Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
r 71 .,, COMMUNITY DEVELOPMENT Permit#: ELR2017-00194
-Ft GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2017
Parcel: 1 S 136 DA00100
Jurisdiction: Tigard
Site address: 11308 SW 68TH PKWY
Project: Comcast Subdivision: None Lot: None
Project Description: HVAC controls
Contractor: HUNTER DAVISSON INC Owner: BENENSON 68TH PARKWAY KEY LLC, T
1800 SE PERSHING ST 708 3RD AVE, 28TH FLOOR
PORTLAND, OR 97202 NEW YORK, NY 10017
PHONE: 503-542-3628 PHONE:
FAX: 503-542-3654
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/09/2017 $75.00
12%State Surcharge-Electrical 10/09/2017 $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-'01-009 . You may o tain a copy of the rules or direct questions to OUNC by calling 503.23 .1987 or 1.800..2344.
Issued By: '` , i Permittee Signature: �- tlJ
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 603.639.4175 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.
IEDElectrical Permit ApplicatioiB CEi FOR OFFICE USE ONLY
- City of Tigard AUG 2 9 2017 Received e/.7,447 � �` ! -7 /
II DateBy: f�5 TV ermit No Lie�0// dey5/
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 501598. / DateBy: Other Permit:
Inspection Line: 503.639.4175 "'' ' � See Page 2 for
CIGAR D p ateReadyBy: / / ,Saris: Ei
Internet: www.tigard-or.gov BUILDING DIV SI ) tified/Method: , (3//7 ,. Supplemental Information
TYPE OF WORK 4
PLAN REVIEW
❑New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more 0 Building over three stories.
El 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
El 1-and 2-family dwelling pai Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump. ❑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","1-3",
Job no./2242 Job site address://30E' Sp b' 7 o .,,,JcSix or100Hr more. occupancy.
J 0Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:-; d 0,e t7?�Ja} 0 Health-care facilities. 0 Supply voltage for more than
OG S 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.. Project name:CASLOM ,a4T' r NI 0 Service or feeder 600 amps or more.
CZN r
Cross street/directions to job site:
tope r eN FEE SCHEDULE
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
DESCRIPTIONOF WORK (with above sq.ft.) 75.00 2
/66 /1 Limited energy,multi-family 75.00 2
0 LA) /0 701y,o /701 C Cont OLS' residential(with above sq.ft.)
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
201 amps to 400 amps 133.56 2
Name:
&I.1/4)e NSD N Ca/ot' ct( 401 amps to 600 amps 200.34 2
Address:7o ' ' 'r I AJC '7 q' Floc
r' 601 amps to 1,000 amps 301.04 2
p� Over 1,000 amps or volts 552.26 2
City/State/ZIP:/ ,u/ Kr Ari/ /G0/2 Temporary services or feeders installation,alteration,and/or
Phone:(ala)7/j'6- quo 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
` j APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
ii p above service or feeder fee,
7.42 2
Business name:H''„rd`e r,�Otv:sso/,, _/Jc' each branch circuit
y d B.Fee for branch circuits without
Contact name: 6Ack4 pa 4e, service or feeder fee,first 56.18 2
/� V branch circuit
Address: F ro u S-E- , 49 S
Nk3J l ��b Each add'l branch circuit 7.42 2
City/State/ZIP:A f` iA� ® r1 Miscellaneous(service or feeder not included)
l off, Each manufactured or modular
p'�' p 7,2 3 Fax::( )
dwelling,service and/or feeder 67.84 2
Phone:(�03 ) � !
/ 1 Reconnect only 67.84 2
E-mail: C r�b Q..@ cm,-�'er I//SSo,4 • Cf2 n,-� Pump or irrigation circle 67.84 2
l CONTRACTOR Sign or outline lighting 67.84 2
Business name: Signal circuit(s)or limited-energy / See
panel,alteration,or extension. Page 2 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:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr
/
` •
Inspections for which no fee is
CCB Lie.: ,/ Electrical Lic.:a6` 'J',2 Cl.ESuprv.Lie.: 47,13 L (3 specifically listed(%z hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ,a,
Subtotal: -7�,
cia
Print name:--7—_ `I? ,c--:` S4 Date: �9..117 Plan review(25%of permit fee):
State surcharge(12%of permit fee): P,CT&
Authorized signature: a
? TOTAL PERMIT FEE: C1 y
This permit application expires if a permit is not obtained within '.
Print name: �'t Date: j /
G �- w � �� ' � days after it has been accepted as complete. i,`'.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp ELR ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB