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Permit (65) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: ELR2019-00114 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/11/2019 t ;1 R t, 9 Parcel: 1S134BC00401 Jurisdiction: Tigard Site address: 12442 SW SCHOLLS FERRY RD 100 Project: Providence Medical Group Subdivision: None Lot: None Project Description: Low voltage wiring and t-stats. Contractor: AMERICAN HEATING INC Owner: PROVIDENCE HEALTH&SERVICES-ORE 5035 SE 24TH AVE ATTN: REAL ESTATE&CONSTRUCTION PORTLAND, OR 97202-4765 4400 NE HALSEY BLDG 2 STE 190 PORTLAND, OR 97213 PHONE: 503-239-4600 PHONE: FAX: 503-239-7038 FEES Description Date Amount Specifics: Restricted Energy Permit 06/11/2019 $75.00 12%State Surcharge-Electrical 06/11/2019 $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 AR 952-001-0010 through OAR 952-001-0090. You may obtain a •py of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. '':Pr/ / �OIssued By: .fes. i t�LLI�/. /�� 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. Electrical Permit Application '' FOR OFFICE USE ONLI" City of Tigard RECE I F tr..ece. d / P s ', S/G�,�y� r 13125 SW Hall Blvd.,Tigard,OR 97223 3 PlanDaReview � i//% L __. --.k �S�fG / WI i it Phone: 503.718.2439 Fax: 503.598.1960 JUN -` 2019 DateBy: /1— 5 i� f l ARD Inspection Line: 503.639.4175 �� Date Ready/By: Juris: ® See Pa *i for Internet: www.tigard-or.gov CIS OF I I t. A(i[)Notified/Method: Supplemental Information C%-c ..'. /�y h-, YFWw e W..i �v s • / jr4 ;;,, ❑New construction • ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below): 0 Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition ❑Other: where the available fault current 0 Marinas and boatyards. ' ` ' EtiiaiRY Ok ,P, ,q exceeds 10,000 amps at 150 volts or 0 Floating buildings. less to ground,or exceeds 14,000 0 Commercial-use agricultural ❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings. ❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JO-_W:�E INFORlk t'1IOl 8 / ❑Emergency system. larger separately derived system. 0 Addition of new motor load of 0"A","E","1-2","1-3", Job no.: Job site address: 12442 SW Scholls Ferry Road 100HP or more. occupancy. 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 ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.:#1100 Project name:Providence Scholls Ferry 0 Service or feeder 600 amps or more. $5, D # ' Cross street/directions to job site: Fee.�� '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 1 Tax map/parcel no ,. Limitedmited energy,residentialtial 75.00 2i '/' % ,. R FioI- o1p* � , / (with above sq.ft.)XA X /g„ / gs;.... . � , . .�� Limited energy,multi-family 75.00 2 low voltage wiring and T-stats residential(with above sq.ft.) Renewable Energy, :; ','; ::,, ' ' ❑ See Page 2 Services or feeders installation,alteration,and/or relocation M: OFERT'OWNEI t j„i 200 amps or less 100.70 2 201 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 Phone:( ) I Fax:( ) relocation 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 Date: Owner signature: t , , �QIP: I ! '..” C©NTA i, ' rye Branch circuits—new,alteration,or extension,per panel I A.Fee for branch circuits with 'i• '; • above service or feeder fee, Business name:American Heating Inc. each branch circuit 7.42 2 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 City/State/ZIP:Portland,OR.,97202 Miscellaneous(service or feeder not included) 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 r E-mail:brad@americanheating.net Pump or irrigation circle 67.84 2 ,.r � . F; .n MENOMENtreeffernITTIMM , ,m `" < Sign or outline lighting 67.84 2 Business name:American Heating Inc. Signal circuit(s)or limited-energy 1 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 min) 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 s.-cificall listed(h hr min) Suprv.Electrician signature,required: y ""'" y 1 Subtotal: Print name: T Steve Young Date: 6-3-19 Plan review(25%of permit fee): State surcharge(12%of permit fee): Authorized signature:W c- TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Print name: Brad Manchester I Date: 6-3-19 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/COM/WEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: ' $-, �.� `1.5 "... �.E Y .Z:cZf.. ax- .wY..CCa�.-, at'f' :. r .i+h :'§ 6 `G.I ,�,H Q .�s:,.: ,r�';..,{ y. ,... Fee for all residential systems combined: $75.00. e - ®�© y Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 _© 5.01 to 15 kva 133.56 _© ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 _© Wind l eneration s stems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva - 301.04 _© 50.01 to 100 kva 552.26 _© ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040 ■ 552.26 _© ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 MI 7.42 _© ❑ Vacuum Systems* >100 kva-no additional charge - 0.0 _© Each additional ins•ection over allowable in an of the above: ❑ Other: Each additional inspection is ■ 66.25/hr —� char l ed at an hourl 1 hr min inspections for which no fee is ■ 90.00/hr _. s.: