Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00065
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/18/2011
Parcel: 25101 DB00100
Jurisdiction: Tigard
Site address: 7340 SW HUNZIKER RD 210
Project: Cornerstone Clinical Services Subdivision: Lot: 0
Project Description: HVAC system.
Contractor: AF TECHNOLOGIES Owner: HILLTOP BUSINESS CENTER LLC &
PO BOX 6551 HUNZIKER LLC
BEAVERTON, OR 97005 9430 NW KAISER RD
PORTLAND, OR 97231
PHONE: 503 - 466 -2900 PHONE:
FAX: 503 - 466 -2922
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/18/2011 $75.00
12% State Surcharge - Electrical 03/18/2011 $9.00
Type of Use: SF
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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued sub; ^ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0090. You may o• - • • of the r - - questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
^
Issued = ;i / i� Permittee Signature:
d'
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar. 17. 2011 4:57PM Trilogy Custom Homes No, 1356 P. 2
Electrical Permit Application FOR elf t I(I I st: t)\ l- ti
11 City of Tigard ^� `F Received _
g Date/B : ' /$ g ii'' Permit No,: 671- !! - c 3
NI 13!25 SW Hall Blvd., Tigard, OR 97223 Plan Review �
Phone: 503.718.2439 Fax: 503.598.1960 Datr1B : Other Permit:
Inspection Line: 503.639.4175 i ��� - 02
.' 1, "� Dale Ready/By: lutist: ® Page 2 for
I ii AR 1
Internet: www,tigard- or.gov Notified/Method: Supplemental Information
❑ New construction 0 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
0 ❑ Service or feeder 400 amps or more ❑ Building over three stones.
Demolition ❑ Other
where the available fault current ❑ Marinas and boatyards,
,, , f
0 f x , t : 4 S + e 1 A + 1 exceeds 10,000 amps at 150 volts or ❑ Floating building,
. lean m ground or exceeds 14,000 ❑ Commercial -use agricultural
I and 2 - famiI dwelling t C ptrl7nerClaJ/i Indust sal ❑Accessory building
❑ Multi anion for all other installations, buildings, ❑ Master builder ❑ Other: d Fire pump. ❑ Installation of 75 KVA or
` f ',..'•'''''.' 1 r „ r Emergency system. larger separately derived system.
; . f . ❑ Addition of new motor load of ❑ "A". "E", "1.2' 1_3..
Job no.: 11 034, • Job site address: 7.3+'10 Sy f Iunz T c r• ? 1 or more, occupancy,
� ❑ Six or more res u ❑ Recreational vehicle parks.
City /State /ZIP : -- t r „ s C� 5 ClHealth - ogre facilities. El Supply voltage for more than
4 • ❑ Hazardous locations. 600 volts nominal
Suite/bidg. /apt. no.: Project name: c;ffiv? ,rd ,. cruets • , ❑ sc.vice or feeder 600 amps or more
r
Cross street directions to job site: ' . • W .:
naerletioa Orr. Pee. Total •
'- — New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.4 q
Tax map /parcel no
Ea add'1501) sq. R. or portion 33.92 ]
Limited energy. residential
75.00 2
y,(]�1 Limited energy, multi - family 75,00 2
VTI� residential (with above sq, ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2 •
..r.. ' ' '' + r , s , 201 amps to 400 turps 133.56 2
r r _
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps i 1 125.08 2
Owner installation: This installation is being made on property that I own which is not qp] amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
3 � ; i : " j ��i above service or feeder fee,
.. ...,. . , .r ... _. �..,..w .._ 'r. - r.., , *,f each branch circuit 7.42 2
Business name: B, Fee for branch circuits without
- service or feeder lee, first 56.18 2
Contact name: branch circuit
• Each add'1 branch circuit 7,42 2
Address: Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 67,84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
-mail: Pump or irrigation circle 67.84 2
5 , Sign or outline lighting 67.84 2
,. ..,:, / a tt 'J ' w 17.- tc..., `,,. a.
,. signal circuits) or limited- energy -
Business name: F Le a L a • e C p anel alteration, o extension, l Pa SC 2 �� 2
� F act additional ins • eetio n over allowable In an of the above
(
Address: 1 Additional inspection (I hr min) 66.25/ hr
City /State/ZIP: * & ' IT> i P✓, ` (I�] 007 n (] hr min) 66.25! hr
l - Industrial plant (1 hr min) 78.18/ hr
phone: 5 Q'3 1,�. M - ��aQ Fax: C �1 t - I�t;� �� Inspections for which no fee is
IDk7 Lic.. listed (K hr min
C 90 00/ hr CM }� b s cdieall 11
67 V Electrical Lie. l . l J� 1 0 suprv, L ie, 5 22 , t- t ' ....
Suprv. Electrician signature, required: subtotal; ^ 1.1gal.
Plan review (25% of permit fee):
Print name; Vtitcri INIZD 0 a .$ Date: .3 r i --/ ,ti State surcharge (12% of permit fee); g'-'
T OTAL PERMIT FEE:
Authorized signature: / r i N ' lit; / 1 ! . + This permit application expires if a permit is not obtained within 180
Print name: 6. 4 s ,E ir ' Date: 3 - ! 7 ri� * Number of ins owed per accepted as wmplete
pe permit.
1:1Bu17dinalP arm *ra∎ET.n- PermlrAnn Are 07/01/1!1 e.n .m.rr, r m�mn.mwo
Mar. 17. 2011 4:57PM Trilogy Custom Homes No, 1356 P. 3
Electrical Permit Application - City of Tigard
Page 2 . Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
,= I e. g, V - and Air . , • _ ..nuig System*
r Vacuum Systems*
❑ Other:
Fee for gad commercial $75.00
system
(SP:F. OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
r.
El 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
∎Bmidinecrmitcl l C- PcrmltApp.dce 07/01/10