Permit (67) 1111,,
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2018-00075
13125 SW Hall Blvd.,Ti Date Issued: 05/29/2018
Tt .�i?. and OR 97223 503.718.2439 9
Parcel: 1 S 136DA00100
Jurisdiction: Tigard
Site address: 11308 SW 68TH PKWY
Project: Comcast Subdivision: None Lot: None
Project Description: HVAC system.
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 05/29/2018 $75.00
12%State Surcharge-Electrical 05/29/2018
Type of Use: COM g $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:
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 f. • -s adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may o.ain a copy of the les or direct questions to OUNC by calling 503. .1987 1.800.332.2344.
Issued By:i 1 _ _-rmittee 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 FOR OFFICE USE ONLY'
CEI "VE Received `
City of Tigard
DateB : :fl� Permit#: 1 iii S
. " 13125 SW Hall Blvd.,Tigard,OR 97223 ���
`� Plan Reviet-- -_1 t Related Permit#:
Phone: 503.718.2439 Fax: 503.598.1960 ``AA Date/B : ,.
T I GA RD inspection Line: 503.639.4175 t‘AP‘.‘( Ready Date/By: H See Page t for
Internet: www.tigard-or.gov li TI `J Notified/Method: Supplemental Information
TYPE Of WOenrki A 4\J
❑ toSIO . , ' ` '; PLAN,REVIEW:
New construction F]Addition/alteratt / Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current ❑Marinas and boatyards.
'CATEGORY OF CONSTRUCTION'; rz:, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El 1-1-and 2-family dwelling . Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
El Multi-family 0 Master builder ❑Other: ❑Fireum .
p p ❑installation of 150 KVA or
JOB SITE INFORMATION.AND,LOCATION , ❑Emergency system. larger separately derived
Job#:/613707 JOb site address: .{/ ❑Addition of new motor load of system.
I /J'0 iTv/ /~Al`f(/tlely IOOHP or more. ❑•.A„ "E„ `•l-2„"1-3„
City/State/ZIP.�t p� / oe ?,a.2..? I ❑Six or more residential units. occupancy.
J f ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: MGai--L 7, G ❑Hazardous locations. ❑Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: SEE SCHEDULE.
Description '
1 Qty. I Each ITotal I R..:
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
;'DESCRIPTION;OF WOE , Limited energy,residential
/� (with above sq.ft.) 75.00 2
Lo UD Nu P �� G t" I�p d Limited energy,multi-family
v residential(with above sq.ft.) 75.00 2
Renewable Energy El See Page 2
"J..PROPERTY oWNFIt•. , I' ., ' p TENAServices or feeders installation,alteration,and/or relocation
NameANN•
eroN Cy�'T0..L Ad - LZ[ 200 amps or less 100.70 2
Address: 70? t"'r� Ti/2 /? a/ J 0 201 amps to 400 amps 133.56 2
�
---- - 401 amps to 600 amps 200.34 2
City/State/ZIP: , � N[I/ �
New or O��7 601 amps to 1,000 amps 301.04 2
Phone:(,2/2) 2S-3_9,er/02 Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
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
p At'PI,ICAIYM a., . .. , ... p Ct}1y1'ACTf PFRSC?i�,'
Branch circuits-new,alteration,or extension,per panel
// ` � A.Fee for branch circuits with
Business name: 4 j'-1 e r Ax v -0 N�2-N C,• above service or feeder fee, 7 42 2
� each branch circuit
Contact name: yaN /o B.Fee for branch circuits without
Address: Q ' service or feeder fee,first 56.18 2
�t�0 a S"c /'rS4�N 5 .Q' branch circuit
City/State/ZIP: /O r-/(4tNel de q rte 2o.,2.... Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(....cif) 54/02..._S‘,287Fax: : 67.84 2
( ) Each manufactured or modular
� � dwelling,service and/or feeder
Email:(Nio07 ., ot/t/�2.1'c40.troA1 , GO//‘ Reconnect only 67.84 2
CONTRACTOR - .. Pump or irrigation circle 67.84 2
Business name: S/�'1e k Ave, Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
panel,alteration,oT extension. '
Address: �ee Page 2 754✓2
City/State/ZIP: Each additional inspection over allowable in`any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.:/ /a Electrical Lit.:,241. ,-aC4(1 Suprv.Lic.:6o o ZEE specifically listed(%hr min) 90.00/hr
•i
,:ELECTRICAL PERMIT;FEES .
Suprv.Electrician signature,required: Subtotal:
Print name:—Ji./1., /4V,'.-ON 1 Date:.570 C/_./ep 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: ......_ ,i , TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: ^pyQ A ,- Date:,j d C-/e days after it has been accepted as complete.
• Number of it
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
Fee for all residential systems combined: $75.00 Description Qty. Each Total j
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is
specifically listed(%hr min) 90.00/hr
COMMERCIAL WORK ONLY: ELECTRICAL.PERMIT FEES.
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
O Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
O Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015