Permit •
•
'CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• ' � • COMMUNITY DEVELOPMENT Permit #: ELR2013 -00108
Date Issued: 05/23/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S136DA00100
• Jurisdiction: Tigard
Site address: 11308 SW 68TH PKWY
Project: Comcast Tech Ops West Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: (2) low voltage to relocate existing and set new thermostats (50) and check DDC and pneumatic controls
Contractor: HUNTER DAVISSON INC Owner: BENENSON 68TH PARKWAY KEY LLC, T
1800 SW PERSHING ST BY PROVIDENCE HEALTH SYSTEM
PORTLAND, OR 97202 ATTN: PROPERTY MANAGEMENT
1235 NE 47TH STE 160
PORTLAND, OR 97213
PHONE: 503 - 542 -3628 PHONE:
FAX: 503 - 542 -3654
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/23/2013 $150.00
• 12% State Surcharge - Electrical 05/23/2013 $18.00
Type of Use: COM
Class of Work: FND
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: Y
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: Y Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $168.00
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 Ce Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 or 1.800.332.2344. \
Issued By: 4A V Permittee Signature: ��' / :410
OWNER INSTALLATION ONLY 41111Plir '
•
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 } P ermit Application RECEIVE) FOR OFFICE USE ONLY �/� p
•J g Date/By: Si' 3 .6 e 00(00)
City of Ti and y Permit No
° 13125 SW Hall Blvd., Tigard, OR 97223 MAY 1 3 2013 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other.Permit:A / . -exasb
TI G A R D Inspection Line: 503.639 CITY OF TIGARD Date Ready /By: � ury5; El See Page 2 for
Internet: www.tigard- or.gov Notified /Method: �� , / Supplemental Information
BUIL DING DIVISION
y TYPE OF WORK _ PLAN REVIEW
❑ New construction IXI Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
Other: ❑ 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 AfCommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: El 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 ", "I -2 ", "l -3 ",
: Job site address: ¢ C, jj IOOHP or more. occupancy.
Job no.
��� /�t�(! �(i(� ( ' / �CW�� ❑ S ix or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: fr n Q p � 7' ? ❑ Health-care za Hazardous (cation ❑ Supply voltage for more than
It / `) ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: I Project name: 0 G , 4g ,- 7 T ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 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
/n F' ,, fi 2 yj -1Y�l �4V/1 s',G7,f/6t T/#/�j96, ij$ residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
1 �� 4i Q (/ "me Aro i3v/ii,1v/)�,� , (, 200 amps or less 80.30 2
❑P ROPERTY OWNER J� TENANT 201 amps to 400 amps 106.85 2
Name: n �l. ` 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: //?e-g , 5 - 4/ b �7, Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
/JG'�6 !Fax: 7, relocation
Phone: ( ) ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
,'APPLICANT I A CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
—
B usiness name: �—
�lt/i,F� — ,D���D.v Lam B. Fee for branch circuits
'�� I'� :fi rte. L firs branch or feeder fee,
Contact name:
,� N7 ` t � first branch circui t 46.85 2
Address: / ,5-Z f� 57; Each add'I branch circuit 6.65 2
/ Miscellaneous (service or feeder not included)
City /State /ZIP: �0 GIL 9 7'070. Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (SO ) .,5 — 3661 Fax :: ( ) Reconnect only 66.85 2
E -mail: j �eglL ∎// - �� "dA / S Se 01/1 Pump or irrigation circle 53.40 2
� cJ - CO CTOR Sign or outline lighting 53.40 2
i energy circuit(s) a) e r t o n,
Business name: or
,S ,� energy panel, alteration, or
Address: extension. Describe: ' Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax :20/...6:_ 6 lv / /// /—
/ — Investigation per hour (I hr min) 62.50
CCB Lic.: / o,/ 6 2 Electrical Lic.: ? Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, d: - Subtotal:
Print name: /,t/ Date: S�v /3 _ Plan review (25% of permit fee):
! State surcharge (8% of permit fee): \
Authorized signature: A. _, (� _ TOTAL PERMIT FEE: is' b V V
Print name: `A �fleAtozy,�.z Date: �03 This permit application it e i n is as permit nco obtained within 180
J` / D days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC - PermitApp doc 05/23/06 440-46 I 5T( t t /05 /COM/WEB
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*
El Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
X Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
g HVAC
❑ Instrumentation
❑ Intercom and Paging Systems .
El Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
4:2 Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC- PermitApp.doc 03/23/06