Permit (217) CITY OF TIGARD111
ELECTRICAL RESTRICTED ENERGY PERMIT
ir. COMMUNITY DEVELOPMENT Permit#: ELR2019-00159
13125 SW Hall Blvd.,Ti Date Issued: 08/26/2019
TIGARD: and OR 97223 503.718.2439 9
Parcel: 2S 101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY,STE#10
Project: Oregon Academy of General Dentistry Subdivision: VARNS ACRES Lot: 9
Project Description: AN wiring for digital video,audio and automation for new tenant.
Contractor: PROJECTUS Owner: TRIANGLE POINTE TWO LLC
6750 SW BRADBURY CT 901 NE GLISAN ST, STE 100
PORTLAND, OR 97224 PORTLAND, OR 97232
PHONE: 503-598-8968 PHONE:
FAX: 503-746-9110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/26/2019 $75.00
12%State Surcharge-Electrical 08/26/2019 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 1 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 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 0 952-0 090. 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: 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.
'f Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
y. 1 l
rucxr
Fee for all residential systems combined: $75.00 Renewable De9crlo° Qty Eace z°`�'
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
El G• arage 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 an ( hr min
Inspectioatns forhowhiurlych1 no fee is) 90.00/hr
s.-cificall listed %z hr min
•.. � S s �a •
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
LI C• lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
E Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
I-1 O• utdoor Landscape Lighting* •
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
k• I:\Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 06/17/2015