Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• 1111 COMMUNITY DEVELOPMENT Permit #: ELR2013 -00129
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2013
Parcel: 151 36DA00100
Jurisdiction: Tigard
Site address: 11308 SW 68TH PKWY
Project: Comcast Tech Ops West Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: Low voltage for accces /intrusion system
Contractor: CONVERGINT TECHNOLOGIES Owner: BENENSON 68TH PARKWAY KEY LLC, T
16575 SW 72ND AVE BY PROVIDENCE HEALTH SYSTEM
PORTLAND, OR 97224 ATTN: PROPERTY MANAGEMENT
1235 NE 47TH STE 160
PORTLAND, OR 97213
PHONE: 503 - 228 -8522 PHONE:
FAX: 503 - 228 -8521
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/12/2013 $75.00
12% State Surcharge - Electrical 06/12/2013 $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: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: Y 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 a • • -nce with - 'proved 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. ATT 'TION: Oregon la • re• • es ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 •010 th • gh OAR 952 -00 .090. You y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Iss - d By: • / / i 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' t A2 5 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.
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Electrical Permit Applicat;7 l cEivED FOR OFFICE USE ONLY
City of Tigard "�� 1 e� 2013 Permit No.: e ...., /3 -06/.29
13125 SW Hall Blvd., Tigard, OR 97225U 1 D Plan Review
71
Date /B Q
C Other Permit: /A /J 640 ,25/
Phone: 503.718.2439 Fax: 503.598.1960
TI (3AR D Inspection Line: 503.639.4175 CITY OFTIGARD Dale Ready/By: Juris: gi See Page 2 for
Internet: www.tigard- or.gov
BUILDING DIVISION Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
® New construction ❑ Addition /alteration /replacement
❑ 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 all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E' . "I -2 ". "I -3 ",
Job no.: Job site address: 11308 SW 68 Parkway IOOIIP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR, 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Comcast New Tech Operatio ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. II. or less 168.54 4
Ea. add'I 500 sq. Ii. or portion 33.92
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. (l.)
Limited energy, multi - family 75.00 2
Access system & Intrusion residential (with above sq. (l.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 2 01 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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
® APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
Business name: each branch circuit 7.42 2
B. Fee for branch circuits •idow
Contact name: service or feeder fee, first 56.18 2
branch circuit
Address: Each add'] branch circuit 7.42 _ 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Convergint Technologies Signal circuit(s) or limited- energy X Sec 75-.00
panel, alteration, or extension. Page 2 I 2
Address: 16575 SW 72 " Avenue Each additional inspection over allowable in any of the above
Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: Portland, OR, 97224
y ' Investigation (1 hr min) 66.25/ hr
Phone: (503) 228 - 8522 Fax: (503) 228 - 8521 Industrial plant (I hr min) 78.18/ hr
Inspections for which no fee is 90.00/ hr
CCB Lie.: 148358 Electrical Lic.:)6- //73c LE Suprv. Lie.: 3506LEA specifically listed (%hr min)
f � �J ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /1d w`T Subtotal: 75 ---,,,0
Print name: William E Van Every Date: 6 -12 -13 Plan review (25% of pennit fee): - •'
/'/ ��,�� )� State surcharge (12% of permit fee): .p 941
Authorized signature: (..
/.. �e ( K TOTAL PERMIT FEE: q el. 0d
Print name: William E Van Every Da te: 6 - I2 - This permit application expires if a permit is not obtained within 180
ry days after it has been accepted as complete.
• Number of inspections allowed per permit.
t: \ Building \ t' ermits \t:I.C_PermitApp_EI.R_ERE.doc Rev 05121/2013 440-461 I Ii051COM /wI =B
Electrical Permit Application — City of Tigard.
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qh'. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
El Heating, Ventilation and Air Conditioning OAR 918 - 309 -0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3 '
❑ Vacuum Systems* >100 kva—noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑
Other: Each additional inspection is
• charged at an hourly (I hr min) . 66.25/ hr I
Inspections for which no fee is 90.00 / hr
specifically listed (' /: hr min) _
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE 'OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee): •
Check Type_of Work Involved: TOTAL PERMIT FEE:
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This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation • .
El Fire Alarm Installation
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HVAC
❑ Instrumentation •
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El Intercom and Paging Systems
El Landscape Irrigation Control*
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El Medical
El Nurse Calls
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El Outdoor Landscape Lighting*
• El Protective Signaling
® Other Access Intrusion
Total number of commercial systems:
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*No licenses are required. • Licenses are required
for all other installations
I: \Building\ Permits \ELC_PermitApp ELR_ERE.doc Rex 05/21/2013 •