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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 31 COMMUNITY DEVELOPMENT Permit#: ELR2018-00152 T GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243 Date Issued: 09/10/2018 s. :V Parcel: 1S135DA02400 oOk4 �\�i • Jurisdiction: Tigard Site address: 11045 SW HALL BLVD Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7 Project Description: Low voltage for audio and stereo systems,data telecommunications,and nurse calls. 10/25/18:REPRINTED to correct address from 11035 to 11045. Contractor: ERIC OLSON ELECTRIC COMPANY Owner: BROOKSIDE RCF LLC 10013 NE HAZEL DELL AVE PMB 432 5987 SE ROBHIL DR VANCOUVER,WA 98685 MILWAUKIE, OR 97222 PHONE: 360-609-4901 PHONE: FAX: 360-693-2980 FEES Description Date Amount Specifics: Restricted Energy Permit 09/10/2018 $225.00 12%State Surcharge-Electrical 09/10/2018 $27.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 3 Audio&Stereo: 1 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data&Telecommunications: 1 Fire Alarm: 0 HVAC: 0 Instrumentation: 0 Intercom/Paging: 0 Landscape/Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls: 1 Protective Signal: 0 Security Alarm: 0 Other: 0 Total $252.00 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 503.232.1987 or 1.800.332.2344. Issued By: ��`K ����-� Permittee Signature: ©A"\ 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. CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 11111 2.: COMMUNITY DEVELOPMENT Permit#: ELR2018-00152 Date Issued: 09/10/2018 T1 3ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135DA02400 Jurisdiction: Tigard Site address: 11035 SW HALL BLVD Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7 Project Description: Low voltage for audio and stereo systems,data telecommunications,and nurse calls. Contractor: ERIC OLSON ELECTRIC COMPANY Owner: BROOKSIDE RCF LLC 10013 NE HAZEL DELL AVE PMB 432 5987 SE ROBHIL DR VANCOUVER,WA 98685 MILWAUKIE, OR 97222 PHONE: 360-609-4901 PHONE: FAX: 360-693-2980 FEES Description Date Amount Specifics: Restricted Energy Permit 09/10/2018 $225.00 12%State Surcharge-Electrical 09/10/2018 $27.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 3 Audio&Stereo: 1 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data&Telecommunications: 1 Fire Alarm: 0 HVAC: O Instrumentation: 0 Intercom/Paging: 0 Landscape/Irrigation: 0 Landscape Lighting: 0 Medical: 0 Nurse Calls: 1 Protective Signal: 0 Security Alarm: 0 Other: 0 Total $252.00 Other Desc: Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a co of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332 2344. ,.....--; Issued By: "/.071..40(1__.. Permittee Signature: — /r OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application I t>It()I I I( 1 I. t>vI \ City of Tigard Received 49 h 'ili 13125 SW Hall Blvd.,Tigard.OR 97223 RECEI Date+B ' Plan Review ��!! Phone: 503.718.2439 Date/B : Related Permit 4: a G�- l 1 t ,�i;T w Email: TigardBuildingPermits@Tigard-or.gov rr ?O'�$ Ready Date/By: 0 See Page 2 for inspection Line: 503.639.4175 Internet: w �.[t ar o^ NotifedMethod: IraiMI Supplemental Information ❑New construction ©Additionlaiteratiq�/ t [ DIVI Please check all that apply(submit a sets of plans wtitemschecked): ii�� Cl Service or feeder 400 amps or more Q Building over three stories. ❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards. CATEGORYor,Con TRU €ION. exceeds 10.000 amps at 150 volts or Q Floating buildings. ❑ 1-and 2-family dwelling 0 Commercial/industrial []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: ❑Fire pump. 0 Installation of 150 KVA or AI*aft,owot 1 A.TI NA4D LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address: S to i c SL 100HP or more. City/State/ZIP: a CJS 0 Six or more residential units. occupancy. ` � `��� Q Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt#: Project name: Q Hazardous locations. 0 Supply voltage for more than ()Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: vie SCHEDULE:---', Description i Qty, I Each I Total I New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.fl.