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Permit (36) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT t 'I. . COMMUNITY DEVELOPMENT Permit#: ELR2019-00015 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2019 Parcel: 1 S 135AB00900 Jurisdiction: Tigard Site address: 10200 SW GREENBURG RD 365 Project: Farmers Insurance Subdivision: METZGER,TOWN OF Lot: 9 Project Description: Access control system. Contractor: HIT HOLDINGS INC Owner: LINCOLN CENTER LLC 1313 NW 17TH AVE BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97209 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503-227-6688 PHONE: 312-636-5012 FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 01/23/2019 $75.00 12%State Surcharge-Electrical 01/23/2019 $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: 0 Security Alarm: 0 Other: 1 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 ru ••.ted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of he rules or.' -ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By:,— • 'tee 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 Application F012 of I ICF. FSI: 011.1 CI Ra�+� Received City of Tigard / Permit#: 1 13125 S W Hall Blvd.,Tigard,OR 97223 , Date/B : �/ r» E=� C � — g 2SO� Plan Review = Phone: 503.718.2439 ;_\N Date/By: Related Permit#:/Y'- f)`z)`,(% )3^�a Email: TigardBuildingPennits@Tigard-or.gov Ready Date/By: Jurys' ® ee Page 2 or �J J T I G A R D Inspection Line: 503.639.4175 Intemety Ari o. , . pp �y MI# tified/Method: Supplemental Information ka�``� Ili 6 TYPE OF,W06><v�L� v PLAN REVIEW p New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition 0 Other: where the available fault current ['Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling raCommercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND.LOCATION 0 Emergency system. larger separately derived 0 Addition of new motor load of system. Job#: Job site address: ic:9 Zo C2 SW�,f-etµ 100HP or more. ❑«A„ «E„ <`1-2""1-3" ❑Six or more residential units. occupancy. City/State/ZIP: d L 7 2 Z3 ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: Project name: 0 Supply voltage for more than /14 f .wC! ❑Hazardous locations. 600v volts nominal. tet• ❑Service or feeder 600 amps or more. Cross street/directions to job site: FEE SCHEDULE Description I Qty. '....: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'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential 75.00 2 �VLS)LL// '..G✓ C GCS's C.O'vl, s-` S7S hf 4.1 (with above sq. t) (/� �(j' Limited energy,multi-family 75.00 2 residential(with above sq.ft.) © PROPERTY OWNER TENANT Renewable Energy 0 See Page 2 - Services or feeders installation,alteration,and/or relocation Name: �wSe-{ 200 amps or less 100.70 2 Address: /OZO 5C't,gfi& /d 401 amps to 600 amps 201 amps to 600 amps 100.34 2 C 200.34 2 City/State/ZIP: at-re) ©A 9'7274 3 601 amps to 1,000 amps 301.04 2 Phone:( ) 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` Q CONTACT PERSON Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with Business name: above service or feeder fee, each branch circuit 7'42 2 Contact name: B.Fee for branch circuits without Address: service or feeder fee,first 56.1 S 2 branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) 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: /t`� .t ,--r.1.--cit N f 071' s Sign or outline lighting 67.84 2 3/3 /V� /7 n `'a panel,circuit(s)ern or limited-energy See 2 ' 2 Address: �M/✓7C. panel,alteration,or extension. Page City/State/ZIP: /� o t2 ? zo 7 Each additional inspection over allowable in any of the above / ((( Additional inspection(1 hr min) 66.25/hr Phone:(.73) 2.z 7-��J s Investigation(1 hr min) 90.00/hr Email: �y (/ Industrial plant(1 hr min) 78.18/hr �� / � 5�"n" —`� Inspections for which no fee is 90.00/hr CCB Lic.: 2/3 z6' Electrical Lic.:4/ SZ Suprv.Lic.: 4 176y4/ specifically listed(V2 hr min) Suprv.Electrician Si ttfit lired: ELECTRICAL PERMIT FEES Subtotal: `5•-s- Print name: --/-2-14.4 f Date: /- y 2 3-1 0 Plan Review Required(25%of permit fee): l / State surcharge(12%of permit fee): TOTAL PERMIT FEE: P7 Authorized signature: This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017 440-4615T(I1/05/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 Description Fee for all residential systems combined: $75.00 I • Total Renewable Qty. Each ble 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 55226 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 min) Inspections for which no fee is 90.00/hr specifically listed 'h hr min) COMMERCIAL WORK ONLY: 7.F.50-1 '. . d. Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): * 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 ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ►r1 Protective Signaling ❑ Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 10/26/2017