Permit ti CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2013 -00053
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/12/2013
Parcel: 1S134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE P -A
Project: FMC Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 3
Project Description: (4) low voltage for HVAC
Contractor: OREGON HEATING & AIR CONDITIONING Owner: FRESENIUS MEDICAL CARE, NA
19300 SW 118TH AVE 5251 DTC PARKWAY
TUALATIN, OR 97062 GREENWOD VILLAGE, CO 80111
PHONE: 503 - 691 -9699 PHONE: 303 - 712 -1814
FAX: 503 - 691 -8556
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/12/2013 $300.00
12% State Surcharge - Electrical 03/12/2013 $36.00
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 $336.00
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 •52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
or
Issued By: Add A L-- � . Permittee Signature: Pet(c4
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.
03/12/2013 11:48 503- 691- 8556 OREGON HEATING PAGE 02/03
RF Electrical Permit Application EITE FOR OFFICE USE ONi.Y
City of Tigard 2 201: Date/B ': 3 ? ..1 13 3
MAR 1 . R�Gwd f 1 Pem 'itNn.: E'L2 �v13
* 13125 SW Hall Blvd,, Tigard, OR 97223 Plan Review &a Permit
3 000
- C Phone: 503.639,4171 Fax: 503,598.1960 Date-03Y: Other Permit:
Inspection Line: 503.639.4175 CI kV I I G ' ' I} Date heady /8y: kris: i t See page 2 for
T ``'� 1' g BUILDING DIVISI 4 Nr d /Metl,od: TI 4
Internet: www.tigard-or.gov Supplemental Information
TYPE OF. *FORK PLAN REVIEW
[] New construction ' Addition/aLteration/replaoement 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 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 0 Commercial -ase agricultural
❑ 1- and 2- family dwelling [. CommerciaVindustrial ❑ Accessory building, amps for all other installations. buildings.
❑ Multi - family . ❑ Master builder ❑ Other: ❑ Fite PUMP. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. largerseparately • "1 -3 system.
[] Addition of new motor load of ❑ "A ", "E E"", ,"1 J -2 " , "1 - 3",
Job no._ (l0'--C' 1 Job site address: 030 0 .SW /1 :ix 194.5 '' ❑ Six o a r es. Recreation.
f pD ix o or m more residential units. ID Kecreationei vehicle parks.
City/State/ZIP: r t b f 4. -7 ( 0 facilities. [] an
Supply voltage for mare them
l � ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: % I Project name: tr Lett5 Fete-. ❑ Service or fettle 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: D «ription 1 Qtv. I 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' 1 500 sq. ft. or portion 33.92. 1
Tax map /parcel no.: - Limited energy, residential
DESOUFTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
( ) T er 5 residential (with above sq. Pt,
_ r Services or feeders installation, alteration, and/or relocatioe
_ 200 amps or less 100.70 2
—" El PROPERTY OWNER 1 LI TENANT 201 amps to 400 amps 133.56 2 .
401 amps to 600 amps 200.34 . 2
Name: 601 amps to 1,000 amps 301.04 2
•
Address: over 1,000 amps or volts 55226 2
— • Temporary services or feeders Installation, alteration, and/or
City/State /ZIP: • relocation
Phone: ( ) I Fax: ( ) 200 amps or less 5936 1
20.1 amps so 400.emps . 125.08 2 .
Owner installation: This installation is bein made on property that I own which is not 401 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, per panel
Owner signature: Date: A. Fee for branch circuits with
in APPI.)iCA,NT L g-CONTACT PERSON above service or tBeGer fee, 7.42 2
each branch circuit
•
Business name: 0 f r�p1 H 9.1 FT B. Fee for branch circuits w ithout
service or feeder fee, first 56.18 2
Contact name: J O5 t f ,54•e f . branch circuit
Each add' 1 branch circuit . 7.42 2
Address: 19 -$ .-w 1/111....„ AVC.. Miscellaneous (service or feeder not included) •
Each manufactured or modular 67.84 2
City/State/ZiP: '"•. , ((��, 1 r. 0 P. 7CJ6s - dwelling, service and /or feeder
Phone: ( 99 � ) b� 1 - c i tote( • Fax: : 003 ) 6 t ! r 6 6 " Reconnect only 67.84 2
y Pump or irrigation circle 67.84 2
E -mail J`F e lg 0 � p " 'ZAN _ . Sign or outline lighting _ 67.84 2
,q CO -y OR Signal circuit(5) or limited energy l
Business name: ti C 9$64.� . Jt / g i C / panel, alteration, or extension. ~ Page 2 _ �� 2
l �7 r Each additional inspection over allowable in any of the above
Address: (! ?
1'i so C , ^'V , t - f � V _ 4 T Additional inspection (1 hr min) 66.25/ hr
investigation (I hr min) 66.25/ hr
City/State/ZIP:1 [0. ` co 9 Industrial plant (1 hr mm) 78.18 / hr
Phone: ( ) 6 1 — 16GZ A 7 . Fax: ( ) 1 ut 1 gS _56 Inspections for which no fee is 90.00/ hr
J f _ specifically listed (%z In min)
CCB Lic...Ala„ I a,cp Electrical I.ic.: 5/0 Suprv. Lie.: )`7981..Ej5, ELECTRICAL P1ERNTT •FEES
Subtotal: r00-00
Suprv. Electrician signature, required: Plan review (25% of,permit fee):
Print name: l e , , • (te" Date: 03 if )f13 _
State surcharge (12%ofpermit fee): 36
• TOTAL PERMIT FEE: ` 6.
Authorized signature: AO-'' mss This permit application expires if a permit is not obtained svithie 180
days after it has been accepted as complete
Pra name- � s 4 •
p , e �' Ra te: s 3�l � • Number of inspections allowen per permit.
HRniidina \Permits\ELC- Penni,ADD.doc 07/O1i10 - .404615r(11/03/COM(W B
03/12/2013 11:48 503- 691 -8556 OREGON HEATING PAGE 03/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combiined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ 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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irr Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
No licenses are required. Licenses are requited
for all other installations