Permit (55) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2018-00022
13125 SW Hall Blvd.,Ti Date Issued: 02/12/2018
T ta1R.L and OR 97223 503.718.2439 9
Parcel: 1 S135BD01300
Jurisdiction: Tigard
Site address: 10830 SW GREENBURG RD
Project: Washington Square Hotel Subdivision: MEADOW VIEW Lot: 8
Project Description: Audio and stereo system,data telecommunications,cable Television,and CCTV systems for lobby,manager's
office,and throughout hotel.
Contractor: HECKTEC TECHNICAL LLC Owner: SCHAEFER, ROBERT M&SALLY J&
3484 HILLSIDE CT MILLER, GERALD V
HUBBARD, OR 97032 BY SHILO INN-WASHINGTON SQUARE
11600 SW SHILO LN
PORTLAND, OR 97225
PHONE: 503-572-1938 PHONE:
FAX: 503-982-4823
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 02/12/2018 $300.00
Type of Use: COM 12%State Surcharge-Electrical 02/12/2018 $36.00
Class of Work: ALT
Total Number of Systems: 4
Audio&Stereo: 1 Boiler Controls: 0
CCTV: 1 Clock Systems: 0
Data&Telecommunications: 1 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: 1 Total $336.00
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 II 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 issuan , or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio enter. Tho•e rul- 'e set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5 .232 or .i30'.3 . 4.
Issued By: . �_ $ ri
",
f Permittee Signature: �►�,
.,
OWNER -4--
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 FoR oii icl: I si:OyLI
City Tigard2 E ,,E }�E Received 17filjriniMeill
III
- of ry � a Date/B : � _
IMINA
• 13125 SW Hall Blvd.,Tigard,OR 97 -`"' Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: : le,t 5%.`• i
Inspection Line: 503.639.4175 2018
)) pp Ready Date/By: Juris: H See Page 2 for
I I G A RD Internet: www.tigard-or.gov 2 L C� L1 Notified/Method: i(, Supplemental Information
TYPE OF vo
AIFYOF TIGARD PLAN REVIEW
❑New construction :i 'ddition/a*ritunbulviSIO. Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition • Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-familyMaster builderOther: amps for all other installations. buildings.
❑ 0 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Job#: Job site address: /J� Q'� ) (�r'I i ❑Addition of new motor load of system.
l 0 U G St) C-�f-s2e hl�/rc 100HP or more. ❑`<A„ `E» `I.2„«1.3„
City/State/ZIP: ��r iii✓✓✓` ` ❑Six or more residential units. occupancy.
1 L,c t ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: ( Project name: (6- c lv 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 6 fk T- r J a C e_ FEE SCHEDULE
I/ ).2 V Description I Qty. I Each Total
-c.C'`A}\1 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK = Limited energy,residential
�� / (1 r' _ l / l' \I (with above sq.ft.) 75.00 2
)i 1 I I e i"1 YV e w C k.. J^r �`, 6 1 I lic04. — Limited energy,multi-family
�/ �I residential(with above sq.ft.) 75.00 2
''�L ���V ' Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 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 59.36 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
0 APP ICANT ❑ CONTACT PERSON Branch circuits-new,alteration,or extension, .er panel
A.Fee for branch circuits with
Business name: /-/çY-t- 'c \ �C�,�ick_r above service or feeder fee, 7 42 2
Contact name: each branch circuit
Qv.t I..\ ii:,e C B.Fee for branch circuits without
Address: S ��l 'LA ��C Sri service or feeder fee,first 56.18 2
7 v branch circuit
City/State/ZIP: �1'' G Y(---
- Each add'I branch circuit 7.42 2
�iMiscellaneous(service or feeder not included)
Phone:( j ) t7 7'Z 1 Q 2_7 Fax: :( ) Each manufactured or modular
67.84 2
/,� dwelling,service and/or feeder
Email: AQ_c_K- 11 e_, ill SIA , Cow- Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: eC>J. e , ) <c - i, Sign or outline lighting 67.84 2
,
^, Signal circuit(s)or limited-energye?✓
�, pj
Address: -W-(2... panel,alteration,or extension. Y�(See Page 2 ,�Gl� 2
City/State/ZIP: l_rr��, Each additional inspection over allowable in any of the above
t1 fe,..4
fiA� 7 2(-[w-4� Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
/�/ Industrial plant(1 hr min) 78.18/hr
Email: id/ Inspections for which no fee is
CCB Lie./(,,Z 5 t
Electrical Lic.:er ((,p.. Suprv.Lic.:a f Li specifically listed(I(/ '%hr min) 90.00/hr
' ELECTRICAL PERMIT FEES
Suprv.Electricia sii4, equired:
A.r- Subtotal: ; .
Print name: 4,t N t ,i2.K Date: ' i 2 ZC� 0 Plan Review Required(25%of permit fee): r
State surcharge(12%of permit fee): .46,c?—
t L.-
Authorized signature: TOTAL PERMIT FEE: ;3 7 ip,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE -1 '
Description I Qty. I Each I
Total
Fee for all residential systems comb'1 ed: $75.00 Renewable electrical energy systems:
Che , Ty s • of Work Involved 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
A b I io .nd St- - j 15.01 to 25 kva 200.34 2
_ Wind generation systems in excess of 25 kva:
Burglar � 25.01 to 50 kva 301.04 2
� 50.01 to 100 kva 552.26 2
Poi�r . r*
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heat'•:,Ve . ,on Air 1 and ioning Solar generation systems in excess of 25 kva:
S em* A,
r
Each additional kva over 25 7.42 3
Vacuimi Syst'ms >100 kva-no additional charge 0.0 3
r Each additional inspection over allowable in any of the above:
k TV a./ \(.. Each additional inspection is 66.25/hr 1
Other: CC., charged at an hourly(1 hr min)
Inspections for which no fee is
specifically listed('h hr min) 90.00/hr
ELECETCAL; P RMIT r a, FEES
COMMERCIAL WORK ONLY: . � ; :. � .
Subtotal Enteron Page 1):
Fee for each commercial system: $75.00
3r * 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
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
1:8. C4 1 CCTV
Total number of commercial systems: 7
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELCPennitApp_ELR_ERE.dor Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10830 SW GREENBURG RD, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2018-00022
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor