Permit 4 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11111 COMMUNITY DEVELOPMENT Permit#: ELR2015-00023
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/28/2015
Parcel: 2S112AB02300
Jurisdiction: Tigard
Site address: 14150 SW MILTON CT
Project: Medical Teams International Subdivision: BONITA INDUSTRIAL PARK Lot: 5
Project Description: Replacement of(11)RTU's with same. Disconnect/reconnect existing gas lines.
Contractor: AMERICAN HEATING INC Owner: MEDICAL TEAMS INTERNATIONAL
5035 SE 24TH AVE PO BOX 10
PORTLAND, OR 97202-4765 PORTLAND,OR 97207
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 01/28/2015 $75.00
12%State Surcharge-Electrical 01/28/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 1 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 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 c•- • the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
S
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 ApplicatCEIVED
11 City of Tigard nae;B"y: 5 Permit No.: s/� �'r•
13 125 SW Hall Blvd.,Tigard,OR 972 Plan Review `a`�-�[ �7 aro�-3
Phone: 503.718.2439 Fax: 503.598.1 15 2015 DateBy: Other Permit:
TI G a It U Inspection Line: 503.639.4175 Date Ready/Fly: 3uris: 6i! See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
g
TYPE HF'tW�6R1JG DIVISION PLAN REVIEW
❑New construction Please check all that apply(submit 2 sets of plans w/items checked below):
® 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
❑Emergency system. larger separately derived system.
JOBS t 1 •TION AND LOCATION ❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.:314628 Job site address: 14150 Sw Milton Ct 1 more. occupancy.
❑Six x o or r m moore residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tlgard OR,97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Mdical Tea rti/_nternational ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 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'!500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 7500 2
Low volt wiring disconnect/reconnect residential(with above sq 0)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ 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
relocation
Phone:( ) Fax:( ) ---200 amps or less 59.36 - 1
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:American Heating Inc. each branch circuit
B.Fee for branch circuits without
Contact name:Brandon Hutchinson service or feeder fee,first 56.18 2
branch circuit
Address:5035 SE 24th Ave. Each add'I branch circuit 7.42 2
City/State/Z1P:Portland,OR,97202 Miscellaneous(service or feeder not included)
Each manufactured or modular 6184 2
Phone:(503)239-4600 Fax::(503)239-7038 dwelling service and/or feeder
Reconnect only 67.84 2
E-mail: b.hutchinson @americanheating.net Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)or limited-energy I See 75760
panel,alteration,or extension. Page 2 2
Address:Brandon Hutchinson Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OR.,97202 Investigation(1 hr min) 66.25/hr
-
Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90 00/hr
Lic.: 33135 Electrical Lic.: 26993CRE Suprv.Lie.: 2640LEB specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: G Subtotal: 75-00
Print name: T Steve Young r Date: //S _/5 Plan review(25%of permit fee): -----
State surcharge(12%of permit fee): Q•dam
Authorized signature: TOTAL PERMIT FEE: $q.CO
This permit application expires if a permit is not obtained within 180
Print name: Brandon Hutchinson Date:7/j"--7/_<.- days after it has been accepted as complete.
' Number of inspections allowed per permit.
I Ituilding\Permits\ELC_PennitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(11/05/COMIWEB
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 Qtv. I Fee I Fotal 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
H 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
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with
OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
n V• acuum Systems* >100 kva—no additional charge 0.0 3
n Each additional inspection over allowable in any of the above:
O• ther: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min) ,
Inspections for which no fee is 90.00/hr
specifically listed(Ya 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
HAudio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ L• andscape Irrigation Control*
❑ Medical
n N• urse Calls
n O• utdoor Landscape Lighting*
H Protective Signaling
n Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I\Building\Permits\ELC_Permit App_ELR_ERE.doc Rev 05/21/2013
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14150 SW MILTON CT, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00023
Jeff Grove
Violation Summary:
Inspector Contractor