Permit (95) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
,1111
I COMMUNITY DEVELOPMENT Permit#: ELR2018-00036
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/07/2018
T t t;;+ R.D9 Parcel: 2S101AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE 200
Project: Dr.Steven Gabel MD PC Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Install limited energy circuit for HVAC for TI.
Contractor: ARJAE SHEET METAL CO, INC. Owner: TIGARD TRIANGLE PARTNERS LLC
8545 SE MCLOUGHLIN BLVD. 18187 SIERA DR
PORTLAND, OR 97222 LAKE OSWEGO, OR 97034
PHONE: 503-231-7717 PHONE:
FAX: 503-230-4888
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/07/2018 $75.00
12%State Surcharge-Electrical 03/07/2018 $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 $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-00 ''90 Yo,Ray obtai a cop the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4(�.,/ ��\'1AN16../.c. Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicati i , V1.4' y.
, / holt OFFICECSE 011.1
City of Tigard °
Received
• 13125 SW Hall Blvd.,Tigard,OR 9723 DateB : i It 0 Permit#: 0 a �bo ?�
= Phone: 503.718.2439 Fax: 503.598.1960 1,1
Plan Review J
Inspection Line: 503.639.4175 Date/B : Related Permit#13/1//,‘„ �
I1GARD Ready �
N Date/By:www.tigard-or.gov ( p ,i' 1 r'1 irt.,fir- Notified/Method: J�,s. See Page 2 for
�r�$ j 4rt,_ Supplemental Information
TYPE UITMWG 1Vis N, PLAN REVIEW
New construction i x Y r_ a
❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION
❑ 1-and 2-family dwelling Commercial/industrialexceeds ground,10,00oraexceeds
et s1 14,000 volts or
❑Floating buildings.
0 Accessory buildingless to exceeds
❑Commercial-use agricultural
❑Multi-family ❑Master builder ❑Other: amps for all other installations. buildings.
JOB SITE INFORMATION AND LOCATION 0 Fire pump. ❑larger
separately 150 KVA or
❑Emergency system. larger derived
Job#: I Job site address:/Z 1 i ro14/ .i 0 7-m ^V ❑Addition of new motor load of system.
/ /`�- C 100HP or more. ❑`A» `E» <1.2» l_3„
City/State/ZIP: 77C4A.0 ('F4 �'.N7 . 9 3 0 Six or more residential units. occupancy.
Suite/bldg./apt.#: �J ` t 1 ❑Health-care facilities. ❑Recreational vehicle parks.
,,Z6 I Project name: Ot - G Ce- ❑Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: ❑Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description 1 Qty. I Each I Total
Subdivision: New residential single-or multi-family dwelling unit.
I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea.add'l 500 sq.ft.or portion 33.92
i/�` ,� '/ Limited energy,residential 1
V y �� L ma. 61 yac (with above sq.ft.) 75.00 2
�1 Limd er )(lulultmily
resiitedentialnegabovei-fasq.ft.) 75.00 2
0PROPERTY OWNER I 0 TENANT Renewable Energy ❑ See Page 2
Name: Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:
( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
Owner installation:This installation is beingmade onpropertysrelocation
intended for sale,lease,rent,or exchange,according to ORS 7,449,670,and 701.not 2001 amps toor less 59.36
1
201 amps to 400 amps i I 125.08 1 2
Owner signature: Date: 401 amps to 599 amps 168.54
(.APPLICANT 2
/f � �,... I ❑ CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
Business name: R'`�r+-l` f � Pk
`. A.Fee for branch circuits with
TIS�` a' /'�t7 �` above service or feeder fee,
Contact name: )(0`r✓ k`J ,0 cm each branch circuit 7.42 2
Address: (�L65—
� r•`� B.Fee for branch circuits without
J L riC.LQ V 6.41_1"/ /8C�D branch it feederitfee,first
S� branch circuit 56.18 2
City/State/ZIP: hL Ct I LI�t 6• (y2 Q' 21- Z Each add'l branch circuit
7.42 2
Phone:(sx0) f S I Fes::( ) Miscellaneous(service or feeder not included)
( Each manufactured or modular
Email: 14-e-A-t/rl�4. ^FtC` Q_ci
Reconnect only 67.84 2
dwelling,service and/or feeder 67.84 2
CONTRACTOR
Business name:
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
panel,alteration,or extension. See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Phone:( ) Additional inspection(1 hr min) 66.25/hr
I Fax:( ) Investigation(1 hr min)
90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
3p I Electrical Lic.: I Suprv.Lic.: ?...(4.r C specifically listed(%hr min) 90.00/hr
CCB Lic.: rj
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Print name: `C q/ al Subtotal:
t V✓4(L Date: 7 ,1' C 0 Plan Review Required(25%of permit fee):
VState surcharge(12%of permit fee):
:/
Authorized signature
TOTAL PERMIT FEE:
Print name: IC CI-A/ 1(Cto, I This permit application expires if a permit is not obtained within 180
. thv/L 1. I Date: `3 ) , ` 41 days after it has been accepted as complete.
I:\Building\Permi[s\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015 * Number of inspections allowed per permit.
440-4615 T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL ��} FFEE SCHEDULE x
RESIDENTIAL WORD ONLY: Description H Q1 Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 100.70 2
5 kva or less
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
0
15.01 to 25 kva 200.34 2
Audio and Stereo Systems*
Wind generation systems in excess of 25 kva:
Burglar Alarm
25.01 to 50 kva 301.04 2
❑
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
>100 kva-no additional charge 0.0 3
❑ Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
❑ Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr min)
ELE RI AI 'PEIZ IIT FEES
COMEt RCIAL WORK ONLY x Subtotal(Enteron Page 1):
Fee for each commercial system: $75.00 * 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
j -HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: t
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015