Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II- g COMMUNITY DEVELOPMENT Permit#: ELR2016 00037
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/29/2016
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 440
Project: Spec Space Subdivision: VARNS ACRES Lot: 9
Project Description: HVAC system. �`
000
ii0
Contractor: AMERICAN HEATING INC Owner: GK TRIANGLE CORPORATE PARK III L
5035 SE 24TH AVE ATTN KBS REALTY ADVISORS
PORTLAND, OR 97202-4765 P 0 BOX 28270
SANTA ANA, CA 92709
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 02/29/2016 $75.00
12%State Surcharge-Electrical 02/29/2016 $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: 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 •• of 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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2016-00037
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/29/2016
Parcel: 2S 101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 440
Project: Spec Space Subdivision: VARNS ACRES Lot: 9
Project Description: HVAC system.
Contractor: AMERICAN HEATING INC Owner: GK TRIANGLE CORPORATE PARK III L
5035 SE 24TH AVE ATTN KBS REALTY ADVISORS
PORTLAND, OR 97202-4765 P O BOX 28270
SANTA ANA, CA 92709
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/29/2016 $75.00
Type of Use: 12%State Surcharge-Electrical 02/29/2016 $9.00
Class of Work:
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCN: 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 s a 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 th irect estions to OUNC by calling 503.232.1987 or . 00.332.2344.
c�
Issued By: Permittee Signature:
NER 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 ApplicationFOR OFFICE LSE ONLN'
V, I
co Received
City of Tigard Date/By-
Permit No.:
13125 SW Hall Blvd.,Tigard,OR OPlan Review
Phone: 503.718.2439 Fax: 503.5 8.1960 T % Date/By: Other Permit:
Juns
Inspection Line: 503.639.4175 ate Ready/By: r �� Of�Se-e Page 2 for
.i1 X S 1.. ,1
-or.gov otified/Method: Supplemental Information
Internet: www.tigard _�U o, pp
_!
grU PLAN REVIEW
"a OF
Please check all that apply(submit 2 sets of plans whtems checked below):
El New construction Addition/alterati t ent -
El Demolition C]
Other: Service or feeder 400 amps or more [I Building over three stories.
where the available fault current [I Marinas and boatyards.
exceeds 10,000 amps at 150 volts or []Floating buildings.
WIWI,
CNS, R less to ground,or exceeds 14,000 0 Commercial-use agricultural
El 1-and 2-family dwelling Z Commercial/industrial ❑Accessory building amps for all other installations. buildings.
El Multi-family El Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
4613'SITE,INFORMATION AN16j()CA7I
El Emergency system. larger separately derived system.
d N
D Addition of new motor load of [3 "I-Y,
Job no.:516071 Job site address: 13221 SW 68th Parkway I OOHP or more. occupancy.
I D Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 D Health-care facilities. ❑Supply voltage for more than
D Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:440/450 Project name:Suite 440-450 @ TCP III D Service I or feeder 600 amps or more.
Cross street/directions to job site: Description -Qty. Fm. Total f -
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
75.00 2
DESGRII'TION,OF•
with above sq.ft.)
Limited energy,multi-family 75(WO 2
low volt wiring and T-stats residential with above sq.ft.)
Renewable Energy 0 St.Page 2
Services or feeders installation,alteration,and/or relocation
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 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 ore tension,per panel
A.Fee for branch circuits with
g,' -
v above service or feeder fee,
�:!lt 60*Cr PERSON
Business name:American Heating Inc. each branch circuit 7.42 2
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 1 7.42 2
Miscellaneous(service or feedernot included
City/State/ZIP:Portland,OR.,97202 Each manufactured or modular 67.84 2
Phone:(503)2394600 FFa;: :(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
'Q
Qn
'm Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)or limited-energy 1 See
panel,alteration,or extension. Page 2 _ 7 J . 2
Address:Brandon Hutchinson Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP:Portland,OR.,97202 Investigation(I hr min) 66.25/hr
Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr
I Inspections for which no fee is 90.00/hr
CCB Lic.: 33135 Electrical Lic.: 26993CREhr min
Eny (V� )
S,prv.Lic.: 2640LEB scificalllisted
A
Suprv.Electrician signature,required:
Subtotal:
Plan review(25%of permit fee):
Print name: T Steve Young Date: ;t',),6 State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: Brandon Hutchinson Date: This permit application expires if Permit'quint obt fined within 180
A days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.dm Rev 05/21/2013 4404615T(I 1/05/COWWEB
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
13221 SW 68TH PKWY 440, TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00037
Jeff Grove
Violation Summary:
Inspector Contractor