Permit (224) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2020-00007
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2020
Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 400
Project: Miller Consulting Engineers Subdivision: ASHBROOK FARM Lot: 5
Project Description: Limited Energy for HVAC.
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: 503-542-5895
FAX: 503-542-3654
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/23/2020 $75.00
12%State Surcharge-Electrical 01/23/2020 $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 0 R 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503..1987 o>1.800.3321J 44.
711110
Issued By: -��_ 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 Application FOR OFFICE USE ONLY
.t City of Tigard Recei
Date/B d elli v P i�i2, r •do 7
'I13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: e, __�_ i�
Inspection Line: 503.639.4175 Ready Date/By:,/ 44 t 'is: 0 See Page 2 for
T I GARD Notified/Method'�'/ZCf Supplemental Information
Internet: www.tigard-or.gov
'2'/ "— 1 PLAN REVIEW
TYPE OF WORK '
❑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.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ound,or exceeds 14,000 ❑Commercial-use agricultural
1=11-and 2-family dwelling �]Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE':INFORMATION AND.LOCATION ❑Emergency system. larger separately derived
ID Addition new motor load of system.
Job#: /9373 I Job site address: 7600 Sint C,N i Sf r-,Q, 100HP or of nee. occupancy.
O p 7� ❑Six or more residential units. ❑ocRcupancy.
vehicle parks.
City/State/ZIP: Tt rfc^,r fC 7 ❑Health-care facilities.
�JL,/ /I (4M t_/� Y f{t / ❑Hazardous locations. ❑Supply voltage for more than
Suite/bldg./apt.#: !f, I Project name:M , W Coop
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: in;iter 4—,j6f�1e s.. q/ FEE SCHEDULE
J J Description I Qty. I Each 1 Total
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 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(with above sq.ft.)
Low I/0(tqC'Q- /�✓4 �� CS"� Limited energy,multi-family 75.00 2
t f residential(with above sq.ft.)
16 Renewable Energy ❑ See Page 2
PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: (eel)) CO M M eCL f ci,4 CO tJ#ro G�ors _74 c . 200 amps or less 100.70 2
Address:_53----?3 S. or P xi 201 amps to 400 amps 133.56 2
401 amp to 600 amps __ 200.34 2
City/State/ZIP: ,•'t/ f;0,f C/ lAbq ye'e/t. 601 amps to 1,000 amps 301.04 2
Phone:(3Cq) V H. / 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
APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
Business name: Nt,t,rf
nn -T A.Fee for branch circuits with
C— . /j-u O,4 ;JG• above service or feeder fee, 7.42 2
�. , each branch circuit
Contact name:iey4, tee,-f B.Fee for branch circuits without
/ .J ✓oservice or feeder fee,first 56.18 2
Address: /800 SL-- �csX,t',,fn Stce,Qf branch circuit
City/State/ZIP: PQ-f'LeiNd t cf7e2,0, Each add'I branch circuit 7.42 2
d Miscellaneous(service or feeder not included)
Phone:(5;',3)s'a`3 .er. Fax: ( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: -et,-�'`c urs—tr cbilsspN,60 An Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
A. or outline lighting
Business name: .,S�.MC.. AS �/�oJ� Sign67.84 2
Signal circuit(s)or limited-energy ' See Page 2 I 2
Address: panel,alteration,or extension. An
Each additional inspection over allowable m any of teabove --
City/State/ZIP:
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
90.00/hr
CCB Lic. /sa I Electrical Li i.:ag: ,a C�:E'1 Suprv.Lic.:6o 0�E specifically listed(%hr min)
•' ,:ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: A illik Subtotal:
low
Print name: `M Qal/i SSO/VDate: /—'7--,,lc, ❑Plan Review Required(25%of permit fee):
_
Authorized signature: JJJJJJ L t State surcharge(12%of permit fee):
�J o�� TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: hyo N AteR:t Date: /-7-a.0 { days after it has been accepted as complete.
Number of inspections allowed per permit.
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f
-Electrical Permit Application—City of Tigard
E` Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
DescriptionI *
Fee for all residential systems combined: $75.00 wQty. Each Total 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
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
specifically listed hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
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:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
HVAC
Fl Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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 06/17/2015