Permit (102) illCITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELR2018-00133
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2018
TIGARD 9 Parcel: 2S101AB03100
Jurisdiction: Tigard
Site address: 12115 SW 70TH AVE 101
Project: Oregon Reproductive Medicine Subdivision: 2012-009 PARTITION PLAT Lot: 3
Project Description: Limited energy for wiring and t-stats.
Contractor: AMERICAN HEATING INC Owner: TIGARD TRIANGLE PARTNERS LLC
5035 SE 24TH AVE 12115 SW 70TH AVE, SUITE 200
PORTLAND, OR 97202-4765 TIGARD, OR 97223
PHONE: 503-239-4600 PHONE:
FAX: 503-239-7038
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/15/2018 $75.00
12%State Surcharge-Electrical 08/15/2018 $9.00
Type of Use:
Class of Work:
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 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 - •• • by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through 0 2-001-0090. You m- •• . ..copy of thrules or direct.uestions to OUNC by calling 503.232.1987 or 1.800.332.2344. /`
")(Issued By: t/ . 1 �r -- Permittee Signature: - '7-.4-C/ M4Y1C�"I C S--/C/'`
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
City of Tigard i-. t I. ;E V f',,,,,,i' Received
Permit No.. i
Date/B : a I lv I.
,1111 13125 SW Hall Blvd.,Tigard,OR 97223 , r, ,.,n i 0 Plan Review
' a Phone: 503.718.2439 Fax: 503.598.1960 i Li IL "h 4.,1 Z.li!O Date/B : Other Permit:41 co,...„. i,
1.,i GAR,D Inspection Line: 503.639.4175 Date Ready/By: Juris: la See Page 2 for
Internet: www.tigard-or.gov , ':''.-,,,2 l-" Notified/Method:
t'en 'I Lit fi i':L"-s..:A... Supplemental Information
Aiiii ,,i, '-'-,?-?-'•-__-_:-----.J„050,,,, ,,,,,,,,o;,,,,ANTE.ov,,,w0,,,MO,Wi,n,''---V:_l4V,-0,•:,:,•6',',..K0Affe, _-_, ,,, 441M.1..',•'Nk" ", ', ',''''''',',11M',,,,'*-,' " ''-''V'','''t'z',''''' "-'''',',"'' '' '"
L.j
I' New construction-1"''''''''''' Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
ED
0 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.
iiii,OF c k„,(411- , ,,,,.,r-4„e1.0.440r; - exceeds 10,000 amps at 150 volts or 0 Floating buildings.
' less to ground,or exceeds 14,000 0 Commercial-me agricultural
0 1-and 2-family dwelling z Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
0 Emergency system, larger separately derived system.
;',1,:.;;"-_•;., INF*,!,li':-'..?4 ilq' - ,—LOCA ,. • •,-,, ,,m---,,,,;----,-,------ ---,,,--,, El Addition of new motor load of El"A","E","1-2","1-3",
---..---•-,.---,w,i54Z4-4e.afftriiAr-,'-', --,-,---.,-A-.%..,F',044,4,,,, d-'-,---,- ---,-,,p -.P,'''l .
1UUtil"or more. occupancy.
Job no.: Job site address: 12115 SW 70th Ave
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:#101 Project name:Oregon Reproductive Med 0 Service or feeder 600 amps or more.
Cross street/directions to job site: 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 I
Tax map/parcel no.:
Limited energy,residential
75.00 2
D
"'Pri :.'--'40!-404"te;A;: .' (with above sq.ft.)
l •-: 1A10:4,4„-iitiiiik:- '''"""-'1""'4 49''''''' Limited energy,multi-family
75.00 2
low voltage wiring and T-stats residential(with above sq.ft.)
Renewable Energy 0 See Page 2 • :::':-.:,.:'
Services or feeders installation,alteration,and/or relocation
rt,x7,,,, ,, ,,.,:tf::„,54,,,1..;:1;;,;,,- , ,,,,,:::. ,,,,,,:',V 200 amps or less
oivr4KttiiiiaPW 100.70 2
' ';'"'*''''''' ' -...-''''" ''''' ''''4''''''''' ' ' ' ' 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:
Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( )
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
4 '''''- ' ',''''''','''"4 itilOci,if;"''- ,,,,,,:4.4i;lrY -6:N=604* 'Njw'' i.'-',,:-." ','.,; A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:American Heating Inc. each branch circuit
B.Fee for branch circuits without
Contact name:Brad Manchester service or feeder fee,first
56.18 2
branch circuit
Address:5035 SE 24th Ave. Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP:Portland,OR.,97202
Each manufactured or modular
67.84 2
Phone:(503)239-4600 Fax: :(503)239-7038 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:brad@americanheating.net Pump or irrigation circle 67.84 2
oketwsr0;A0144',.irnm.,::::, 4.1towov:::--,.' Sign or outline lighting 67.84 2
Business name:American Heating Inc. Signal circuit(s)or limited-energy1 See
panel,alteration,or extension. Page 2 2
Address:Brad Manchester Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OR.,97202
Investigation(1 hr mm ) 66.25/hr
Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lic.: 33135 Electrical Lic.: 26993CRE Suprv.Lic.: 2640LEB specifically listed('/2 hr mm )
`Jgrilt414414*,LECTItie ittilsota.FEEW.,:; :' ,141
Suprv.Electrician signature,required:
Subtotal:
Print name: T Steve Young Date: 7-23-18 Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: / C"--- TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Brad Manchester Date: 7-23-18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(11/05/COMMES
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12115 SW 70TH AVE 101 , TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2018-00133
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor