Permit (188) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
■ COMMUNITY DEVELOPMENT Permit#: ELR2018-00144
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/30/2018
T I c_;;E It.T� g Parcel: 2S 101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 500
Project: Health Net Subdivision: None Lot: None
Project Description: Limited energy for HVAC.
Contractor: OREGON AIRE INC Owner: GK TRIANGLE CORPORATE PARK III L
7715 NE 33RD DR STE A ATTN KBS REALTY ADVISORS
PORTLAND, OR 97211 P 0 BOX 28270
SANTA ANA, CA 92709
PHONE: 503-335-2222 PHONE:
FAX: 360-423-1978
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/29/2018 $75.00
12%State Surcharge-Electrical 08/29/2018 $9.00
Type of Use: COM
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 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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503'32.1987 or 1.800.332.2344.
Issued By: P` Permittee Signature: . Are . 11
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'
Cl ofTigard p Daceived 7 ���/J�.��
1114 . 13125 SW Hall Blvd.,Tigard,OR 9 II - * r;',„1 „ i ` DateBy: �� //� rmit#�L(K/tiU� ���L/
6 ''° 1 Plan Review c Q�
Phone: 503.718.2439 Fax: 503.59 19 Date/By: Relateit�: e,/
Inspection Line: 503.639.4175 + Ready Date/By: . ns: See Page 2 for
T I G A R D Internet www.tigard-or.gov AUG 2 0 2018 ified/Meth. , /17V Supplemental Information
altMi:. _ :: ".. l>1.._,e„ E .tX6,�pR
, �: `> .,.
� r r llama'``' :. _...
ID New construction ®Addition/a a gfl' lnFlir-, Please check all that apply(submit 2 sets of plans w/items checked):
r'•° '. 6 _ I t.,a % ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
z' .:_;. '„ ,�EGORY C :1;d:T W .4,, :'l ,,Y exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family ❑Master builder ❑Other: Fire um all other installations. Installation
0 Fire pump. ❑Installation of 150 KVA or
' .SIT1; "1 a; I (� ` ` c 0
Emergency system. larger separately derived
,>.. : � x -�. ❑Addition of new motor load of system.
Job#: I Job site address: 13221 SW 68th Parkway 100HP or more.
❑"A» "E" "1-2» "1-3"
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:500 Project name:Centene Corp TI Phase II ❑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: 1 '
Description I Qty. I Each Total
New residential single-or multi-family dwelling unit.
Subdivision: I 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
Pr liklErig:P1'0.--
' 1 PECWAIG10 011.E !- : Limited energy,residential
Relocation of thermostats to accommodate the new wall layout (with above sq.ft.)
Limited energy,multi-family
Add 2 new VAV boxes to the control panel,programming associated with TI residential(with above sq.ft.)
'Talk ® t Renewable Ener
P1. I
-- - - e= -,. - RSIServices 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:( ) I 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
lel , , . ❑ f P . i,,i Branch circuits—new,alteration,or extension, er s and-.. . .. ._ . .- .. A.Fee for branch circuits with
Business name:Oregon-Aire,Inc above service or feeder fee, 7 42 2
each branch circuit
Contact name:Matt Tidwell B.Fee for branch circuits without
Address:7715 NE 33rd Drive Suite A service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Portland,OR 97211 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)332-2222 Fax: :(503)335-9977 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:mtidwell@oregon-aire.com Reconnect only67 84
2
"" KO.O :. _3 A':f, V . „ Pump or irrigation circle 67.84 2
Business name:Oregon-Aire,Inc Sign or outline lighting 67.84 2
Address:7715 NE 33rd Drive Suite A Signal rcualteration,or extension.t(s)or limited-energy
panel, 0 See Page 2 2
City/State/ZIP:Portland,OR 97211 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)335-2222 Fax:(503)335-9977 Investigation(1 hr min) 90.00/hr
- Industrial plant(1 hr min) 78.18/hr
Email:mtidwell@oregon-aire.com w ,(�c_J el Inspections for which no fee is
CCB Lic.: 64235 Electrical ' 5015LBB. Suprv.Lic.:e s secifically listed('A hr mm) ill 90.00/hr -.
E711' IIIYIIT ES
Suprv.Electrician signature,req ed: Subtotal:
Print ame: Randolph S i ort Date: Mil 17 21 - 0 Plan Review Required(25%of permit fee):
- -- -•-• A w , — - '- State surcharge(12%of permit fee):
� �!� 5.1-?,.
/,� ✓� 0 '(
Authorized signature✓`a %�1-&f 4. . � a, S�C'`� t TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Matt Tidwell Date: Aug 17,2018 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe 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:
Description Qty. I Each I..� Total...I *
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n 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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >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
El 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 90.00/hr
specifically listed(%2 hr min)
Subtotal(Enter 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
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.dor Rev 06/17/2015
Electrical Permit Application ti FOR OFFICE USE oyLl
City of Tigard AUG 3 9201 Dat/BReceived Permit#:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 C. f Date/B : Related Permit#:
Email: TigardBuildingPermits@Tigard Wgov Ready Date/By: Juris: ld See Page 2 for
1 I G A R D Inspection Line: 503.639.4175 Internet: www.tigard-Or.gov '' Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition 0 Other:
0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ACCommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fireum .
p p 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
/322� 5 68P Rex/
/ is ❑Addition of new motor load of system.
Job#: Job site address: Y IOOHP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: �6�es') �� ❑Six or more residential units. occupancy.
72.2,3 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: _g__l74h Heti- 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 SCHEDULE
Description I Qty. I Each 1 Total I *
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 75.00 2
tete ee. Thein et zb 4 accommo�,/„.�" (with above sq.ft.)
div tst C�G�f�' nizz) Limited energy,multi-family 75.00 2
ii i( ,-" Ce�m 2 VA if /�yy .. residential(with above sq.ft.)
PP 0TENANT Renewable Energy 0 See Page 2
❑ PROPERTY OWNERServices 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:( ) 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
APPLICANT t3-1 ONTACT PERSON Branch circuits-new,alteration,or extension,per panel
� A.Fee for branch circuits with
lO
Business name: 6-10/ A/feci j/''/C above service or feeder fee,
7.42 2
A each branch circuit
n
Contact name: //!4 7T'"Tlz7 �'L1, B.Fee for branch circuits without
.3� c �j � /0 service or feeder fee,first
Address: 77/5—Alt- Lf branch circuit 56.18 2
City/State/ZIP: -1� � �� 972./7 Each add'l branch circuit 7.42 2
/
L� Miscellaneous(service or feeder not included)
Phone:( ) �)3 ,c 72.O
22-9 Each manufactured or modular
Email: �-lU,./f� /� ,r} dwelling,service and/or feeder 67.84 2
eii Q1tTh- I PC , (.(47 Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: O .7A/, 1J�/ec-J/4/C Sign or outline lighting 67.84 2
�/ /ti Signal circuit(s)or limited-energy
Address: 7��� A/�J?�/Q,Dg, (,�t!repanel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: ®e / �� �� 9 7 L`� f/ Each additional inspection over allowable in any of the above
- Additional inspection(1 hr min) 66.25/hr
Phone:(6.5b3 g35-,.. a 2,2- Investigation(1 hr min) 90.00/hr
`j l t! eve/i � -a i - ,CO m Industrial plant(1 hr min) 78.18/hr
Email: Lf
Inspections for which no fee is 90.00/hr
CCB Lic.: 6 [..235 Electrical Life Suprv.Lic.: '555/_&8 specifically listed('h hr min)
! —,L,-,
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required. Q� i
"`�`-� Subtotal:
Print name: (fly �0 e L Date: \�/9 0 Plan Review Required(25%of permit fee):
/ ' State surcharge(12%of permit fee):
Authorized signatur,a ow/ e- z:!`,�� TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: o Ti a Well Date::Z) .04)/di days after it has been accepted as complete.
til
v * Number of inspections allowed per permit.
I:\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615 1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK'ONLY:
nEE.SCHEDULE
n- 't" Description I QtyI Each Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01to15kva 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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >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
90.00/hr
specificalllisted('Vs hr min)
CO I 11 CIA114:1 ORK O LY:
PRIIVIIT FEW6
Subtotal(Enter on 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
[HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13221 SW 68TH PKWY 500, TIGARD, OR, 97223 September 21 , 2018 at
9:06:53 AM
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2018-00144
Inspection Type: Inspector:
198 Low voltage final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor