Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2013-00298
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/20/2013
Parcel: 25101 DB00103
Jurisdiction: Tigard
Site address: 7360 SW HUNZIKER RD 200
Project: Washington County Clinic Subdivision:CONDO SUPPLEMENTAL PLAT NO.4: Lot: 22830-2
Project Description: Low voltage for data
Contractor: DIVERSE COMMUNICATIONS Owner: HILLTOP BUSINESS CENTER LLC
PO BOX 3939 HUNZIKER LLC
HILLSBORO,OR 97123 9430 NW KAISER RD
PORTLAND,OR 97231
PHONE: 503-366-1131 PHONE:
FAX:
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 11/20/2013 $75.00
12%State Surcharge-Electrical 11/20/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 oth= =pplicable law. All work will
be done ccordance • approved plans. This permit will expire if work is not started within 180 days of issuance, or if w• ' suspended for more the 180
days. TTENTION: Oregon <w =• . you to follow the rules adopted by the Oregon Utility Notification Center. •se rules are .y o *AR
952- 01-0010th • gh OAR 952-0• -0090. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19: or .:00.33/
sued By: / _ ! './-'" 4s/& ' Perm ittee 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 Application FOR OFFICE USE ONI.V": .
City of Tigard g ��I r�
Date/By. a ,9011 �..-V/ Permit No.: 1/_/4910i S_�a�s
° 13125 SW Hall Blvd.,Tigard, 9 ;h∎ .,
, G Plan Re Other Permit:
Phone: 503.718.2439 Fax: 503.59:.1 Other Permit:
I'I C. It a Inspection Line: 503.639.4175 NOV 2 0 2013 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF W a r ,.1 '0: I A.' I .
❑New construction Addition/altee WAGMi4Sd01' 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 ❑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","1-2","1-3",
(�
I OOHP or more. occupancy.
Job no.: f 3 Q Job site address: p S N(1.021 k_e R�. ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Ti G ke ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
❑Service or feeder 600 amps or more.
Suite/bldg./apt.no.: (:)0 O Project name: �kco (,� I C FEE.SCHEDULE . '
Cross street/directions to job site: 4A-46/4/A..)(p re A.) eca jJr-v 0...1_1 131c. Description I Qty. 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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
(with above sq.ft.) 75.00 2
. , DESCRIPTION .OF WORK - ( q
Limited energy,multi-family 75.00 2
DATA residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
'❑ PROPERTY OWNER I 'III 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:( ) I Fax:( ) relocation
200 amps or less 59.36 I
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
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,
7.42 2
Business name: each branch circuit .
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit _
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) I 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: l I Signal circuit(s)or limited-energy See
\V e�� (�t/H u 1 e f!n /.3 �,L/�T/U iU,) �A/ . panel,alteration,or extension. ! i Page 2 75.- 2_..
Address: Each additional inspection over allowable in any of the above
P•a- fox ��3�3
� q Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: )41.(Ss 0,_,:, t J f, / ) 1 a-3 Investigation(I hr min) 66.25/hr
Phone:(s63) 65, 0 _ O- I Fax:( ) to l�J/y Industrial plant(I hr min) 78.18/hr
( Inspections for which no fee is 90.00/hr
CCB Lie.: /35-996 I Electrical Lic.: - 4 CLe. uprv.Lie.: 2 L 38 LE,4 specifically listed(%]hr min)
Suprv.Electrician signature,required: / �,� ELECTRICAL;PERMIT'FEES
�— Subtotal: 7 S ,06
Print name:k CA M-F I E ICI Date: 1 I z�, )Z o,13 Plan review(25%of permit fee): 0 —
" State surcharge(12%of permit fee): / °a
Authorized signature: — / TOTAL PERMIT FEE: g�,a,
Print name: Date: t This permit application expires if a permit is not obtained within 180
re.A'� CA N F I E 11 o b.:d 1 days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:'.Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46t5T(11/05/COM/WEB
•
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 Q4'. 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
I=1 Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ 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—no additional charge 0.0 3
• Each additional inspection over allowable in any of the above:
ElOther: Each additional inspection is
charged at an hourly(1 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:
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.
El Boiler Controls
El Clock Systems
E Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems: I -
*No licenses are required. Licenses are required
for all other installations
1.\Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 05/21/2013
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
7360 SW HUNZIKER RD 200, TIGARD, OR, 2013 -11 -26 00:00:00
97223
Record Type: Record ID:
Commercial - Electricial Limited Energy ELR2013 -00298
Inspection Type: Result:
135 Low voltage PASS
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
7360 SW HUNZIKER RD 200, TIGARD, OR, 2013 -12 -02 (null)
97223
Record Type: Record ID:
Commercial - Electricial Limited Energy ELR2013 - 00298
Inspection Type: Result:
199 Electrical final PASS - No C of 0
Comments:
Violation Summary:
Inspector Contractor