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 'J)ESCRIPTION`Of WOR$ • • Limited energy,residential 75.00 2 L,J \t�‘ C� (with above sq.ft.) o Limited energy,multi-family 75,04 2 residential(with above sq.ft.) � Renewable Energy 0 See Page 2 <" ''' I Services or feeders installation,alteration,and/or relocation Name: 1?,_e_�‘..\` , 0 `ekV_ 200 amps or less 100.70 2 Address: c;#1(‘ ,L�‘` \^ 0 201 amps to 400 amps 133.56 2 �J 401 amps to 600 amps 200.34 2 City/State/ZIP: Vv la_j 9-12-1:1_2-Z.Z- 601 amps to 1,000 amps 301.04� 2 Phone:(j(S) TO k- I( 1-2..., Over 1,000 amps or volts 552.26 2 l Temporary services or feeders installation,alteration,and/or Email: ` 9 '1 �OQ • cc:,Y��-h�^����w`�Gt�..wlJkf� 4v1 relocation Owner installation:This installation istileing 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 Branch circuits-new,alteration,or extension,per panel ..' . `. . It1I > ON ,` A.Fee for branch circuits with Business name: 0 s D n SiQ � I,/') // above service or feeder fee, 7.42 2 V I c r t l each branch circuit Contact name: IT' B.Fee for branch circuits without " rservice or feed er fee,frstAddress:Lon93IVc Lt kik, pro f a( , branch circuit 56.18 2 City/State/ZIP: Van 1,0V IV, W/ 9 C7 tlY B� Each add branch circuit 7.42 2 2 Phone:(3t00 l g tMiscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 Email: 1-1,(yn ern 1 (-�y�/ r { y�^ dwelling,service and/or feeder � ' '-ft `+'l 4 �'�., i1�� 5 4 t/r Y l Reconnect only 67.84 2 CONTRACTOR. Pump or irrigation circle 67.84 2 Business name:. (L C)I s,D n .e.0-1,---1c,.-�-�-1< �fl/ Sign or outline lighting 67.84 2 Address: to V 1 3 N E 012Q, lids Ave,lpm �� Signal circuit(s)or limited-energyxensSee Page 2122?52 panel,alteration,or extension. wi City/State/ZIP: `�1/) f 1,s I'-' Each additional inspection over allowable in any of the above V r t ID 7 Additional inspection(1 hr min) 66.25/hr Phone:(3 ® ` —S' ° Investigation(I hr min) 90.001 hr Email: 1 �}'�✓ pU Ir i c.D j1 VD v e J'^moi i L y Y' ( / Industrial plant(1 hr min) 78.18/hr �-C LSC l 6-C d/J P 67 I if Inspections for which no fee is 90,001 hr CCB Lic.: f g Lj o� Electrical Lic,:37 -1063d Suprv.Lie.: Lig I®S specifically listed('/z hr min) . ,- > i�I 1 Suprv.Electrician signature,required: ,, . " g," Print name: 0 Subtotal:fe � 0C � Date: Cl� � � I � � 0 Plan Review Required{25/o of permit fee): 111 State surcharge(12%of permit fee): 07-7.toe- Authorized signature: TOTAL PERMIT FEE- ' `t�'.- r This permit application expires it'a permit is not tamed within ISO Print name: `/^ Date: I 1 (1 1 tt days after it has been accepted as complete. Number of inspections allowed per permit. 1a Building Permits:ELC_PermitApppELR_ERE.doc RevtCt262017 440-4615011^05.COMWEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: I IIt,V V 0 Description 1 Qty. I Each 1 Total Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 5 kva or less 100.70 Check Type of Work Involved: 5.01 to 15 kva 133.56 2 D Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 Wind generation systems in excess of 25 kva: El Burglar Alarm 25,01 to 50 kva 301.04 2 50.01 to 100 kva 552.26 2 El Garage Door Opener* >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) El 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: E Other: Each additional inspection is 66.25/hr charged at an hourly(I hr min) Inspections for which no fee is 90.00/hr specificattylisted(Vzhr min? Subtotal(Enter on Page 1): I Fee for each commercial system: $75.00 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: E(Audio and Stereo Systems El Boiler Controls El Clock Systems DVData Telecommunication Installation El Fire Alarm Installation El HVAC El Instrumentation El Intercom and Paging Systems EI Landscape Irrigation Control* El Medical Nurse Calls El Outdoor Landscape Lighting* El Protective Signaling E) Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I,Building`Permits,ELC PertnitApp_ELR,ERE doc Rev 10 26 2017 City of Tigard Tel: 503.718.2439 Location: Inspection Date: 11045 SW HALL BLVD, TIGARD, OR, 97223 Record Type: Record ID: Commercial - Electrical Limited Energy ELR2018-00152 Inspection Type: Inspector: 198 Low voltage final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor