Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
III COMMUNITY DEVELOPMENT Permit#: ELR2015-00003
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2015
Parcel: 2S 101 AA08700
Jurisdiction: Tigard
Site address: 12511 SW 68TH AVE
Project: Kassay Clinic Subdivision: WEST PORTLAND HEIGHTS Lot: 34
Project Description: Interior TI for new tenant,some demolition,new walls,ceiling,casework&finishes
Contractor: ESDS CORPORATION Owner: BEVELAND BUILDING LLC
10700 BEAVERTON-HILLSDALE SUITE 15 12511 SW 68TH AVE
BEAVERTON, OR 97005 PORTLAND,OR 97223
PHONE: 503-641-9170 PHONE:
FAX: 503-641-6980
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 01/06/2015 $75.00
12%State Surcharge-Electrical 01/06/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
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: 1
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is i • ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i .ccordance wi 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. A' ENTION: Oregon - =s 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-,11-0090. oo y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu-• 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• Z f �yl1-01111"...rj Date: � � /S�
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 Applicatiow ,, `�iIVEp FOR OFFICE I SE:O\l.1
LI.L Received `e � /� �_0 �6,
City of Tigard Received / Permit No: f
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
0 Phone: 503.718.2439 Fax: 503.598.1960 6 6 Date/B : Other Permit:
i \It I t Inspection Line: 503.639.4175 JAN 2 015' Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov {`y f Notified/Method: Supplemental Information
TYPE OF WbL1EUN ll(,ARD PLAN REVIEW
❑New construction /k Addition/e�e
T ritli 1ON 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
❑ I-and 2-family dwelling "Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ❑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","I-3",
Job no.: Job site address: I < j 100HP or more. occupancy.
�. )I S r!b(�► (1f:-" ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: T�y�. �� Z3 ❑Health-care facilities. ❑Supply voltage for more than
Y op._ 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:° 5 •( ez j tit t ❑Service or feeder 600 amps or more
[t ! FEE SCHEDULE
Cross street/directions to job site: Description 1 4. 1 Fee. I Taut I
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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Cr( Limited energy,multi-family
! ( �, d/a/J f}L residential(with above sq.ft.) 75.00 2
_
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
PROPERTY OWNER 1 ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
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 I
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 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first
56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) Fax: ( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:-- a S Signal circuit(s)or limited-energy i See i
panel,alteration,or extension. Page 2 75--- 2
Address:10 713 C SL.J 13 ts..vm✓dFrg 7vry _fit e..r notAs ,S+...IThe , - Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: EOVNl-tZ?-D'^' Q� 9 7 t7D 5 Investigation(1 hr min) 66.25/hr
Phone:moo ) 6 h+) 9 l.7 v Fax.( ) /e//i y Industrial plant(I hr min) - 78.18/hr -
7�ii) Inspections for which no fee is 90.00/hr
CCB Lie.: 59 7 Electrical Lic.:yt..V13(..1-ii.Supry ic.:5 1 3 i4 y specifically listed(%,hr min)
Suprv. Electrician s?a,ttu e required: ELECTRICAL PERMIT FEES
I'-' Subtotal: 75:c c'
Print name: M ) K� 1Z t \L Dat 1 Z L Plan review(25%of permit fee):
V . State surcharge(12%of permit fee): 9. °O
Authorized signatu fir' TOTAL PERMIT FEE: S�/'Dc'
This permit application expires if a permit is not obtained within 180
Print name:��Xi-- s e1� v Date: 1 1 S
,� days after it has been accepted as complete.
' Number of inspections allowed per permit.
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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 1 Qty. 1 Pee 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
Wind generation systems in excess of 25 kva:
H Burglar Alarm
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
n 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
H Vacuum Systems* >IOOkva—noadditionalcharge 0.0 3
Each additional inspection over allowable in any of the above:
I Other: Each additional inspection is 6625/hr
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(A 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.
n Boiler Controls
n Clock Systems
Ti Data Telecommunication Installation
H Fire Alarm Installation
❑ HVAC
Ti Instrumentation
Intercom and Paging Systems
H Landscape Irrigation Control*
❑ Medical
n N• urse Calls
❑ O• utdoor Landscape Lighting*
J°l Protective Signaling
n O• ther
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
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