/bldg./apt.#: G7ID 1 Project name: Mw,►net Aloes
Ce4riol IDHazardous locations. ElSupply voltage for more than
0 Service or feeder 600 amps or more.
600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
Li Pblrr. 'O*tr New residential single-or multi-family dwelling unit.
Subdivision: 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 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
/� (( d__ (with above sq.fl.)
Access toW O\ sy + - i kcee. e,loat3 Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 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 1
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
Ei APPLICANT I 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: f�� above service or feeder fee,
"r" ,, `S each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:
tIAL l Sign or outline lighting 67.84 2
µOC't'LOWS ICAO Cam( 56i14`t'K3 I`'a.-- Signal circuit(s)or limited-energy
Address: ACT N E 26 rl,,4I,eI L STE 14/ panel,alteration,or extension. iiiSee Page 2 25:`L'"2
t/-�` Each additional inspection over allowable in any of the above
City/State/ZIP: Ht 161pDf a )Qt To Additional inspection(1 hr min) 66.25/hr
Phone:(503 ) €1,541 3 433 Investigation(1 hr min) 90.00/hr
Email: bA'6.4,4 S i�'�5 hL� jf a� �(Z7 /ti Industrial s plant(1 hr no) 78.18/hr
7 �"`rT Inspections for which fee is 90.00/hr
CCB Lic.:1713 A I Electrical Lie.:aE 216 Suprv.Lic.:.tg 1 specifically listed(%hr min)
' J ELECTRICAL PERMIT FEES
Suprv.Electrician signs ulred: i)N Subtotal:
Print name: 5 cgN 1.4.n,aK Date:$.y.Z0Z Z 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: edr��
This permit application expires if a permit is not obtai within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less I00.70 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 552.26 2
with OAR 918-309-0040)
❑ 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 any of the above:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically haled('A hr min)
7 w q ,'
i.�� w.c a
COMMERCIAL WORK ONLY: ..Subtotal(Enter on Page 1): 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
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
• Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
lol Other: ACCebS 6okk ttr,
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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