Permit y u CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
B COMMUNITY DEVELOPMENT Permit #: ELR2013 -00172
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/18/2013
Parcel: 2S 113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 115
Project: Davidson Benefits Planning Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Low voltage for data
Contractor: HATFIELD COMMUNICATIONS LLC Owner: PORTLAND SW CENTER LLC
PO BOX 83825 BY FELTON PROPERTIES INC
PORTLAND, OR 97283 ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: 503 - 978 -8888 PHONE:
FAX: 503 - 978 -8899
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/18/2013 $75.00
12% State Surcharge - Electrical 07/18/2013 $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: 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 la . A / ork will
be done i =dance w approved flans. This permit will expire if work is not started within 180 days of issuance, or if work is suspende• •r the 180
days. TENTION: Oregon a requi =s you to follow the rules adopted by the Oregon Utility Notification enter Those . rulle/ ar • set
' h in OAR
952- 1 -0010 through OAR 95201 -00 ay obtain a copy of the rules or direct questions to OUNC by calling 50 19 : • r 1 800. .
I I''
•
ssued By: " , Permittee Signature: . , iA ✓���
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 ONLY Reced •
City of Tigard tJCEIVED Dateive 7 3 Ca4 Permit No.: Ea -6/0 I - 7,g
V 13125 SW Hall Blvd., Tigard, OR Plan Review
' C . - Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 I! I I 1 8 '773 Date Ready/By: Juno: El See Page 2 for
G A E o p N otified/Method: Supplemental www.tigard or.gov pp lemental Information
T QF TIGARD
TYPE �] � nN1� {nAi PLAN ,REVIEW
❑ New construction ❑ AdditiorP t/1' TdL'eM2�[" 1� 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.
El ,DSt Demolition gther: 711 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 dwellingommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: 1 Job site address: 7‘32 ,s t9 0 4/ Sf /i� 100HP or more. occupancy.
❑
e i
0 Six or more residential units. Recreational vehicle parks.
----
City/State /ZIP: ❑ Health - care facilities. 1:1 Supply voltage for more than
/ q �l� o � / n ❑ Hazardous locations. 600 volts nominal.
7/515 Suite/bldg. /apt. no.: //s" Project name: P,90, S0) Y } �(�+l E /4 ?t ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qn. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WO (with above sq. ft.)
J / Limited energy, multi- family 75.00 2
/�,L4) O 'y / � to a J e - e A / cle residential (with above sq. ft.)
L , / � R Energy ❑ See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER I TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: ;�s. o dsOAi „F 4,,N A/i_l J 401 amps to 600 amps 200.34 2
Address: 76 3z Sw yar AAp7 Rd ....fie - // 5- 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP: y , x ,, el 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
. APPLICANT I ❑ CONT PERSON A. Fee for branch circuits with
7d above service or feeder fee,
7.42 2
Business name: //J V r � _rC L each branch circuit
'LL � W" � B. Fee for branch circuits without
Contact name: service or feeder fee, first 56.18 2
eU J b ranch circuit
Address: T ' 0 , g Z' Each add'l branch circuit 7.42 2
�%�
City/State /ZIP: ,� / /� Miscellaneous (service or feeder not included)
ry /^ i B/ v (� g ��� Each manufactured or modular
( 7 7 76 — /� (� /� ( 0 3 ) ^ 76 ^ /IJ / dwelling, service and/or feeder 67.84 2
Phone: ,x/7 j� rf rf Fax: : J ! U jJ /
Reconnect only 67.84 2
E -mail: / C eU / ,7 h p 7 e 2H'! . ce S Pump or irrigation circle 67.84 2
f , CONTRACTOR •
// Sign or outline lighting 67.84 2
Business name: x L,/ ^ � 6 � U�II s Signal circuit(s) or limited energy / See 7 5
/ / /7 �T � M panel, alteration, or extension. l Pa e 2 2
Address: � 1 f; 82_5 Each additional inspection over allowable in any of the above
n Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: r, !, .972-q3 —
irov. Investigation (l hr min) 66.25/ hr
Phone: gJ Fax � ) � 8 ^ e / j e Industrial plant (1 hr min) 78.18 / hr
7 i r l , y Inspections for which no fee is
CCB Lic. :/6 7,e3 Electrical Lic.: L'4/ f Suprv. ic.: 92QgLeB specifically listed (%z hr min) 90.00 / hr 4 it / � , / ELECTRICAL PERMIT FEES
Suprv. Electrici i gna re, required: i , j f % y Subtotal: 7s D c2
Print name: / � Date: 7 - /$�- � j Plan review (25% of permit fee): —�
X..-40/1 = State surcharge (12% of permit fee): ' 00
Authorized signature g 0�� / TOTAL PERMIT FEE: p- f • c.O
Print name: W Date: O This permit application expires if a permit is not obtained within 180
P !h 0 ► r / 7 �p `l3 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:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. r Fee I Total I •
Renewable 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
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
El Heating, Ventilation and Air Conditioning OAR 918- 309 -0040)
System* Solar generation systems in excess of 25 kva:
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
charged at an hourly (1 hr min) 66.25/ hr 1
Inspections for which no fee is 90.00/ hr
specifically listed (%z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
El Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
/ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \Building\Permits\ELC_PermitApp ELR_ERE.doc Rev 05/21/2013