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Permit y el 1111 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT / • COMMUNITY DEVELOPMENT Permit 4: ELR201500120 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/11/2015 Parcel: 1S126DC04800 Jurisdiction: Tigard Site address: 9495 SW LOCUST ST A Project: Baker Research Center Subdivision: LEHMANN ACRE TRACT Lot: 4 Project Description: Low voltage for HVAC Contractor: AMERICAN HEATING INC Owner: MATHESON, ROBERT T REVOCABLE TRU 5035 SE 24TH AVE BAKER,JAMES PORTLAND, OR 97202-4765 BAKER, DIANE R 1030 NW JOHNSON ST#610 PORTLAND, OR 97209 PHONE: 503-239-4600 PHONE: 503-379-0106 FAX: 503-239-7038 FEES Description Date Amount Specifics:, Restricted Energy Permit 05/11/2015 $75.00 12%State Surcharge-Electrical 05/11/2015 $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: 1 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 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 952-001-0090 You may obtain les or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued 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. 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 Appli p FOR OFFICE USE ONLY ��1r�� Received /I City of Tigard Date/By: 611/1/7 5 � I Permit No.:S j )�/5 )4,0 Irri 13125 SW Hall Blvd.,Tigard,OR 97223 C. "+� TA Plan Review ether Permit: Phone: 503.718.2439 Fax: 50 1960 Date/By Air :4 2015 TI GARD Inspection Line: 503.639.4175 Date Ready/By: luris: El See Page 2 for Internet: www.tigard-or.gov Notified/Method: Supplemental Information {'t'T't epi d';f�A(}!! "11, 'E gli 1YORk. PLAN REVIEW ❑New construction ®Add itionk • :tl10 Jrep l ace?it► at Please check all that apply(submit j 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 ®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","1-2","1-3", Job no.:215186 Job site address:9495 SW Locust St 1001{P or more. occupancy. ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP:Tigard OR 97223 ❑Health-care facilities. ❑Supply voltage for more than ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name:Baker Research MBM TI ❑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 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 Limited energy,multi-family 7500 low volt wiring and T-stats residential(with above sq.ft.) Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation 4E0 PROPERTY OWNER ❑ 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 Phone:( ) 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 ® CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 2 Business name:American Heating Inc. each branch circuit B.Fee for branch circuits without Contact name:Brandon Hutchinson service or feeder fee,first 56.18 2 branch circuit Address:5035 SE 24`h Ave. Each add'l branch circuit 7.42 2 Miscellaneous(service or feeder not included) City/State/ZIP:Portland,OR.,97202 Each manufactured or modular 67.84 2 Phone:(503)239-4600 Fax::(503)239-7038 dwelling,service and/or feeder Reconnect only 67.84 2 E-mail:b.hutchinson @americanheating.net Pump or irrigation circle 67.84 2 CONTRACTOR Q� Sign or outline lighting 67.84 2 Business name:American Heating Inc. Signal circuit(s)or limited-energy , I See S panel,alteration,or extension. Page 2 2 Address:Brandon Hutchinson Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr City/State/ZIP:Portland,OR.,97202 Investigation(1 hr min) 66.25/hr Phone:(503)239-4600 Fax:(503)239-7038 Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: 33135 Electrical Lie.: 26993CRE uprv.Lic.: 2640LEB specifically listed(%hr min) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required:01 i� Subtotal: ?5-(:)c) Print name: T Steve Young Date: - 7 •/$ Plan review(25%of permit fee): State surcharge(12%of permit fee): cooVICt Authorized signature: TOTAL PERMIT FEE: be 1.00 )f This permit application expires if a permit is not obtained within 180 �� Print name: Brandon Hutchinson Date: /J days after it has been accepted as complete. • Number of inspections allowed per permit. I:1Building\Permits\E1.C_PennitApp ELR_ERE.doc Rev 05/21/2013 440.4615T(11/05/COM/WEB Location: Record Type: Inspection Type: Result: Comments: Inspection Date: Record ID: Inspector: City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 9495 SW LOCUST ST A, TIGARD, OR, 97223 Commercial - Electrical Limited Energy 198 Low voltage ﬁnal PASS - No C of O ELR2015-00120 Jeff Grove Violation Summary: Inspector Contractor