Permit tiCITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 ° COMMUNITY DEVELOPMENT Permit#: ELR2016-00088
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/04/2016
Parcel: 1 S126BC01500
Jurisdiction: Tigard
Site address: 9000 SW WASHINGTON SQUARE RD
Project: Embassy Suites Hotel Subdivision: 2005-035 PARTITION PLAT Lot: 3
Project Description: Install OFCI hood and connect to existing grease duct systems and install OFCI condensing unit and evaporator
cooler for key walk-in cooler.
Contractor: FIRE SYSTEMS WEST INC Owner: FO PORTLAND PROPERTY LLC
600 SE MARITIME AVE#300 BY WINSTON HARTON HOLDINGS LLC
VANCOUVER, WA 98661 745 FIFTH AVE 33RD FL
NEW YORK CITY, NY 10151
PHONE: 360-771-7835 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/04/2016 $75.00
12%State Surcharge-Electrical 04/04/2016 $9.00
Type of Use:
Class of Work:
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 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. ATTENTIl•. o ,,on law requires you to follow the rules adopted by the Oregon Utility Notification Center. hose rules set forth in OAR
952-001-00 %through OAR •52-10.90.You may obtain a copy of the rules or direct questions to OUNC by calling 503.2319 .800.332. .
Issue. By: Permittee Signature: k
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 Applivit
• `I n ht)It orrlt I: 1sI: o��l.l
��I M �L.�' Received ��
CityO T1 and Permit#: / �(�
111111 g 4 2016 DateB : �(/ �(�y'�� � 0[2'�0�O Z7
13125 SW Hall Blvd.,Tigard,OR R Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503. 6 Date/B :
Inspection Line: 503.639.4175 Ready Date/By: orris: ® See Page 2 for
I I t,;\It I) Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
DIVISION
PLAN REVIEW
0 New construction GNCZcadition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATrf"ORY OF COMIWCITON exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El1-and 2-family dwelling l ommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB srrE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address: q0 o° syn 10 i..(i N .,.� 100HP or more. ❑"A","E","1-z","l-3",
Ci /State/ZIP. ^ AA Z ❑Six or more residential units. occupancy.
ty \ a, 0`\ 7Z Health-care facilities. 0 Recreationalvehicle parks.
Suite/bldg./apt. � Pr0 Project name: L- ❑Hazardous locations. 0 Supply voltage for more than
J hSsy �J t�S" �� ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ✓ FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
��^^�� ,-- _ �j 1_ (with above sq.ft.) 75.00 2
ALM, �� kt�h�^-t `� l� 6x?-s\-1,.., ����� Limited energy,multi-family •
residential(with above sq.ft.) 75.00 2
_Renewable_ Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,pier panel
W
_` A.Fee for branch circuits with
Business name: 't f t S W 1 it—S..\--- above service or feeder fee,
7.42 2
each branch circuit
Contact name: itil
( K .f41- ) B.Fee for branch circuits without
}, service or feeder fee,first
Address:
00 SE rkA►11 N. e + �Q branch circuit 56.18 2
City/State/ZIP: \I pc14C,O V VE+z_ W 3114(p ' Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 30 )-7-•)( 7535 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: to2f- ,yST-i,.(zj t ej7" Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy See Page 2 2
Address: panel,alteration,or extension. IR
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: L191'12_ Electrical Lic.: '' ,_ Suprv.Lic.: (49.
3SLej°r specifically listed C2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ / Subtotal:
Print name: -51/4554%1 Date: (,/i1/Lp 1 6 0 Plan Review Required(25%of permit fee):
l/ l State surcharge(12%of permit fee):
Authorized signature: 4 TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: M+ SC S ,M Date: 4 04;-zit( days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 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 for all residential systems combined: $75.00 DescriptionI Qty. 1 Each I Total 1
Ren =
y 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:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* 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 66.25/hr 1
charged at an hourly(1 hr mm)
Inspections for which no fee is 90.00/hr
specifically listed(V2 hr mm)
COMMERCIAL WalKONLY» ELEORKAL.. '' SubPM
o a (Enter
P LT
t t I(E t on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
`1 Fire Alarm Installation
HVAC
Instrumentation❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: A
*No licenses are required. Licenses are required for all
other installations
I\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015