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Permit v. • CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • • COMMUNITY DEVELOPMENT Permit #: ELR2009 -00357 T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/11/2009 Parcel: 2S 101 DA00102 Jurisdiction: Tigard Site address: 13221 SW 68TH PKWY 300 Subdivision: TRIANGLE CORPORATE PARK Lot: 2 Project: Health Net Project Description: Low Voltage for HVAC. Work on 3rd floor only. Owner: FEES GK TRIANGLE CORPORATE PARK III L Description Date Amount BB# 73- 1771- GK1130, CBRE, PO BOX 2096 Restricted Energy Permit 12/11/2009 $67.84 WARREN, MI 48090 12% State Surcharge - Electrical 12/11/2009 $8.14 PHONE: Contractor: AMERICAN HEATING INC 1339 SE GIDEON ST PORTLAND, OR 97202 PHONE: 503 - 239 -4600 FAX: 503 - 239 -7038 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: N Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: N Fire Alarm: N HVAC: Y Instrumentation: N Total $75.98 Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Required Items and Reports (Conditions) Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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. ATTEN s • • •n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 through OAR • 2 -00 1100. Y- may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.3332.2344. • / / / / Issued B • • II._ . /� iii. 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. Cali 503.639.4175 by 7:00 a.m. for an inspection that business day. 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 Applicatiof iECEI VF FOR OFFICE USE ONLY City of Tigard Received ^,,,�� J 2�� `J y q Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 112009 2009 Plan n Review / �/ v� view Permit No.: i Q, � J Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date ReadyBy: �yy 0 See Page 2 for Notified/Method: i! Supplemental Information Internet: www.tigard- or.gov BUILDING DIVISION TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ 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 ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1 - and 2- family dwelling XCommercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", "1 - 3", / -f �t 1 00HP or more. occupancy. Job no.: Job site address: 322 SW (0 � Pi�wy Re creational vehicle arks. ❑ Six or more residential units. ❑ P City/State /ZIP: / P a 'c/ 722 3 ❑ Health-care a Hazardous fcation ❑ Supply voltage for more than J ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: f%eq /4 /I /e l- ❑ Service or feeder 600 amps or more. FEE SCHEDULE. Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. ft.) Limited energy, multi-family /0 W va l f4y e W i r f j - r f oc 4 � •- residential (with above sq. ft.) 75.00 2 J Services or feeders installation, alteration, and/or relocation Sensor 5 200 amps or less 80.30 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: e' pora services or feeders installation, alteration, and/or Phone: ( ) Fax: ( ) 200 amps or Tess 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Branch circuits — new, alteration, or extension, ter panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: An I/ e4 7Li.1� B. Fee for branch circuits � a /c , o J / without servi or feeder fee, 46.85 2 Contact name: C � t 7`- first t branch circuit , Address: /3-7 s a &/ d p0,-) - Si Each add'I branch circuit 6.65 2 G� Miscellaneous (service or feeder not included) City/State /ZIP: /hr d O� / 7202 Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: (503) 2.31- '/t'0 0 Fax: : (503) 23q-703 Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Signal circuit(s) or limited - Business name: A n eric 4 ,,, li -/-/41 energy panel, alteration, or /� Address: extension. Describe: Page 2 —' • St( 7 5E & i (• 2 e o n �7� City/State /ZIP: �O ( -I. / L./ a/7 c / O� % / 2 02 Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (503 )23,7_ *00 Fax: (5 03 ) 23,-7030 Investigation per hour (1 hr min) 62.50 CCB Lic.: 33/3 5 Electrical Lic.: 26 9 off Suprv. Lic.:24o LE 6 Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES l` � � Suprv. Electrician signature, require Subtotal: S— I—trve, ` ' 1^ _ I I ^ Q Plan review (25% of permit fee): Print name: �! �✓� Date: C � ` State surcharge (12% of permit fee): , / y Authorized signature: o TOTAL PERMIT FEE: 75 . T 0 � // This permit application expires if a permit is not obtained within 180 Print name:. ; / I V / a, y , ��S f r� Date: /2///a days after it has been accepted as complete. • Number of inspections allowed per permit. :\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(II /05 /COM/WEB 114 i: CI TY OF TIGARD . 4 4GLe.r2GC . 7± , .?/ e-de9-e Z__.,CZ ELECTRICAL PERMIT : ` "a COMMUNITY DEVELOPMENT Permit#: ELC2009 -00353 T 1 GA R L7, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/24/2009 Parcel: 2S101 DA00104 Jurisdiction: Tigard Site address: 13333 SW 68TH PKWY Subdivision: FARMERS INSURANCE Lot: 0 Project: Triangle Pointe Project Description: Add /alter (5) branch circuits, sign /outline lighting for (1) sign, and restricted energy for fire alarm installation in lobby. 11/24/09, adding low voltage for access control. Owner: FEES TRIANGLE POINTE LLC Quantity Description Date Amount 901 NE GLISAN ST #100 PORTLAND, OR 97232 5 crt Branch Circuits 07/24/2009 $73.45 wo /Purchase Service or PHONE: Feeder 1 ea Sign or Outline Lighting 07/24/2009 $53.40 Contractor: 1 ea Signal circuit or Limited 07/24/2009 $75.00 Energy Panel ROSENDIN ELECTRIC INC 1 ea 12% State Surcharge - 07/24/2009 $24.22 2925 NW ALOCLEK DR #170 Electrical HILLSBORO, OR 97124 1 ea Signal circuit or Limited 11/24/2009 $67.84 PHONE: 503 - 615 -8189 Energy Panel FAX: 503-615-0689 0 ea 12% State Surcharge - 11/24/2009 $8.14 Electrical Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $302.05 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. ATTENTIO • regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -001 -0 through OAR 2 -001- 100. You may obtain a copy of the rules or direct questions to OUNC by callin .6699 or 1.800.332.2344. / Issu d By: 0 Permittee Signatur . e r 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' 4111111.11111k. —r < !'. / Date: I/ LICENSE NO. Call 503.638.4175 by 7:00 a.m. for an inspection that business day. 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.