Permit (181) 114CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2016-00259
T(GA:R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/14!2016
Parcel: 2S112DA01300
Jurisdiction: Tigard
Site address: 6640 SW REDWOOD LN 300
Project: Portland Clinic Subdivision: 1996-048 PARTITION PLAT Lot: 1
Project Description: Low voltage for HVAC
Contractor: HUNTER DAVISSON INC Owner: PACIFIC REALTY ASSOCIATES
1800 SE PERSHING ST ATTN: N PIVEN
PORTLAND, OR 97202 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-542-3628 PHONE: 503-624-6300
FAX: 503-542-3654
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/14/2016 $75.00
Type of Use: COM 12%State Surcharge-Electrical 11/14/2016 $9.00
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 t g 952-001-0090.1-� 0 � You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332. 4.
Issued B •Cit-O124V-- ,Lr(L)
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.
Electrical Permit App
RECEIVE') FOR OFFICE USE ONLY
City of Tigard Received
City
g Date/By: Permit No.: 4 Lo/6-06 2 5 C�
' ', 13125 SW Hall Blvd.,Tigard.110 P7 24 1 2 016 ��Ali ��
g``11 Plan Review
Phone: 503.718.2439 Fax: 51 .59871960 960 DateBy: Other Permit: tiff a„ee7g�J
T 1 G A RD Inspection Line: 503.639 / ,q
g ;g Date Ready/By: Juris: 0 See Page 2 for 7
Internet: www.tigard-or.�,4 I r t Ik3<1 till Notified/Method: Supplemental Information
0 New construction X Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling IV Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND' LOCATION ❑Emergency system. larger separately derived system
0 Addition of new motor load of ❑"A","E","1-2","I-3",
Job no.: Job site address:. r/0 SW/ it)J01 4N� Six10or or more. occupancy.
� ❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: //7c d a, �' '�' 0 Health-care facilities. 0 Supply voltage for more than
1
U ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.. 300 Project name: O 'l,. d CL.i/ 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: _. Description I Qty. I Fee. I Total
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'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.RJ 75.00 2
' f Limited energy,multi-family 75.00 2
0e Ct, „... e zoo �/_;t Ala�' ,rkil jc residential(with above sq.ft.)
v Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
PROPERTY OWNER 0 TENANT 200 amps or less 100.70 2
Name: , n / -r 201 amps to 400 amps 133.56 2
�� Q.1 v6 t V� E+ ��" 401 amps to 600 amps 200.34 2
Address: /2�3�,� "/W ,4ie.,100
601 amps to 1,000 amps 301.04 2
ty i,,si6ap / O,e
,–.1–, 3 Overm ora y r volts 552.26
lte 2
City/State/ZIP: (;/ / / Temporary services or feeders installation,alteration,and/or
Phone:(5-o2) ? 7C f/ 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, s er panel
[:41 APPLICANT ❑ CONTACT PERSON A. an
aboveFeefor servicebrch or feedercircuits feewith,
Business name: iiiit,I+€r.. 'Ss0� _Loc., each branch circuit 7.42 2
y" / B.Fee for branch circuits without
Contact name: 2„A-- l r service or feeder fee,first 56.18 2
/ . f/ branch circuit
Address:/ �tJ ,527-
. �a► Each add'l branch circuit 7.42 2
City/State/ZIP:, -1(,rt/J�/ c ? 2,..-,
Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(563') �- ( ) dwelling,service and/or feeder
i J ./� . Fax:
1 /� Reconnect only 67.84 2
E-mail:2 7N C At,t4 7 f'C�t v/.Wo.")t Coil" Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: AA f�,��/,��jp�J — _I� * Signal circuit(s)or limited-energy / See
I /" panel,alteration,or extension. / Page 2 2
Address: /6K-.),t,„ nZ.S',,,Jc � Each additional inspection over allowable in any of the above
/�ur-'? Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:�jri�dJ ,/� VVVV _ Investigation(1 hr min) 66.25/hr
Phone:(50) 77. //IC Fax:( ) Industrial plant(1 hr min) 78.18/hr
CCB Lic.: / Electrical Lic.: Suprv.Lic.: r Inspections for which no fee is
16 p W 7 t 3 j�I;;j3 specifically listed(1/2 hr min) 90.00/hr
Suprv.Electrician signature,require 'E�LECTRICAI., P-ERMI't FEES
'9C:
.__..- ✓�` Subtotal: -z J�oO
Print name:- _ Date: Plan review(25%of permit fee): �'
�?' 5.,.._ttr State surcharge(12%of permit fee): 9,Gc)
Authorized signature: / -",//� TOTAL PERMIT FEE: 60
"""� ° This permit application expires if a permit is not obtained within 180
,t T�,/ /
Print name: l e. Date:f/' /G' / 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 440-4615T(11/05/COM/WEB