Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' I COMMUNITY DEVELOPMENT Permit#: ELR2018-00203
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/21/2018
TiC;r�l C� g Parcel: 2S101DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE#20
Project: New Horizons Wellness Services Subdivision: VARNS ACRES Lot: 9
Project Description: Limited energy for data and telecommunication installation for TI.
Contractor: LEAR ELECTRIC CO INC Owner: TRIANGLE POINTE TWO LLC
6002 NE 112TH AVE 901 NE GLISAN ST, STE 100
PORTLAND, OR 97220 PORTLAND, OR 97232
PHONE: 503-255-0733 PHONE: 503-297-8791
FAX: 503-255-0676 __
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/21/2018 $75.00
12%State Surcharge-Electrical 11/21/2018 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 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: 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 0 52-001-0090. •u may obtain a •py of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4 / ,- Permittee Signature: �t.r 75 (-1
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.
REGPVED
Electrical Permit A lication
Ap rt>Iz f�l'rlt�l: I sl°; t>Nl,v
City of Tigard NO V 14 2018 Detect C _
iii 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review % `�'
11111 Phone: 503.718.2439 Fax: 503.5 0Ot r /-1(1) Date/B : it4 , �� ,�
Inspection Line: 503.639.4175 1._I L.L.i>;,.a �..f l,/(j,O IN Ready Date/By: BI See Page 2 for /
1'1 V A h.I) Internet: www.tigard-or.gov Notified/Method: Supplemental Information
'Mi.!ill r'III t i,tlrl4 t djr Itifit 4 �ji.,�'Ii iI t(; .;�f1� 1, �i'}` ,. t � 1 t .;i? i i l i' �,;;�3`�';; 3'f U t" t � {,.
u =. ill 1. 1 t 1`IiI#:'h{I if[_;!i 11 l 11Iid 1<�lis,. 10. t, i i3f`ri'ii `lt'l it lei '{
�} ## ��f�t�( {J� Jai {{ii ..,
._I r_.,_, .;{�.3...�.� . ��{".(:,,#�{CIl, i?��iir'a q{ {.ItF��i � �;.Ft �I s �tt9. 7�„ i ri7„w,,�• �. � i�i r i y�- i9�I,�,,.�tSi.,114..1�I�I
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
El Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
Other:
� where the available fault current 0 Marinas and boatyards.
r ' ...;fld rd `! ,?dt , iiii k0, Of , '440:0 '?C. illi�t,ii;31= 1;!I !slllli;Ci(,"
exceeds 10,000 amps at 150 volts or 0 Floating buildings..
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.1:1 Multi family ClMaster builder 0 Other: 0 Fire pump. 0 Installation
n of 150 KVA or
/ i 1 R3:. Ny0,.4 {1t00# W *rv*Ai:ihI lliill€{i
0 Emergency systchn, larger separately derived
Job#:18-420 Job site address:13333 SW 68th Parkway Ste 20 ID Addition of new motor load of system.
l OOHP or more. 0"A",'B" "1-2","1-3",
City/State/ZIP:Tigard OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt,#:20 I Project name:New Horizons TI ['Hazardous locations. 0 Supply voltage for more than
Cross Street/direCtlOI1S to job site: ❑Service or feeder 600 amps or more. 600 volts nominal( {
y,3{iij'#`ilr{ 11?1i1iiii'i..ij�l i)i i'd'i�.. o Sit., Ij i},{ 1=},��,{fit r t,
.��Ik � I�ij �� s�; I,
Description I Qry. I Each 1 Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
t {tits+I 11�a er , i# Ea.add'l 500 ft.or portion 33.92 1
,.< r,.r....t!t"I.tif i t;f i .r11�.,!,IIIi<;1ii f 1 :Nt t4,. ,,.,i VAillktlli 4Vi °.lSif iiiI Iiiiiiliii ii'$' 11 r ilt #�'�`<illiIiiillG ll 1I1 Limited energy,residenial
Tenant Ira rovement 75.00 2
p (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
1 i ` Is „,-,1.4,T t4 sr{Ii N lr Ii i Iryi i11Renewable EneSee Page 2rgy
€` Iff,i{(Ry4 l`' f1,,t .} IitT !'iii 1111111' Services or feeders installation,alteration,and/or relocation
Name:Triangle Pointe Two LLC 200 amps or less 100.70 2
Address:901 NE Glisan Street STE 100 201 amps to 400 amps 133.56 2
City/State/ZIP:Portland OR 97232 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:(503)297-8791 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 20o 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
^# it j+t•!},5,,. ,,t 't#Pi',`ir * 'I ,# ! }Ii=,ii t! 1.�Lst (� A bi i0,0 ? tII Cdljf� Branch circuits—new,alteration,or extension,per panel
�_ , ]' Ct' �,�. v , ` , A.Fee for branch circuits with
Business name:Lear Electric Co.,Inc above service or feeder fee,
each branch circuit 7.42 2
Contact name:David Mumford B.Fee for branch circuits without
Address:6002 NE 112th Ave service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Portland OR 97220 Each add'l branch circuit 7.42 2
Phone:(503)255-0733Miscellaneous(service or feeder not included)
Fax: :(503)255-0676 Each manufactured or modular
Email:tamara.glebe@learelectric.com
dwelling,service and/or feeder 67.84 2
. ,.
