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Permit
I CITY OF TIGARD LECTRICAL RESTRICTED ENERGY PERMIT 11 C . COMMUNITY DEVELOPMENT Permit #: ELR2013 -00075 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/04/2013 Parcel: 2S113BA00400 Jurisdiction: Tigard Site address: 7632 SW DURHAM RD 105 Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D Project Description: (4) low voltage for thermostats. 6/24/2013: REPRINTED to correct suite address. Contractor: OREGON HEATING & AIR CONDITIONING Owner: PORTLAND SW CENTER LLC 19300 SW 118TH AVE BY FELTON PROPERTIES INC TUALATIN, OR 97062 ATTN: FELTON, MATT 520 SW 6TH AVE, STE 610 PORTLAND, OR 97204 PHONE: 503 -691 -9699 PHONE: FAX: 503 -691 -8556 FEES Description Date Amount Specifics: Restricted Energy Permit 04/04/2013 $300.00 12% State Surcharge - Electrical 04/04/2013 $36.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio & Stereo: Boiler Controls: CCTV: Clock Systems: Data & Telecommunications: Fire Alarm: HVAC: Y Instrumentation: Intercom/Paging: Landscape /Irrigation: Landscape Lighting: Medical: Nurse Calls: Protective Signal: Security Alarm: Other: 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 9 -0 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ^ / Issued By: Permittee Signature: d/CJ -�L C �� �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 603.639.4175 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. CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT >t COMMUNITY DEVELOPMENT Permit #: ELR2013 -00075 -r WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/04/2013 Parcel: 2S113BA00400 Jurisdiction: Tigard Site address: 7632 SW DURHAM RD 100 Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D Project Description: Remove walls, new walls, doors, relites, cabinetry and plumbing for TI Contractor: OREGON HEATING & AIR CONDITIONING Owner: PORTLAND SW CENTER LLC 19300 SW 118TH AVE BY FELTON PROPERTIES INC TUALATIN, OR 97062 ATTN: FELTON, MATT 520 SW 6TH AVE, STE 610 PORTLAND, OR 97204 PHONE: 503 - 691 -9699 PHONE: FAX: 503 - 691 -8556 FEES Description Date Amount Specifics:, Restricted Energy Permit 04/04/2013 $300.00 12% State Surcharge - Electrical 04/04/2013 $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 �� 95 (( 2- 001 - 0090. Y You , may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 1.L Issued By: . l Or'l.Ct o Permittee Signature: �k\ A e47U&J 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. 04/03/2013 13:45 503 - 691 -8556 OREGON HEATING PAGE 02/02 • Electrical Permit A e licat o t .CEIV I tilt t)i rlcl. l tiu: c)Nl y • City of Tigard APR 0 3 2013 INNISCUEEM Permit No.: ezz , 3 - 0007x' ' 13125 S W Mall Blvd., Tigard, OR 97223 Plan Review _ . Phone: 503.639.4171 Fax: 503.5 DareB : �� 1 3 °DOfP 7 Inspection Line: 503.639.4175 t OF TIGARD Date Ready /By: l Other permit. E5 see Page 2 for l �. Ott ti BUIL D ING DIVISION " , Internet: www,tigard or.gov t3g tifiedQvlethod: t t Internet: Supplemental Information TYPE OF WORK 1PL,AN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): NEW construction ❑ feAddition /alteration /replacement El Service or feeder 400 amps or more ❑ Building over time stories. Demolition ❑ Other; where the available fault currant El Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ] Floating buildings. - -� less to ground, or exceeds 14,000 ❑ Cornmorcial.use agricultural ❑ 1- and 2- family dwelling ®"Commercial /industrial 0 Accessory building amps for all other installations. buildings, ❑Multi- family D Master builder ❑ Other: El Fire pump. ❑installation JOB SITE INk OR14fATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of El "A ", "0 ", "1 -2", "1 -3", Job no.:1303 00 F (, Job site address: ? $ L(✓ 0,A.1 k,10t . J or more. ooenpattey. El Six of more residential units. El Recreational vehicle parka. City /State /ZIP: 1 r C�[2 / 0 q 7 a .- ,11 l t"lealth-care facilities. ID Suppty voltage for more than f ❑ Hazardous locations. 600 volts nominal, Suite/bld2. /aft. no.: Project name`. 4t/ct.r4e (t 1-1 u r . C' C El S ervice or feeder 600 amps or more, P FEE SCFTFUI LE Cross street/directions to job site: pescriptien . Qty. tre6 Total . New residential single or multi - family dwelling unit. Includes attached garage. Subdivision; Lot no.; 1,000 sq. ft or less l 168.54 4 Tax map/parcel n0 -: Ea. add') 500 sq. ft. or portion 33.92 1 Limited energy, residential 75.00 2 DESCRIPTION OF WORD (with above sq. ft.) Limited energy, multi- family 7500 2 (} ) I4lxl U t e -1-4W549-15- -1 residential (with above sc). #t) Services or feeders installation, alterations, and /or relocation 200 amps or less 100.70 2 El PROPERTY OWNER d TENANT 201 amps to 400 amps 1 33,56 2 . 401 amps to 600 amps 200.34 2 Name: - 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amp or volts . 552.26 2 City/State/ZIP: /State /Z1P: Temporary services or feeders installation, alteration, and/or t3 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 riot 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 ❑ APP I W CON TAC PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: C" t ,,e)/1 c'a fo I ,4-(I B. Fee for branch circuits without ! servic OT feeder fee first 56.18 2 Contact name: '�a r0 � branch circuit - Each add'I branch circuit 7.42 2 Address: f el ?sc9 p S IV 1 Miscellaneous (service or feeder not included) Each manufactured or modular • City /State/ZIP: . Q � �� t,4, � . C0 t` ( i/ 7e I dwelling, service and /or feeder 67.84 2 ( Reconnect only 67.84 2 . P1,onc:(Sc,l) 6E1 1— � /�� � 1"ax::(So3) 6�(—`�s.s4 E -mail: -f C15 er- e3I c 1 L.,�ic'/` t9 - CGrey\ , Pump or irrigation outline circle 67.84. 2 'i.- Sign or a„tline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy _ Business name: C3 .re 9=091 panel, alteration, or extension. Page 2 WO• 2 / ©91 e . �" r �J Each additional inspection over a ? owabIe In any of the above Address: pi 3 cc 5 Lti F)514—t, /tr, Additional inspection (i hr min) 66.25/ hr f Investigation (1 hr min) 66.25/ hr City /State/ZIP: 1 r 1�ot:(, I G L i T A 7 l 0 ie 1 / r {y Industrial plant (1 In min) 78.18/ hr Phone: ( -SC3.) 69,1— Wo rj' Fax: (5 8 ) b / p s E 6 inspections for which no fee is 90.OQ! hr specifically listed (/s hr min) CCB Lic.:)'(a„( au Electrical Lic.1 yo Suprv. Lie.:'79b(IIN ELECTRICAL PERMIT FEES _ Subtotal: 30c)•(>0 Suprv. Electrician signature. required: — Plan review (25% of permit fee): Print name: -. r _ Date; G 4/0 '3 State surcharge (12% of permit fee): 3 G -cs 0 : 1 TOTAL PERMIT FEE: 3II 6 • U 0 Authorized signature: - /�. Ibis permit application expires if a permit is not obtained wyithIn 150 Print name: ""j 5\ ¶ 5f ier Date: CL-V days after it has been accepted as complete. Number ot'inspeetions sllowed.per permit.