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Permit (69) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: ELR2019-00057 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/25/2019 T t c;;ti R Dg Parcel: 2S101AA02900 Jurisdiction: Tigard Site address: 12123 SW 69TH AVE Project: Compass Oncology Subdivision: WEST PORTLAND HEIGHTS Lot: B Project Description: Limited energy for protective signaling. Contractor: CONVERGINT TECHNOLOGIES Owner: MCKESSON SPECIALITY HEALTH 7678 SW MOHAWK ST 10101 WOODLANDS FOREST DR TUALATIN, OR 97062 THE WOODLANDS,TX 77380 PHONE: 503-228-8522 PHONE: 281-863-4723 FAX: 503-228-8521 FEES Description Date Amount Specifics: Restricted Energy Permit 03/25/2019 $75.00 12%State Surcharge-Electrical 03/25/2019 $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: 1 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 i u pended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Thos= - are set forth in OAR 952-001-0010 through OAR 952-001-0090. You m obtain a cop •f the rules or direct questions to OUNC by calling 503.23 • .800. 44. ,i —.moi Issued By: _...-e.--4°.. � Permittee Signature: I 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 ApplicationFOR OFFICE ISE ONl.v 1 City of Tigard Received �"—/ ,,;______�1 Al Date/B J l 13125 SW Hall Blvd.,Tigard,OR 97223 M�t c Plan Review g Phone: 503.718.2439 Fax: 503.598.1960 Date/B : - ' a i —AO" T 1 G A K U Inspection Line: 503.639.4175 j;, Ready Date/By: Juris: See 'age 2 for Internet: www.tigard-or.govd; y .,k otifed/Method: Supplemental Information .'. -3#1 ..q437,47:_,?:'5Sa . ;:.:-::=Uy. f. - - _. .- 3:.; - :.',.4 .o-, m ;.!, ':% ❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition El Other: ❑Service or feeder 400 amps or more ❑Building over three stories. where the available fault current 0 Marinas and boatyards. '`'In%,.'1',77,4": ' t, x¢ ?I " exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑ Multi-family 0 M# aster builder 0 Other: 0 Fire PemP. 0 Installation of 150 KVA or P + s+ �"€ r,- e • ',;-• -•:-. • I t T• t ---:2, 0 Emergency system. larger separately derived Job#: Job site address: 12123 SW 69thAv ❑Addition of new motor load of system. 100HP or more. ❑"A","E","1-2","1-3", City/State/ZIP:Tigard OR 97223 ❑Six or more residential units. occupancy. .4 r i . ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: : - • -: : 0supp1 voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal Cross street/directions to job site:Dartmouth s s Description Qty. Each Total * 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 'e ` s_I wt7C ' :'5- ; Limited energy,residential 75.00 2 Wire up access control,cameras and security headend panels.Field cable (with above sq.ft.) Limited energy,multi-family 75.00 2 by others. residential(with above sq.ft.) t _ ,, Renewable Energy ❑ See Page 2 l t . '*`s �• = aid«,' 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 7. 4 ,r n 1v, Branch circuits—new,alteration,or extension,per panel • - ",,1 A.Fee for branch circuits with Business name:Convergint Technologies above service or feeder fee, 7.42 2 each branch circuit Contact name:Frank Willer B.Fee for branch circuits without sAddress:7678 SW Mohawk St.Bldg.K branche it feederitfee,first 56.18 2 branch circuit City/State/ZIP:Tualatin, OR 97062 Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)228-8522 Fax: :( ) Each manufactured or modular Email:frank.willer@convergint.com dwelling,service and/or feeder 67.84 2 ,w Reconnect only 67.84 2 ...� .,lx. .._ ligkit t1` , : t .. _ .' ry . Pump or irrigation circle 67.84 2 Business name:Same as above Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: panel,alteration,or extension. Page 2 2 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 Industrial plant(1 hr min) 78.18/hr Email: Inspections for which no fee is s ificall listed(1/2.1!7.9. 90.00/hr CCB Lic.: 148358 Electrical Lic.: EL26117, -• Suprv.Lic.: 3506LEA r t? y Suprv.Electrician signature,required: / ("6 4 t o : �✓ '� Subtotal: Print name: Bill Van Every Date: 3/20/2019 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature:, TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180 Printv name: ‘4 Date: 3/20/2019 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: nift ��© Descri lion Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 111. 100.70 _© 5.01 to 15 kva 133.56 �© ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 _© Wind eneration s stems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 _© 50.01 to 100 kva 552.26 _© ❑ Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040 III 552.26 —© ❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 _© ❑ Vacuum Systems* >100 kva—no additional charge 0.0 _© Each additional ins,ection over allowable in an of the above: ❑ Other: Each additional inspection is ■ 66.25/hr —� charted at an hourl 1 hr min snspections for which no fee is —. s ificall listed 1/2hr min III 90.00/hr a' /704 .$e.: ' c": t �,,'�': �,,, �^ .:ta i�R '- "° is,w`.Sus �"<. ',.,..- ., tl^, — 1111 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* ® Protective Signaling ❑ Other: Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations 1:\BuildingTeimits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12123 SW 69TH AVE, TIGARD, OR, 97223 Record Type: Record ID: Commercial - Electrical Limited Energy ELR2019-00057 Inspection Type: Inspector: 198 Low voltage final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor