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Permit (36) .�-, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ' a1 COMMUNITY DEVELOPMENT Permit#: ELR2018-00080 T I t;A R3 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/04/2018 Parcel: 1 S135DD01000 Site address: 11760 SW HALL BLVD Jurisdiction: Tigard Project: Wells Fargo Bank Subdivision: Project Description: (2)Low voltage for HVAC controls. None Lot: None Contractor: HUNTER DAVISSON INC Owner: WELLS FARGO BANK NA 1800 SE PERSHING ST BY DELOITTE TAX LLP PORTLAND, OR 97202 PO BOX 2609 CARLSBAD, CA 92018 PHONE: 503-542-3628 PHONE: FAX: 503-542-3654 FEES Description Date Amount Specifics: Restricted Energy Permit 06/04/2018 $150.00 Type of Use: COM 12%State Surcharge-Electrical 06/04/2018 $18.00 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 Other Desc: Total $168.00 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 OA 2- 1- . Y u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: 6,,-�Q i By: ,/ t 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 RECEIVE FOR OFFICE USE ONLY . City of Tigard Datee/Bed 2YA� ".*7., ' rmitEZ. c.2ilt7 --06seJ e) iiPli 13125 SW Hall Blvd.,Tigard,OR 97223 3 r.I y MAY 2 3 r i„1 /t PDate/B view Related Pennylli' e2e1/ Phone: 503.718.2439 Fax: 503.598.1960 y �' Ff'"1e.3d TIGARD inspection Line: 503.639.4175 r t p- r�� p Ready Date/By: / loris: El See Page2 for Internet www.tigard-or.gov cin(I TIGARD Not d/Method: // (//) Al Supplemental information I c i t® ' . Oft Of w., l” ai „ A,N,tt ivIEW ❑New construction i Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more ❑Building over three stories. 0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEG,ORY OF';Co1 s'11twc'floN, exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling N Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: pump. Installation of 1 0 KVA or Fire m 0 t 5 z ,,.. ; ', JOB silt IN#ORmArtoN AND',,-LOCATION ; '• 'i ❑Emergency system. larger separately derived Job#: / o'i? Job site address: //7 6-p S`�/ ,/ revel ❑l oce oo of ore.motor load of "Atem. I �// p `1/!.f 100HP or more. 0"A","E","1-2","1-3", City/State/ZIP: GlT �� �� 0 Six or more residential units. occupancy. We -` ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: I Project name: W e1/(S �r� o 80,A,4 0 Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE,SCHEDIJI.E Description I Qty. 1 Each I Total 1 ' 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'l 500 sq.ft.or portion 33.92 1 DESCRIPTION'O'WOE- ''�' . _ Limited energy,residential // (with above sq.ft.) 75.00 2 Lol„a Vottc Je, fiwyC CoN'tro`,S Limited energy,multi-family �/ residential(with above sq.ft.) 75.00 2 Renewable Energy 0 See Page 2 0.PROPERTY OBER , " -`1, ."'' "d; TENA1 - Services or feeders installation,alteration,and/or relocation Name: (Ate,(1s= t7 �a,k 200 amps or less 100.70 2 Address: /3v p 5 ' S A 201 amps to 400 amps 133.56 2 �' �'r 4 �'r _40.1 ants to 600 ams 200.34 2 City/State/ZIP: Pof/LccN OR Q iabi 601 amps to 1,000 amps 301.04 P 2 Phone:(S03) Sot— /2 o91 Fax:( ) Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation,alteration,and/or Email:NicaLe,,. w,t�ie1--�(e1/YFeArof o , Gv,(A relocation Owner installation:This installation is being matte 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 '' ,:i,,,,,,,, Branch circuits—new,alteration,or extension,per panel � ��/ �� "' ` ""' ' � CC1N"�AC'C;=PEt�S(�(?t �� A.Fee for branch circuits with Business name:r1lgNfer... atVi.l"SvN 1Nc_• above service or feeder fee, 7 42 2 / / each branch circuit Contact name: �afQ ,_, wrtgh B.Fee for branch circuits without Address: `/Y Q service or feeder fee,first /c6 0 s' /�.r /iJq iii, branch circuit 56.18 2 City/State/ZIP:,,r f d , c,, ' ' 7�a 0,a, Each add'I branch circuit 7.42 2 / Miscellaneous(service or feeder not included) Phone:(col ) t(56-..Ctp, Fax: :( ) Each manufactured or modular L67.84 2 Erna":!� �-tt % / dwelling,service and/or feeder E W - hKN*r O(0.V/,ycro/) C o/kA Reconnect only 67.84 2 ` CQNI' AC., - // . _ Pump or irrigation circle 67.84 2 Business name: Ste^e '9j Iooe, Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address:_ panel,alteration,or extension. 0 See Page 2 2 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 clficall 90.00/hr CCB Lic.: �/2 Electrical Lii :076,, acs Suprv.Lic.:6°p ZEE s p ey h steel(/z hr min) Suprv.Electrician signature,required: -.-',--,t. ELECT ICA:I.,PERMIT,FEES �. ._ Subtotal: l.Scr , 6''_ Print name:`J,`, ntvi SSON 44 Date:..57.-/V/i 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): le, I Authorized signature: N. TOTAL PERMIT FEE: /4",, c Print name: /f7a�,e This permit application expires if a permit is not obtained within 180 N �p,p�� Date:_ .' //4� 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: iV Descn�tion Fee for all residential systems combined: $75.00C�� raci Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less III 100.705 _© 0 Audio and Stereo Systems* 5.0 1to]s kva III 133.56 15.01 to 25 kva IN 200.34 _© ❑ Burglar Alarm Wind leneration s stems in excess of 25 kva: 25.01 to 50 kva 301.04 © ❑ Garage Door Opener* 50.01 to 100 kva - 552.26 _© >100 kva(fee in accordance ■ with OAR 918-309-0040 552.26 © 0 Heating, Ventilation and Air Conditioning System* Solar generation systems in excess of 25 kva: 0 Each additional kva over 25III 42 _© Vacuum Systems* >100 kva—no additional charge 0.0 _© ❑ Each additional ins.ection over allowable in an of the above: Other: Eacr eh adddiattianhonal inspectio our] 1)u nmiis n 1111cha66.25/hr -© Inspections for which no fee is ■ -. s ]fits]] listed '/hr mm 90 00/hr �t 6 \.1:\€ tktAA `R )Cf„ 4�'\C � 41` S a fi a i 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: O Audio and Stereo Systems O Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation HVAC O Instrumentation O Intercom and Paging Systems ❑ Landscape Irrigation Control* O Medical El Nurse Calls O Outdoor Landscape Lighting* O Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\BuildingWermits ELC_PermitApP ELR_ERE.doc Rev 10/26/2017