Reconnect only 67.84
2:� �s:. .� `t � , �O( 'RA` � ��` , ty��• .
1 ,., ; �€ ,.# ,.,.� #t�..1',' Pump or irrigation circle 67.84 2
Business name:Lear Electric Co.,Inc. Sign or outline lighting 67.84 2
Address:6002 NE 112ih Ave Signal circuit(s)or limited-energy ❑ See Page 2 2
panel,alteration,or extension,
City/State/ZIP:Portland OR 97220 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)255-0733 Fax:(503)255-0676 Investigation(1 hr min) 90.00/hr
Email:tamara.glebe@learelectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 52278 Electrical Lie.: 26-411C Suprv.Lic.: 3786S specifically listed('/s hr min) 90.00/hr
Suprv.Electrician signature,required: s '. #1 t_':4p.. R1CAL PE1(MtT*0 `'.i,.,;'.:1::'
Subtotal: —1 --.
Print name: David Mumford ate: 11/14/18 0 Plan Review Required(25%of permit fee):
_ State surcharge(12%of permit fee): _ Q —
Authorized signature, TOTAL PERMIT FEE: IN—
f` ., This permit application expires if a permit is not obtained within 180
Print name: David Mumford Date: 11/14/18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
t:\Building\Permits1ELC_PermitApp_ELR_ERE.doc Rev 06/172015 440-4615T(I1105/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
�y;;vt::°'.);w�•s";�ij3 �FEE>SC:HhI)IILiEt�1f?14�k�t��!kLtH3'�.
. ..........
���` .._.:rir,:i,,.. J;j?:w,vtii'%`�"i:)'4 .. ............ ... • Tote '
)._. ....... �' � �QN19Y:�3;�5�.`�,`,,U{�!sj3y_ '�r'3i �>�' ��i,',':u`.�''�`'_.'�li3ii:Nif: f�•Deuc�511on�.
?rRESIDENTThi �W Q ,�'._.,r, __..,.5.- 5 QO b1e electrical energy systems:
'] Renews tems:
Fee for all residential systems combined: 5 kva or less 100.70 2
Check Type of Work Invoked: 5.01 to 15 kva
133.56 2
200.34 2
❑ Audio and Stereo Systems* 15.0i to 25 kva Wind I eneration systems hi excess of 25 kva:
25.01 to 50 kva
301.04 /
O Burglar Alarm 50.01 to 100 kva 55226 2
❑ Garage Door Opener* >100 kva(fee in accordance 55?,26 2
with OAR 918-309-0040)
excess of 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in _
3
System* Each additional kva over 25 �
6100 kva-no additional charge
0.0 _ 3
0 Vacuum Systems* Eachadditional'ens ectioveraliDwableinan of lite above:
Each additional inspection is 66.25/hr t
❑ Other: cha:'d at an hours 1 hr min)
Inspections for which no fee is 90.00/hr
s ifieall listed Y2 hr min)
<E1EC7'Rit„ECi�P
ER1VIt1YT+EEs3�3'..`�s:��t;:?
�J': > •;1 �#a�r},, c�,+ ,.» '.. .:w)a. :. ......�•',. Subtotal(Enter on Pagel):
CO1VIIVIERCIAL��'VORK,�ONLY'.� ... •.
Fee for each commercial system:
$75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
0 Audio and Stereo Systems
O Boiler Controls
❑ Clock Systems
EC Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
O 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
1:18uddmgll'ermiis\ELC PermitApp_ELR_RRE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13333 SW 68TH PKWY STE 20, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2018-00203
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor