Permit (24) 7CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2022-00099
Date Issued: 9/20/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7320 SW HUNZIKER RD 300
Project: NEIGHBORHOOD HEALTH Subdivision: None Lot: None
Project Description: Adding low voltage data cabling.
Contractor: PAVELCOMM INC Owner: HILLTOP BUSINESS CENTER LLC
1640 NW 14TH AVE 9430 NW KAISER RD
PORTLAND, OR 97209 PORTLAND, OR 97231
PHONE: 503-223-5008 PHONE:
FAX: 503-223-0104
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/20/2022 $75.00
12%State Surcharge-Electrical 09/20/2022 $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: 1 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. 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 01-0090. Yo may obtain a cop of the rules or direct questions to OUNC by calling 503 3or 1.800.332.2344.
Issued By: Permittee Signature: G
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.
,tea
Electrical Permit Application
City of Tigard v EIVE Received ���/u ��. „, ?0- 1
ih u 13125 SW Hall Blvd.,Tigard,OR 7 V Date/By: 1�f% tj{Vf-�—
g Ill Phone: qq Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 q 0 Date/By: Related Permit#:
Inspection lane: 503.639.4175 SEP �+ Ready Date/By: Ions: 13 See Page 2 for
T I G A It O Internet: www.ti d-or. ov -�/ ARp Notified/Method: Supplemental Information
gar g 1 1 of l'I
�+' Vt _
TYPE OF WORK y Ca In/
ISlO PLAN REVIEW
0 New construction Addition/alterr1 ement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the availabk fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ I-and 2-family dwelling ❑Commercial/industrial IDAccessory building
less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived
Job#: Job site address: p ❑Addition of new motor load of system.
_ 73 2D SU) gf t N L�k,e,r l/�i 100HP or more. ❑"A" "E""1-2","1-3
City/State/ZIP: .tL �t. 9 7 ZZ 3 ❑Six or more residential units. occupancy.
f ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:Jo? Project name_ p1 � � ['Hazardous locations.
❑Service or feeder 600 amps or more. El Supply voltage for more than
' 600 volts nominal.
,r�`
Cross street/directions to job site: FEE SCHEDULE
Description I !Xi. I Each j Total l •
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'1500 sq.ft.or portion 33.92 - 1
DESCRIPTION OF WORK Limited energ
y,residential
� -�-- (with above sq.ft.) 75.00 2
/ � - U �� _ Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2 f
❑ PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP:
601 amps to 1,000 amps 301.04 2
Phone:( ) 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 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
Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP' Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: �+ �f Sign or outline lighting 67.84 2
t Signal circuit(s)or limited-energy
Address:I L.40 h,i 1,3 tit az "--- panel,alteration,or extension. 0 See Page 2 ( 2
Each additional inspection over allowable in any of the above
City/State/ZIP: p 4, p- /7247 Additional inspection(1 hr min) 66.25/hr
Phone:(jp 3)223_50a g Fax:(503 ) 3 -t'J!D 4 Investigation(1 hr min) 90.00/hr
Industrial plant(178.18J hrEmail: s�",r"Q " z ' .e. yywr �.r.— Inspections for which no
fee is
CCB Lie.:4,,.3 '.%3 Electric. ig L.,_5. .cL Suprv.Lic.: Citi/LGA specifically listed(t%hrmin) 90.00/hr
Suprv.Electrician signature,required: /) ELECTRICAL PERMIT FEES
a', -- I--- Subtotal: 75 00
1 R�h�SGj 1 Z� Plan Review Required(25% permit )
Print name: ``) { 5 ft �'. sate: 1 ❑ of fee):
State surcharge(12%of permit fee): , 00
TOTAL PERMIT FEE:
�q,Authorized signature: oo
This permit application expires If a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
- * Number of inspections allowed per permit.
I:1Building\Permils\ELC_PermitApp PLR ERE.doc Rev 06/17/2015 4404615T(11/05/COM/WEB
$ _ • -- ELL-zoa2,-COOct
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY • FEE"SL`,13EDULE
Description I OV. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 133.70 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 any 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
specificaly listed('/hr min)
coMMEBCIAL WoRj ON .., f E�W i,Vk �Es
�4 .. ._. 7� _ Subtotal(Enter on Page 1):
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
(1 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
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017