Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
r
;rl 2 ' COMMUNITY DEVELOPMENT Permit #: ELR2012 -00272
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2012
Parcel: 25101 AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Project: Tigard Dental Subdivision: BEVELAND NO.2 Lot: 18 -19, P
Project Description: (1) low voltage HVAC
Contractor: CLIMA -TECH CORPORATION Owner: KAISER FOUNDATION HEALTH
4107 SE INTERNATIONAL WAY STE. 703 PLAN OF THE NORTHWEST #838
MILWAUKIE, OR 97222 ATTN: GENERAL ACCCOUNTING 11TH F
500 NE MULTNOMAH #100
PORTLAND, OR 97232
PHONE: 503 - 650 -8482 PHONE:
FAX: 503 - 722 -0185
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/10/2012 $75.00
12% State Surcharge - Electrical 12/10/2012 $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: 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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987
t 2.1 or 1.80 -�1
Issued By: lk1Jt .ayK- (L1 Permittee Signature: DM p Lj C W / /d k
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.
NOV - 30 - 2012 13:46 WIEIY D 5037220185 P.001
Electrical Permit Applica ion c FOR OFFICE USE ONLY
of Tigard DEC 06 2012 Received Permit No.:
DateB : ( /Q 11 a s j a./2 ,i,20),), - 09,7 7.7_ Illi q 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2439 Fax: 5 Plan Review
g �Y! °i'��G�+"� Date/B Other Permit:
['1 C A R D Inspection Line: 503.639 1 'ILDIN G DIVI SION Da Ready/By: ! rte / ® See Page 2 for
Internet: www.tigard or.gov D Notified/Method: 7 ( !/ Supplemental Information
t 1 " -TYPE OF WORK PLAN -REVIE
❑ 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 CI Marinas and boatyards.
. w!;o > ` CATEGO Y� O exceeds , amps at 150 volts or Floating buildings.
.;•::' >` `:� ��;' �. � : -'. .. �:� . �;.CO � -'`:� � �:: +_., C:.•;'::. d 10000 P ❑
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /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 i =H' FORMATION "AND -LOf ATION -= .
- •- � 0 Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: ,` 1 100HP or more. occupancy.
Q(Z� O(n 3 1105- � � H T
� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 0 � C i I/23 l ❑ Health - care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: �( C.i..`rrt j ,D _ PJ -�L � [�t.( + ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: � :: ,.0 .-t .. : ;_ . !FEE.SCHEDULE; "'; .;
Description 1 Q. 1 Fee. I Total 1 •
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'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
' DESCRIPTION ;WORK . . ' , . (with above sq. ft.) 75.00 2
1 ) / Limited energy, multi - family 75.00 2
a /Te/2 -r7.)J e../)n it.-0 /S imp ra C Q, residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
. 0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
• Name: ' a /64 r Aj /M I f2� 401 amps to 600 amps 200.34 2
601 amps to 7,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /Z1P: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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 above service or feeder fee,
• . CONTACT; PE RSON' ' 7.42 2
each branch circuit
_ c _,� B. Fee for branch circuits r
Business nan
G t t>" � L - � 6,... � � service or feeder fee, f irst
t 56.18 2
Contact name: Go .,P pcujI.I P branch circuit
1 ( Each add'I branch circuit 7.42 2
Address: 9 I O , i S G Z ' t ✓1 ..( hC 1 c�i‘C I ! VJ $te....,76s Miscellaneous (service or feeder not included)
�^ Each manufactured or modular 1
City /State /ZIP: i l t(w ow �'p , (, Ir� C t iZ_2_"t � dwelling, service and/or feeder 67.84 2
Phone: t )(DS gg .4e2_ Fax:: (56) ) - 1 /a, CJi €S— Reconnect only 67.84 2
E -mail:
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: C` 1 Tr- CA-s- panel, alteration, or extension. Page 2 2
C , � . ^ 1 U ■ Each additional inspection over allowable in any of the above
Address: - ( p'7 5 G rt/1 Gtr I mai Lj et.0 's 4 P 7 0 J Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: • � V Investigation (I lie min) 66.25/ hr
! t I �I�-L (2zZ'' Industrial plant (1 hr min) 78.18/ hr
Phone: (50/) 195 gLi g2 _ Fax: (503) 1 ZZ_ O iq s— Inspections for which no fee is 90.00 / hr
CCB LIC.: U Electrica Lic.: O specifically listed (h hr min) t
06 .5 �6 c i y S uprv. Lie.: S6 r-1 g S ELECTRICAL PERMIT FEES .
Suprv. Elec sig n ature, required: I t r`f �� - iI 111E3—
' t -- Subtotal: '� 13,3 /. y { � � f— '� Plan review ( 2 5 % o permit f ee):
Print name: cP 3 r t°_ Date: 1 �3q/l -7 State surcharge (12% of permit fee): i , A 6 -
/ - TOTAL PERMIT FEE: 6 Authorized signature: ` S g ,
/- _. This permit application expires if a permit is not obtained within 180
Print name: J e"._k......c J~ days after it has been accepted as complete.
Q f s e Date: ( � ( / 3 �(� • Number of inspections allowed per permit.
1 \Building\Permits\ELC- PermitApp dot 07/01/10 440- 4615T(I1 /05 /COMAVEB
NOV -30 -2012 13:47 climatec 5037220185 P.002
Electrical Permit Application - City of Tigard ❑ Other
Page 2 - Supplemental Information Total number of commercial systems: I
LIMITED ENERGY PERMIT FEES: *No licenses are required. Licenses are require
for all other installations
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
n Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System=`
❑ Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY: .
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
I :1Building\Permit5\ELGPermitApp floc 07/01/10
Total P.002
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7105 SW HAMPTON ST, TIGARD, OR, 97223
Commercial - Electricial Limited Energy
199 Electrical final
02/27/2013 00:00
ELR2012-00272
PASS - No C of O
Violation Summary:
Inspector Contractor