Permit (223) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111-ii- COMMUNITY DEVELOPMENT Permit#: ELR2018-00092
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/21/2018
T I t A I<:T: 9 Parcel: 1S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 380
Project: PrimePay Subdivision: ASHBROOK FARM Lot: 5
Project Description: Limited energy for relocation of(4)thermostats.
Contractor: HUNTER DAVISSON INC Owner: PLAZA WEST OWNER LLC
1800 SE PERSHING ST BY CHIEF FINANCIAL OFFICER
PORTLAND, OR 97202 680 FIFTH AVE 20TH FL
NEW YORK, NY 10019
PHONE: 503-542-3628 PHONE:
FAX: 503-542-3654
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/21/2018 $75.00
12%State Surcharge-Electrical 06/21/2018 $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: Ore.on 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 0 952-001-0090. •u may obta. a copy of thrules or direct questions to OUNC by calling 503.23'987 or 1.800.31. 344.
Issued By: _A . 0/ 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 Applicata . , (t'' /ED FOR OFFICE USE ONLY
City O Tigard Received ,-
'J f g N R '' 2018 DateB _ i � � .� _
lit
1,1
't 13125 SW Hall Blvd.,Tigard,OR 9722.IU 2 r Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 DateB Related Permit# 01 1 /: C
Inspection Line: 503.639.4175 CITY ( 'i ° ',i1U Ready Date/By: Juris: 0 See Page 2 for
TIGARD_ Internet: www.tigard-or.gov B1i�L.tN tIVISsJ Notified/Method: Supplemental Information
. ' 'TYPE,.OF WORIc,: , , PLAN,-REVIEW - : ,
['New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
El Demolition Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF,�O1V5TRUCTION
exceeds 10,000 amps at 150 volts or 0 Floating buildings.
.. . ... ,._
%itless 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: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION,AND;LOCATION, ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#:/8/ ?? I Job site address: %6o 0 Stnl d a i( Si 100HP or more. ❑"A","E"•"1-2","1-3",
❑Six or more residential units, occupancy.
City/State/ZIP: `1 �4 0( 7/�a 00 Recreational vehicle parks.
yHealth-careardofacilities.
❑Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#:Su, 3gi5I Project name: j-i UM 600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: pr`,H-t r p4G FEi ;SCIWU1JEE.
/'� Description I Qty. I Each I Total I *
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'l 500 sq.ft.or portion 33.92 1
•DESCRIPTION OF WORC ,., Limited energy,residential 75.00 2
�Q,L (with above sq.ft.)
t)CA'rQ� ��ierM of/q�S Limited energy,multi-family
75.00 2
residential(with above sq.ft.)Dil
Renewable Energy ❑ See Page 2
PROPER'I'1' O, NERL . r 'EY TENAN"T . Services or feeders installation,alteration,and/or relocation
/^ 200 amps or less 100.70 2
Name:(II ) CoMM�G1a1 t�o,.i*e•Ci'irs �iJL,
/ / 201 amps to 400 amps 133.56 2
Address: .5.-S 7.7 S, �St ��G(e _
______-_ 401 amps to 600 amps 200.34 2
City/State/ZIP: / '1T/4/ w4 9�i y� 601 amps to 1,000 amps 301.04 2
Phone:(Sc,?) ''2/.�,P.,51,?‘ tl Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: &cxl/Q,a ofSe,t l e c c,v G , GUM, 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: nch circuits mnew alte ttoor extension,perpanel
2
401 168 54
1' Bra — ra' n, n, a
APT'L CAh1T,' ,.a , (, 0 CONTACT,PERS I. l A.Fee for branch circuits with
L " above service or feeder fee,
Business name: W„�o r _�a 61.1 �tiJ G 7.42 2
t k .4 each branch circuit
Contact name' kJ fc.ei B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: ao o YE Ars-b 1 N s-I'n branch circuit
City/State/ZIP:R r1l�rGl �,e 7 ?�d Each add'I branch circuit 7.42 2
(j//`"' Miscellaneous(service or feeder not included)
Phone:(So) S462-1 6240'' I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: rp eed-6,_ j yy�I��J'��� 3' ,AI, eOA/l Reconnect only 67.84 2
/ CONTRACTOR. Pump or irrigation circle 67.84 2
Business name: srjvme A- „ghJe _Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
El See Page 2 2
Address: panel,alteration,or extension.
Each additionaftnspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: Inspections for which no fee is
8 specifically listed(%hr min) 90.00/E hr
CCB Lic.,‘,la 1 Electrical Li :a� ,-aCzI Suprv.Lie.:by p �/�
ELEC'IYtI�AL;PERMIT.FEES : _
Suprv.Electrician signature,required: I k Subtotal:
Print name:'7, Avt ' 'oN Date: ( /-,rf' 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
�/ TOTAL PERMIT FEE:
Authorized signature: �t�� �� GU
� This permit application expires if a permit is not obtained within 180
Print name: /,�� ,097:, ei/l Date:�mZ/- /� * days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\'ermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-46I5T(I 1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
DescrFee for all residential systems combined: $75.00 Renewable
Each Total _
Ren ° Qtr 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 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:
❑ 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
s.-cifically listed(%z hr mm)
a ., - E i,a CAL 1! b:;M
Fee for each commercial system: $75.00+ Subtotal(Enter on Page 1):
* 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
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
I:\Building\Permits'.ELCPermitApp_ELR_ERE.doe Rev 06/17/2015