Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00171
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01 /2010
Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 200
Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project: HealthNet
Project Description: (1) HVAC system.
Owner: FEES
GK TRIANGLE CORPORATE PARK III L Description Date Amount
BB# 73- 1771- GK1130, CBRE, PO BOX 2096 Restricted Energy Permit 09/01/2010 $75.00
WARREN, MI 48090 12% State Surcharge - Electrical 09/01/2010 $9.00
PHONE:
Contractor:
AMERICAN HEATING INC
1339 SE GIDEON ST
PORTLAND, OR 97202
PHONE: 503 - 239 -4600
FAX: 503 - 239 -7038
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
•
HVAC: Y Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332. 344. 'I C
Issued By: Permittee Signature: gr,d f� " es - /er
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 an inspection that business day.
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 APPIicatiOR FOR OFFICE USE ONLY
City of Tigard Received
...- I ,
lig • 13125 SW Hall Blvd., Tigard, OR 97223 SEP 0 1 2010 Date/B :
Pennit No.:
Plan Review I MUM - in5 in
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: a.0 f • 10-colt p
T A Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/I3y: fa See Page 2 for
IG
Internet: www.tigard-or.gov UILDING DIVISION Notified/Method: IMI Supplemental Information
::;'": '::::;;2:',... *;* 1:: :: ' , .: , :.:...4:,c,: .
0 New construction Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
atiestiji :. 'I : : - • , • . ' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
El 1 - and 2-family dwelling 13Commercial/industrial 0 Accessory building amps for all other installations. buildings.
El Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
jiiiWigifi . - . ' ' . a Emergency system. larger separately derived system.
0 Addition of new motor load of 0 "A",
Job no.: 100HP or more.
Job site address: i 322 1 S VV 6) et + 4 Pkwy 0 Six or . occupancy.
more residential units. 0 Recreational vehicle parks.
City/State/ZIP: 7/ j dr, d og 1 7 2 2 3 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: HC4 if ii n c "fr o Service or feeder 600 amps or more.
,TOt.$3'. k 1.'.;;-:: . - . •
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1 •
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
Tax map/parcel no.: Limited energy, residential
67.84 2
0 .' :'', ':" • ':.... - , 'YA.i4;4.-':'. (with above sq. ft.)
Limited energy, multi-family
I OVV Vo I +015 e W 1 le 1 ny residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
,. , ., 200 amps or less 100.70 2
- : • - .. gi
PROPERTY NR -; :, ::-.1, .1• . _ 1:1=1"Ppg. ': 201 amps to 400 amps 133.56 2
. _
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT .. ', - 4: 1. 4CQ-MAMITR5 0 7 1 : ' ' above service or feeder fee,
742 2
each branch circuit
Business name: Am Heal t i 4/ B. Fee for branch circuits
without service or feeder fee,
Contact name: 8 ra , C I /4 oci C hes te 1 first branch circuit 56.18 2
Address: /33 5 E 1 d eo 4 6 -i- Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State/ZIP: p r - ÷ 1 ae) d C9 R 77 2 0 2 -
Each manufactured or modular
67.84 2
dwelling, service
Phone: (503 )231- 4490 Q Fax: : ( SO) 2 3 c,- 7O3 g - and/or feeder
Reconnect only .
67.84 2
E-mail: Pump or irrigation circle 67.84 2
09,1 , . :. i • -,,. ...I.: :. , i: - .',. ': 1 ., ;'-.: y Sign or outline lighting 67.84 2
Signal circuit(s) or limited-
Business name:Amer / C Gj He.* 't /"77 energy panel, alteration, or i 75; 61/
Address: /331 5E 67 1 d-, c0 , 5 -F extension. Describe: Page 2 2
City/State/ZIP: P
.0 r -I- 10-2d Og c /72 02. Each additional inspection over allowable in any of the above
. Per inspection 66.25
Phone: (503 ) 23/- 1 16 , 00 Fax: (5o3 ) 2.31-703 8 Investigation per hour (i hr min) 66.25
CCB Lic.: 3S 135 Electrical Lic.:2 0 113 (RE Suprv. Lic.: 2 oo LE g Industrial plant per hour • PERA 78.18
• :.7`::: .!,' ,'.tttclitiC.AL 'Itll*S';'
Suprv. Electrician signature, requiretr"\-- ..-- Subtotal: - I 5-, jk
Plan review (25% of tx:rmit fee):
Print name:T St e. v e (.9 t ,t Date: 9 --%\ ‘ 0
State surcharge (12% of permit
Authorized signature: -- / 4- TOTAL PERMIT FEE: n.ak-
Print name:gd /14d4 A e57ee- Date: q//// 0 This permit application expires if a permit is not obtained r ias be within 180
days aftet hen accepted as complete.
• Number of inspections allowed per permit.
1: \Building \Permits \ELC-PermitApp.doc 10/01/09 440-4615TO 1/05/COM/WEB