Permit (59) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IL. COMMUNITY DEVELOPMENT Permit#: ELR2019-00048
ff GA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/27/2019
Parcel: 2S103DD00400
Jurisdiction: Tigard
Site address: 13727 SW PACIFIC HWY 300
Project: Brim Hall Dance Academy Subdivision: None Lot: None
Project Description: Limited energy for HVAC.
Contractor: HUNTER DAVISSON INC Owner: VPT LLC
1800 SE PERSHING ST 610 SW ALDER ST STE 1221
PORTLAND, OR 97202 PORTLAND, OR 97205
PHONE: 503-542-3628 PHONE: 971-200-4906
FAX: 503-542-3654
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/27/2019 $75.00
12%State Surcharge-Electrical 03/27/2019 $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 adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may o. •. . a- les or direct questions to OUNC by calling 503.23 1987 or 1.800. 32.2344.
Issued By: - - - 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.
i ' m— "
' ' Electrical Permit Application (A,, FOR OFFICE USE ONLY'
City of Tigard IVI?!` a Date/B.d 404n • _ /i1�✓ i ��
III . 'r 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960 = /'. /�
inspection Line: 503.639.4175 '' '' `°Itea•y Date/By: EMI H See Page 2 fo
T I G A R D
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
. y..I'E..OF'WOttk `+ . ,.,.= _ k',I,AXN:REVIEW
['New construction le 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.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY Or, cmtli VcTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
.(IE ;HITT; INFOI MA'1IOI A$VD,;LOCA:1'd) s 0Emergency system. larger separately derived
4 ❑Addition of new motor load of system.
Job#: ( 1 1 I Job site address:(j" 7 SIN # G/Tt c.• mikado, 100HP or more. ❑"A "E","t-2","t-s'
97�"s 3 mikado),
❑Six or more residential units. occupancy.
City/State/ZIP: 7Fictr � 0� 0 Health-care facilities. 0 Recreational vehicle parks.
,,J ❑Hazardous locations ❑Supply voltage for more than
Suite/bldg./apt.#: I Project name:7 ycisd ANce. . 4 dies ❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: J , FEES SCHEDULE "'
Description 1 Qty. I Each I" Total f *
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'1 500 sq.ft.or portion 33.92 1
''rDESCRIPTION O1F:.i?O . '„ _ Limited energy,residential 75.00 2
L
/ /(,[( �/ (with above sq.ft.)�/6/t NI/4C C a/4'40r. Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
�� If*OPERT'Y OWNED 1'EN i1
,"//,/. �. _,..-_ ❑..i. ., -..• 1 _Services or feeders installation,alteration,and/or relocation
Name:Sc h ceSs o jeC G nym..iL 200 amps or less 100.70 2
Address:C/O Soy4/dt,r //sf�,e� "1•" S / i 201 amps to 400 amps 133.56 2
- - 401 amps to 600 ams 200.34 2
City/State/ZIP:Artfer Ne/ OJ 7 /„,20S 601 amps to 1,000 amps 301.04 2
Phone:(503)x/60?—4/054/ 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: g a h circuits amps168.54
alter tlo r extension'
xtensto per
panel 2
401 amps to 599
r a' no n er a
attitOt, ...„. ,� 0 CONTACT,E I-501X• = ;1 A.Fee far branch circuits with
1
Business name: N�t,I�e�•- Oc L,r -SoN -Z i above service or feeder fee,each branch circuit 7.42 2
/
Contact name:/� B.Fee for branch circuits without
Q "PI- 1I i service or feeder fee,first 56.18 2
N
Address:/crOO 3^4- "kr.1-Al ) r- "f f' branch circuit
City/State/ZIP:Q d pe S'f T77,2 O2 Each add'l branch circuit 7.42 2
ti r��aJ1Miscellaneous(service or feeder not included)
Phone:(.5-03)5W-3C2' I Fax: :( ) Each manufactured or modular 67.84 2
J dwelling,service and/or feeder
Email: e,D�'e��6, Li L.�v�ir Wel(/l ss0/� c.OI� Reconnect only 67.84 2
_. CANT RA II Pump or irrigation circle 67.84 2
Business name: Stere, 4S /9 Sign or outline lighting 67.84 2
'/ Signal circuit(s)or limited-energy ..+, See Page 2 2
Address: panel,alteration,or extension. A�
Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(1 hr min) 90.00/hr
industrial plant(1 hr min) 78.18/hr
Email: Inspections for which no fee is
CCB Lic./HA2 Electrical Li i.:a�,,-a c 2Ei Suprv.Lic.:60 O LEE
s ctfically listed(%:hr min) 90.00/hr
Suprv.Electrician signature,required: i ilki, Subtotal:
Print name:72M QaVt Ss-ON Date:e."<`....,,2'-jq 0 Plan Review Required(25%of permit fee):
41,,,/,
State surcharge(12%of permit fee):
� TOTAL PERMIT FEE:
Authorized signature: /' Vicar
This permit application expires if a permit is not obtained within 180
I Print name: >v v Date e27-/ } days after dal
t has been accepted as complete.
rmi ���+� 9 Number of inspections allowed per permit.
eliding�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:
t ��II�
Fee for all residential systems combined: $75.00
Description � a . Each Total
3r Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 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 55226 2
with OAR 918-309-0040)
❑ 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 6625/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s cifically listed %2 hr min)
N IAL IItogi,
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:
❑ 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 06/17/2015