Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
o COMMUNITY DEVELOPMENT Permit #: ELR2010 00196
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 300
Subdivision: Lot: 0
Project: Optum Health
Project Description: (1) fire alarm
Owner: FEES
BEHRINGER HARVARD WESTERN Description Date Amount
PORTFOLIO LP, BY EASLEY MCCALEB & Restricted Energy Permit 09/23/2010 $75.00
ASSOCIATES I, PO BOX 190700 12% State Surcharge - Electrical 09/23/2010 $9.00
PHONE:
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360 - 699 -2130
FAX: 360 - 719 -1527
Type of Use: COM
Class of Work: FPS
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: y
HVAC: N Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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. ATTEN • . • • e = law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set fort 'n OAR
952 - 001 -01 • through OAR 9 • .01-.100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue. 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.
Can 503.839.4175 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 Applicatiol ,i V F012 OFFICE Icr:: IJSI ONLY
i
City of Ti gard, OR 97223 DDatPlan eBReved /0 � 4'i Permit No.:� --- �CJ'�
/
U PI a 131 2 5 S W H all Blvd., T ie
Phone: 503.639.4171 Fax: 503.598.19 p S EP 3 201 3 Date/B : Other Permit:6ttR� 4 0 o f —1)00Z/00 f I G A Iz D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: '` ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: lit) —j NM Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction gAddition/alteration /replacement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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 Uf Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 7 , ' i7 _ Job site address: � s�) a � A � Six or more residential occupancy.
�i" ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Ti ry d a� 3 ❑ Health -care facilities. ❑ Supply voltage for more than
J ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 3 o p Project name: 00 41 1-4, l-11, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 5 LJ OA /`huM 1- St-,,) ?(j -f-bi 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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
-.(‘& III arm.' residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or Tess 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps [0 400 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 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
- each branch circuit
Business name: 3a-(. rP_lM n 61 0 y� & X46,, B. Fee for branch circuits without
service or feeder fee, first
Contact name: Z D A 5 branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: (y (,'Q O /V ili y C g ii k 6 7 S Miscellaneous (service or feeder not included)
Each City/State /ZIP: I G `Q 1A lA �� & 5 dwelling, serv and/or feeder
v 67.84 2
Phone: ( 300 v 3 I U (3 �� ) Fax: : _ )5,2—, Reconnect only 67.84 2
i Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR �(+ Signal circuit(s) or limited- energy
Business name: 5 G1 TG (/ f•L(iv t /) b / o y y Ut�DI� 7-4c. panel, alteration, or extension. ) Page 2 75" 2
"" n ,
(7375' Each additional inspection over allowable in any of the above
Address: (y (46 0 A lf; H - qg6) s / 9( Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Ci { , �` p LI/ -C v 6 A to mil/(( VA "/ O iJ Industrial plant (1 hr min) 78.18/ hr
Phone: (3 Cj 9 . 0 1 1 3 D Fax: (3 Lb ) 7 / q - / 2 ^7 Inspections for which no fee is 90.00 / hr
specifically listed (Vs hr min)
CCB Lic.: )33 '1 31 Electrical Lic.: G• LiG 7g Suprv. Lic.: (1,27 ,7 BEN ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Subtotal: 75i Ord
Plan review (25% of permit fee)) :
Print name: - 5 M Sti Date: t . ( 2, . A State surcharge (12% of permit fee): 9 .O"0
TOTAL PERMIT FEE: en)
Authorized signature: This permit application expires if a permit is not obtained v within 180
days after it has been accepted as complete.
Print name: JAs #A r S Date: 0 -za„ JD • Number of inspections allowed per permit. P/910
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
Ea 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.doc 07/01/10