Permit 1/111 r, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
It ' COMMUNITY DEVELOPMENT Permit#: ELR2015-00210
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/09/2015
Parcel: 2S 101 DA00104
Jurisdiction: TIGARD
Site address: 13333 SW 68TH PKWY, STE#210
Project: NW Capital Management Subdivision: VARNS ACRES Lot: 9
Project Description: Low voltage for HVAC
Contractor: HVAC INC Owner: TRIANGLE POINTE TWO LLC
5188 SE INTERNATIONAL WAY 901 NE GLISAN ST, STE 100
MILWAUKIE, OR 97222 PORTLAND, OR 97232
PHONE: 503-462-4822 PHONE:
FAX: 503-462-6555
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/09/2015 $75.00
12%State Surcharge-Electrical 09/09/2015 $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: 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 I
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. ATT N: • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those r s ar set forth in OAR
952-001-0 0 through OAR 9 ' 001 ••Bt You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1 87 or 1.800.332 4.
f 7 // I /
Issued y: ` Permittee Signature: \ A vk,
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 App1i FOR OFFICE USE ONLY
EIVEh FOR
Q
City of Tigard Date/By: 9 / /cCj�,.0 Permit 4.64 6,5-00 8/D
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review ��w
: • Phone: 503.718.2439 Fax: 50 196 Date/By: Related Permit#: Jr/�C �l�
P ® 2015 y: .aevs-
T I G A R D Inspection Line: 503.639.4175 Ready Date/By: Juris El See Page 2 for
Notified/Method: Supplemental Information
Internet: www.tigard-or.gov`.1T,/OF TI^t�nD
❑ ❑ Mt 1 7 1r(I�11 ilanx,. PLAN REVIEW
New construction AA 1� /�t�t �tS/rl; l�letTtent Please check all that apply(submit 2 sets of plans w/items checked):
❑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.
❑ I-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building less to ground or exceeds 14,000 ❑Commercial-use agricultural
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
Job#: i Job site address: 13-3 --3 s`•` l _�'� \J �! ❑Addition o of new motor load of system.
V yv/ 1(/ t t�,� 100HP or more. ❑••A„ ••E„ ••1-2" ••1_3",
ty xCa, 1_k R"1 )" A ❑Six or more residential units. o�ueancy.
City/State/ZIP: u/l/ 1 d "' ^ l ❑Health care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: ' O Project name:''f 0 19 r)f♦/! - ❑Hazardous locations. ❑Supply voltage for more than
` t,,/� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: Cali) 1�Vy�`fJ �Y��� - 'tritaMILI
Description Qty. Each Total •
New residential single-or multi-family dwelling unit.
Subdivision: ' Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00
\O, r, I V ` I n /1 , a n,n k 7I - (with above sq.ft.)
V v l 1 Illy lYX �'VV ` \ V Limited energy,multi-family
residential(with above sq.ft.) 75'00 2
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps _ 125.08 2
Owner signature: _ Date: 401 amps to 599 amps 168.54 2
❑ CONTACT PERSON
Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT
, - - A.Fee for branch circuits with
r
Business name: U A V above service or feeder fee, 7 42 2
each branch circuit
Contact name: At 1,144 9 t !..iii: B.Fee for branch circuits without
Address: S, 't 1J'V - Vy service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: 11 w VA�` "k; 7' Each add'!branch circuit 7.42 2
Phone:(--13) U ,--3.- 1,i 4 Fax:: (.46-1_ f_— Each manufactured(service u feeder not included)
r 4 ` R (�� ) l0 Each manufactured or modular 67.84 2
Email: 01 I l '� V`V 0.-e�Y1t,0v- . , Lo1/V� dwelling,service and/or feeder
Reconnect only 67.84 2
,: : f zk
` 3 ._._ .-� _ ,�,„ � _:. Pump or irrigation circle 67.84 2
Business name: , r /Iv L/ Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ,.,( Page 2 2
Address: panel,alteration,l or spe coon �i g
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90 00/hr
CCB Lic.: SI" O I Electrical Lim b_S,I Suprv.Lic.:3-1C.(, specifically listed(�2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: N.A. VAA.;1 /(' ' Subtotal:
Print name: 1 iOA/Kt ( Date: CO ❑Plan Review Required(25%of permit fee):
/ State surcharge(12%of permit fee): _
Authorized signature:
r TOTAL PERMIT FEE:lir� This permit application expires if a permit is not obtained within 180
Print name:_' 1 I�,I !L Date: t hit days after it has been accepted as complete.
Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description 1 Qty. 1 Each 1 Total
Fee for all residential systems combined: 575.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01to15kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
1 Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is
66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: 575.00 « Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
❑ Instrumentation
n Intercom and Paging Systems
Landscape Irrigation Control*
❑ Medical
U Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: l
*No licenses are required. Licenses are required for all
other installations
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