Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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• COMMUNITY DEVELOPMENT Permit #: ELR2010 -00085
Date Issued: 05/18/2010
°T IGAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 500
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: University of Phoenix
Project Description: Low voltage for HVAC
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096 Restricted Energy Permit 05/18/2010 $67.84
WARREN, MI 48090 12% State Surcharge - Electrical 05/18/2010 $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. 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 -00 rough 0 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue By: Permittee Signature: O
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 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 Application FoRO " o;vL V „ =
City of Tigard t , `' D l $ fU Permit No.: ea aolo- g
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ‘,0.‘,':''..,,,',.,,,,,.',111,/\\_ >r Other Permit:
Inspection Line: 503.639.4175 � Date R eady/By: Ja ® See Page 2 for .
Internet: www.ci.tigard.or.us . Notified/Method: "/ s ( Supplemental Informa
-:e'-'7,":7-. - S , .7 . r ,rn , T ^ x f r ,�: 2 Y Y , 7 '1 ( ,1 2 4
t & - L i 'f f t r ! i 7 i: f - ,ii r " s , ; t , n 1 .c . ., t : 4 1 IY )a r-� f ., 1- -a �, Y ''' " 9 �,
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❑ New construction .0 Addition/alteratio ,. .. NO ' Please check all that apply:
❑ Demolition ❑Other
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\- \ \�" ❑Service over 225 amps, comm'i ❑Hazardous location
_ ❑Service over 320 amps rating ❑ Buildng over 10,000 sq. ft.,
, ' Y c ,1 « r,xc r01 F rtre5[5ir�: lorel. r`" c , i t , t of 1- and 2-family dwellings 4 or more new residential
❑ I- and 2- family dwelling 2 Commercial/industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ['Building over three stories ['Feeders, 400 amps or more
, ,� ❑ Other ❑ Occupant Toad over 99 persons ❑Manufactured structures or
.::,�_ ? f :=s_i�.fi:" . ; (0� i . .I1 f) 1' M1 (/ _ x i . . °tf - i .1:1 r- , , i ..� ❑ lam g g plan RV park
y j t ,&:::',.- E essni htin lan P
Job no.: Job site address: 322 51n/ 66' h �� k ❑Health -care facility ❑ Other:
• Submit 2 sets of plans with any of the above.
City/ State/ZIP: 77 arc! 7 72 2 3 The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: SOD Project name: Y1 yI ° x"''3 +, y ,: y 1 l t t 1 ; �I.{ VZZI , ii
�I I e! / O Dercrtptfon Qty. Fee. Total
Cross street/directions to job site: 1 h o e h t x New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or leis 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00. 2
Tax map /parcel no
Limited energy, non - residential 75.00 2
ti v:: r i i , s - : n , i t F , r i •. , r 6 t ' S ? - t i
AiA., . . _,W: t. ,I ` " ' 1 ...::� ,-..,_2..' --. Each manufactured or modular
W / V V O 0 c W i .- i n ^ 1-- s - - 1 - f dwelling, service and/or feeder 90.90 2
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Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
* 201 a s, to 400 a s 106.85 2
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,::','..%‘'.1.I;',-.." � � S, I 4a� ,at. c I°`J rt, 4r �J ; � } n f � F � �!C , �i sp t � c Y5 i � amps mP
_,� ._ ...__ -� ._ ..�._.s.__,_:..1._.2,f._.k s _�_.l�- .....w_� _ __.._�.�_: 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
'I.econnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
`J ,t.. 1NRIT,C5 T1<, i 1 r r' Zi:e:ri t91W I�'ih li tif: fr ._,1. A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: 4 me ,- j e a n H e GI t/ n branch circuit '
B. Fee for branch circuits
Contact name: ey-a) U / Man c 1i e S ' f ' e r without service or feeder fee,
46.85 2
each branch circuit
Address: /33 ' S ,E t 7 / c O ►7 J * Each add'l brarich circuit 6.65 2
City/State/ZIP: Po r -/ - Gn J O 0 97 Q 2 Miscellaneous (service or feeder not included)
( 5o3 ) 23 9 - 7 0 3 8 Sump r irrigation tin g t in g e 53.40 2
Phone:
(503 ) 23 y�/ O 0 Fax: ' Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
z f F, ,r t �F fi a i. Wr t e r <: ;, y ,;. energy panel, alteration, or 1
�1,' t4fl-_. i,E._TLI, '�� (lyJJ�E IY� Va{ �_.,!}.1`.'' :r,. ,..�? t^.^�?...
, extension. Describe: Page 2 2
Business name: r✓J er / C 4/7 e 9 7 /e7 -
Address: 133' 56" 6 i c l (0 S 1- Each additional inspection over allowable in any of the above
q Per inspection 62.50
City/State/ZIP: . Or - /e . 1 O R / 72O2 Investigation per hour (1 hr min) 62.50
Phone: (5 03 23 ,j - 1/ (O 0 0 Fax ) ( ) 231 - 7 8 Industrial plant per hour 73.75
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CCB Lic.: 33 135 Electrical Lic.:2 (p9 y3cgi Suprv. Lic.: zoio LEB Subtotal
Suprv. Electrician signature, requi - ° : ' f Plan review (25% of permit fee)
T S-1 e y0 r Date:
S - 11 - � Q State surcharge (8% of permit fee)
Print name: -
/ TOTAL PERMIT FEE 75
Authorized signature c./46 This permit applicatlon expires If a permit h not obtained within 180
days after It has been accepted as complete
�/ Gf , afiCi / 5 6,- Date:, j — ! — I • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
1:\ Building \ Petnits\ELC•PemtitApp.doc 12/03 440.4615T(10/02/COM/WEB