Permit 11111 CITY GF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s - COMMUNITY DEVELOPMENT Permit#: ELR2015 00039
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/09/2015
Parcel: 2S101 DB00100
Jurisdiction: Tigard
Site address: 7340 SW HUNZIKER RD 210
Project: Cornerstone Clinical Services Subdivision: VARNS ACRES Lot: 9
Project Description: Data telecommunications system.
Contractor: ERTELL ELECTRIC LLC Owner: HILLTOP BUSINESS CENTER LLC
PO BOX 279 HUNZIKER LLC
FOREST GROVE, OR 97116 9430 NW KAISER RD
PORTLAND,OR 97231
PHONE: 503-841-4511 PHONE:
FAX: 503-359-5652
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/09/2015 $75.00
12%State Surcharge-Electrical 02/09/2015 $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 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 co• of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
i
Issued 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' 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.
c Elestrical Permit Application r ,NNV FOR OFFICE USE ONLY
•
�/
City of Tigard Received DateB : QC ::, Permit No ate,20 w..._ y.l03 i
11111 13125 SW Hall Blvd.,Tigard,OR 97223 ^ Plan Review lY
Phone: 503.718.2439 Fax: 503.598.19 9 LO�� Date/By: Other Permit:Du/0,01,0,1a
r I�;n K r� Inspection Line: 503.639.4175 �8 A Date Ready/By: Juris l3 See Page 2 for
Internet: www.tigard-or.gov U `���� ,Notified/Method: i I—% Supplemental Information
TYPE OF WO>J� ���I �SI" PLAN REVIEW
❑New construction Addition/alteriSktpacement 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
❑ I-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","l-3",
Job no.: y.j Job site address: 7340 SW IooH more residential occupancy.
r itA ll L t ktr' ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: .� ❑Health-care facilities. ❑Supply voltage for more than
r'% O Q� ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: ;k Z10 Project name: ( r���, eiz,,z_ _ 1 ❑Service or feeder 600 amps or more.
`1 �1 FEE SCHEDULE
Cross street/directions to job site: i/i,n 7;kr (.I..4Ot L, "J VLP J Description I Qty. I Fee. I Total I "
J� 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
DESCRIPTION OF WORK (with above sq.ft.) 75'00 _
Limited energy,multi-family 75.00
�,l0InS �' ■ residential(with above sq.ft.)
CO SAµ1 tu1R1r. r r t
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: f O bikSO V\ 7.1 4 r\A-4 401 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 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 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42
Business name: c,rias r iP ,,` each branch circuit
B.Fee for branch circuits without
Contact name: D_ service or feeder fee,first 56.18 2
�—�4 I branch circuit
Address: po 8 2.A ct Each add'I branch circuit 7.42 2
r J,���60,13 D /4 �!Z� Miscellaneous(service or feeder not included)
City/State/ZIP: IG l Each manufactured or modular
Phone: I Fax: dwelling,service and/or feeder 67.84
(SD3 )�8t-t o'i/ ( 3 )F 3c -S6 Z Reconnect only 67.84 2
E-mail: Qe. ,_.,, air ki id Pump or irrigation circle 67.84 2
�" CONTRACTOR Sign or outline lighting 67.84 2
Business name: �r.i� )I , C Ift„�C Signal circuit(s)or limited-energy See
Tr^ti 7 panel,alteration,or extension. Page 2 7 ,
Address: Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: �BoSyo Electrical Lic.:r O Supry.Lic.:e- specifically listed(v2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ' cI`-
�. � Subtotal: 7.>-.
Print name. I `, r�r Date: - Plan review(25%of permit fee):
�—' t aLt��� 61 r State surcharge(12%of permit fee): .f�, -
Authorized signat 48-1.W ' TOTAL PERMIT FEE: `tg(i,S''"
/ This permit application expires if a permit is not obtained within 180
Print name. `� . ' ' r(. Dat w days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(I1/05/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 Qty. 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
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34
1=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
1:] 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:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is
90 00/hr
specifically listed(%2 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.
❑ Boiler Controls
I Clock Systems
gData Telecommunication Installation
Fire Alarm Installation
HVAC
Instrumentation
I Intercom and Paging Systems
❑ Landscape Irrigation Control*
Medical
Nurse Calls
Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\Building Termits\ELC_PermitApp_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
7340 SW HUNZIKER RD 210, TIGARD, OR,
97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00039
Chip Barnett
Violation Summary:
Inspector Contractor