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Permit (216) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 91 COMMUNITY DEVELOPMENT Permit#: ELR2016-00270 T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/01/2016 Parcel: 1 S126DC03300 Jurisdiction: Tigard Site address: 9900 SW GREENBURG RD 110 Project: Server Logic Subdivision: LEHMANN ACRE TRACT Lot: 4-5 Project Description: Low voltage for HVAC Contractor: HUNTER DAVISSON INC Owner: ATHERTON REALTY PARTNERSHIP 1800 SE PERSHING ST 2100 S WOLF PORTLAND, OR 97202 DES PLAINES, IL 60018 PHONE: 503-542-3628 PHONE: FAX: 503-542-3654 FEES Description Date Amount Specifics: Restricted Energy Permit 12/01/2016 $75.00 12%State Surcharge-Electrical 12/01/2016 $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 $84.00 Other Desc: Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in a < •- ith approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. AT NTION: Orego law r-euires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001 •010 through OAR 95 01 -00*.. 'ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232 1987 or 1.800.33.. 44. Issu•d By: ` � k Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application g FOR OFFICE USE ONLY 001111:City of Tigard k�_$ r , r, ' Received / DateBy: /a / / 1p k / Permit No.: exi�16 i�a?0 p 13125 SW Hall Blvd.,Tigard,OR 97223 • I ,t Plan Review Phone: 503.718.2439 Fax: 503.x.`(1960 2016 lig Date/By: Other Permit:fa 3 Ti G A R D Inspection Line: 503.639.4175 Date Ready/By: runs: rii See Page 2 for Internet: www.tigard-or.govr, Z Notified/Method: 1e' ' f (,„d <s` Supplemental Information r , rge • I''' '''..;(';;:',;:—.,:-.::::-;..4.44:4 xa-'.PLor:33EYIEW. o New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below): ❑Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building over three stories. 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 Com El1-and 2-family dwelling J Commercial/industrial ❑Accessory building amps for all other installations. ❑buildings.ial-use agricultural ❑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 0"A","E", Job no.: 63 5 Job site address: 7 fro /S IOOHP or more. occupancy. � lV✓ G. t✓eN�� "CI 0 Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: /,e,,,k r Q a ' 7 /742423 ❑Health-care facilities. 0 Supply voltage for more than / ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.:S ifs 110 Project name: I . ' ❑Service or feeder 600 amps or more. - ra'c�a1111111 eFEE SCHEDULE Cross street/directions to job site: �sc.t'z-0 t2 1.-.005tC. 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 Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1 Limited energy,residential 75.00 2 DESCRIPTION OF WORK (with above sq.ft.) Limited energy,multi-family Q New c t.1V rr>L S" f r //etA1 VA f1C,.D residential(with above sq.ft.) 75.00 2 �� i Renewable Ener 0 See Pa 1 e 2 !n� Iii y ,, t off/ ,i ' �1„:. Services or feeders installation,alteration,and/or relocation PROPERTY OWNER 0 TENANT 200 amps or less 100.70 2 p201 amps to 400 amps 133.56 2 Name:C& ) /E ea 4 �(/c/ cc,Ns-tn G a� c4 !Q N 401 amps to 600 amps 200.34 2 Address: /7,0 y70 SE' J,'••f,PAA-. 4 Ai ci( (449,..e r-y�J e j/S 601 amps to 1,000 amps 301.04 2 City/State/ZIP: x'' le c �J`t /p Over 1,000 amps or volts 552.26 2 !M�� c;p` Temporary services or feeders installation,alteration,and/or Phone:(5'63) 3„yt"r_ 7007 I 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, I er panel C8 APPLICANT I 0'CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 2 Business name:'t,(N-f,I' J70 ;,-,s-o N �rrc each branch circuit / / B.Fee for branch circuits without Contact name: -j--;Li-i., elf OyN'ct ,/r`- service or feeder fee,first 56.18 2 branch circuit Address: /o'Cy 0 ,5-z-- �.yx, ' P f' Each add'l branch circuit 7,42 2 City/State/ZIP: v rfi1r 7 7° Miscellaneous(service or feeder not included �� i ®� Each manufactured or modular 67.84 2 Phone:(503) 79 3 7) -c I Fax::( ) dwelling,service and/or feeder Reconnect only 67.84 2 E-mail: i c e j r z,yiV t 1 ,� 0.41/"R..0 4)1(//�Sed N r Gc. �/1 Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: ..5-aMe %c-4)j� Signal circuit(s)or limited-energy See _� panel,alteration,or extension. Pa_e 2 7s' 2 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:( ) I Fax:( ) Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: /Er/e 1 Electrical Lie.:'a(p--e,oW_e Suprv.Lic.: f7i 3 L .; specifically listed(%z hr min) Suprv.Electrician signature,require tom'- ill ''ELECTRICAL'PERMIT FEES _----d..4.. =—.....--41. Subtotal: '7S Print name: r- _ til .c: .1_ Date: 1/ q_j� Plan review(25%of permit fee): State surcharge(12%of permit fee): d© Authorized signature: TOTAL PERMIT FEE: ,C� Print name: q j This permit application expires if a permit is not obtained within 180 J Sn �� �+�/N f� - Date: `j y . /� days after it has been accepted as complete. c� • Number of inspections allowed per permit. I:\Building\Permits\ELC PemitApp ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB