Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00158
T [ GAR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/25/2012
Parcel: 2S 101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY, STE# 010
Project: National American University Subdivision: VARNS ACRES Lot: 9
Project Description: Low voltage for HVAC
Contractor: VERTEX MECHANICAL LLC Owner: TRIANGLE POINTE LLC
111 SW 5TH AVE STE #1850 901 NE GLISAN ST, #100
PORTLAND, OR 97204 PORTLAND, OR 97232
PHONE: 503 - 963 -4732 PHONE: 503 - 297 -8791
FAX: 503 - 963 -4730
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/25/2012 $75.00
12% State Surcharge - Electrical 07/25/2012 $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 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: on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 th gh OAR 52-001-1 '. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332. 44.
��. 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 Applicatil51i EC f E I C)It UI I IC.1 l Sl: ( \l.l
City of Tigard '�" w e d 7 5 /a --" Permit No.: f / C a_00/5-7
1111 13125 SW Hall Blvd., Tigard, OR 97223 ' U L 2 5 2012 Plan Review
II el Phone: 503.718.2439 Fax: 503.598.1 Date/ Other Permit
.1.1 G A R D Inspection Line: 503.639.4175 T / Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard- or.gov CITY OF ! °r ARD Notified/Method: Supplemental Information
�`E�C Dt n
TYPE OF PLAN REVIEW
,New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wfitems 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 , Commercial/industrial ❑ Accessory building amps for ell other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
o
❑Addition of new motor load of ❑ "A ", "E E"", , " "11 -2 "", , "1 -3 ",
Job no.: Job site address: j 3333 sIJ 65-a pi-., I00HPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: % c J 04
❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 votes nominal.
Suite/bldg. /apt. no.: Project name: Pc Tica r om 4 / ' nerrloy (14 t4 4i ❑ Service or feeder 600 amps or morn.
FEE SCHEDULE
Cross street/directions to job site: I Qty. Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'1500 sq. R or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
jw- l,o � In e c... i �¢ /5 -- residential (with above sq. ft)
/ Services or feeders installation, alteration, and/or relocation
•^0105 /V/ 5 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
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
ty relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/ State/Z1P: dwelling, °mIIc �� 67.84 2
Wig, feeder
Phone: ( )
Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy e,0
Business name: Ue L �
I f- leck n 1 ca 1 panel, alteration, or extension. Page t ` 2
Each additional inspection over allowable In any of the above
Address: i / ( 5; J. / 5 p-� S'4 /a'rj Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: 11.... /-h, /-4-1.i or r-7...,..0,, Investigation (1 hr mm) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (c2 ) 9 e) — 4.7 3 2 - Fax: ( 97 ) 9(v 7 - Y 73 o Inspections for which no fee is
specifically listed (V2 hr min) 90.00/ hr
CCB Lic.: t g94/ 6/ Electrical Lic.: (05 Suprv. Lic.: C L„. D. 33 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: . C / 7 f�1 ,� Subtotal: 75 •° a
/ —� Plan review (25% of permit fee): -• a
Print name: 41 ejI�GQ,-- Date: 7/l �j2 State surcharge (12% of permit fee): 0
TOTAL PERMIT FEE: T •a0
Authorized signature: / p/�
� This permit applkatba expires fist permit is not obtained within 180
Print name: / ��j �/ days after it has been accepted as complete.
/ f / n'49 SIDS Date: / 1 .- • Number of inspections allowed per permit
t :\ Building \Pennits\ELC-PermitApp.doc 07/01 /10 440.4615rp1/05/c0AVw&B