Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00280
1 3125 SW HaII Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/15/2010
TIGARD Parcel: 2S 113 BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 300
Project: Optum Health Subdivision: Lot: 0
Project Description: Low voltage for HVAC wiring.
Contractor: HUNTER DAVISSON INC Owner: BEHRINGER HARVARD WESTERN
1800 SW PERSHING ST PORTFOLIO LP
PORTLAND, OR 97202 BY EASLEY MCCALEB & ASSOCIATES I
PO BOX 190700
SAN FRANCISCO, CA 94119
PHONE: 503 - 234 -0477 PHONE:
FAX: 503 -542 -3654
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/15/2010 $75.00
12% State Surcharge - Electrical 12/15/2010 $9.00
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
Intercom /Paging: •N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This per ' s issued s . •- ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance with •proved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day . ATTENTION: Oregon la -qu re •u to follow the rules adopted by the Ore. • • • - • . • enter. Those rules are set forth in OAR
95 - 001 -0010 t rough OAR 952-8 You may obtain a copy of the rules or direct questiorfs to OUNC by g 503. 2.1987 or 1.800. 32.2344.
sued By: AL • / /11 Permr a Signature:
OWNER INSTALLATION 0 LY
•
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.
CaII 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.
Dec. 15. 2010 11:07AM No. 1049 P. 1
Electrical Permit Application FOR OFFICE ISL QNLY
Cl of Tigard i calves Permit No.: C/�/G�DID�W� %��
71 g 5 2 010 Dateie : & 41,,,0 13125 SW He ll Blvd Tigard T igard OR 97223 DEC Plan Review , 4/r01049-'05V/0
Phone: 503,6x9.4171 Fax: 503.598.1960 Date/13 : Olhcr Pcnnit:
TIGAl1U Inspection Line: 503.639,4175 CITY ®FTIGARD DD ateR m Rd /od: ludo. s for
Internet www.ligard- or.gov I
_ 91 Id 311 I EtrLnw1 _
1,. +�. o M ._- ^a N C= .— .. r..ix���_-5._,.. --v- 1 J. r ... -..
lij New construction 1. • ddition /alteration/replaccment Please check all that apply (submit ? < sets of plans wlitems checked bolow):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
111 Demolition ❑ Other: where the available fault current ❑ Marinas end boatyards.
— — Y: exceeds 10,000 amps. al 150 volts or ❑ Floating buildings.
-. = - less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
❑ 1 and 2- family dwelling % Commercial /industrial ❑ Accessory building amps for an other installations. buildings.
0 MUlti-faMily ❑ lvlastcr builder ❑ Other; ❑ E Fre Emergency system, ❑
larger t separately derived system.
z - . i �' ILI.• 0 ^µ 1 @, _ ,Q, —= ---:' i' DI Addition of now motor load of Q ' "A" "E" "1 - 2' "I-3"
z — l00HP or more. occupancy.
Job no (OA i r Job site address: • Recreational y ehielo
� ■ \ ► • El or more residential units. ❑ arks. P
CitylState/ZIP: 011011h-care facilities. ❑ Supply voltage for more than
�[►�' I _ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /a • 110 ' J + It oject name: r ILL. A , _A� O Servt or rccacr 600 amps or more.
Cross street/directions to job site: nerrrielioa 1 Qtr. 3 Fee. I Tetol ( •
Ncw residential single- or multi - fancily dwelling unit.
Lncludes attached garage
Subdivision; Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. A. or portion 33,40 1 -
Tax leap /parcel no.: Limited energy, residential 75,00 2
t Ti 0>I> a_ = 6) ails `� with above sq. n.
Limited energy, multi-family
Milk 11A. ►a • .4i. ' .• ,r_ • residential (with above s4.0) , 75.00 2
Services or [ceders Installation, alteration, and/or relocation
'JUL ta,.. r;, 200 amps or less 80.30 2 •
z "'�' r ° . —r x s 106.85 2 201 amps to 400 am
rr1
-D C[Ri "- Y_+� 6 ( = � � - , -- w''-. -fib . - -- P P
Name: 401 amps to 600 amps 160.60 2
.:r 1 . k P: J - 601 amps to 1',000 amps 240.60 2
Address: kA., £ il l Over 1,000 amps or volts 454.65 2
City /State/ZIP: ' • , c* n Temporary services or feeders installation, alter don, and/o
rdoca lion
Phone: ( ) Fax ( ) 200 amps or Tess 66.85 1
Owner Installation: This installation is being made on property that T own which is not 201 amps to 400 amps [00.30 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, per panel
Owner signature: Date' A. Fcc for branch circuits with
w i _ . ' i ` VT . above service or feeder fcc, 6.65 2
each branch circuit
Business name: ` �� ` ^ - B. Fee for branch circuits -
wirhoa,( service or feeder fee, 46,85 2
Contact name: first branch circuit
Address: J
Each add branch circuit 6.65 2
Miscellaneous service or feeder not included)
City /State /ZIP: Each manufactured or modeler 90.40 2
dwelling, , service and/or fader
Phone: ( ) Pax: ' ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle I. 53.40 2
T=om -.:-:="t,p =r Sign or outline lighting MI 53.40 2
Signal circuit(s) or limited- .!CO
Business name: \ y ' ► 1� A energy panel, alteration, or
Address: � � P , extension. Desc i : Page 2 73 2
t • • 'O./
Each additional inspection over allowable In any of the above
• 4 Ina. ! w 0 Per inspection II 62.50
Phone: (CA) -....i • Fax: I 41v S Investigation per hour (I hr min) 62.50
CCB Lio.: \V) \ Electrical Lie ,-tot : Sup v. Lie.: Industrial plant per hour .73.75
Suprv. Electrician signature, required ` � � � ��'� 1 Subtotal: 7
` /-J Plan review (25% of permit fee): ��"
Print name: Z14,/. . �'�'D - 7:4 -4 �' r Date • ea ,/,..1/./G7 State surcharge (8% of permit fee): . .0c ,
Authorized signature: .- „ ” TOTAL PERMIT FEE: , �.
�F �' � ' f �� i
orAmiti
This permit application ex p re 8 He penult Is n0Y obtained within 1A0
Print name: .. Date: 49�'e days alter It has bete accepted as complete.
ta * * Number of inspections allowed per pertnit.
I:\ riwldlnEVermtisleLC.PermitApp.doc 05/13/06 410- 4615T(11 /05ICOM/WEn
Dec, 15, 2010 11:07AM No. 1049 P. 2
Electrical Permit Application- City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
µ '- .4:„VE
Fee for a ll residential systems combined $75.00 •
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
II Garage Door Opener*
SPA/ eating, Ventilation and Aix Conditioning System*
n Vacuum Systems*
n Other:
Pee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
[1 Fire Alarm Installation
XHVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
fot all other installations
1:\ Duilding \POrmLI$ELC- PermilApp.dce 03/23/06