Permit (166) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2019-00066
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/29/2019
-FIG,l I.Dg Parcel: 2S101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 300
Project: Health Net Subdivision: None Lot: None
Project Description: HVAC system for thermostats and VAV box.
Contractor: OREGON AIRE INC Owner: GK TRIANGLE CORPORATE PARK III L
7715 NE 33RD DR STE A ATTN KBS REALTY ADVISORS
PORTLAND, OR 97211 P 0 BOX 28270
SANTA ANA, CA 92709
PHONE: 503-335-2222 PHONE:
FAX: 360-423-1978
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/29/2019 $75.00
12%State Surcharge-Electrical 04/29/2019 $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: 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 enter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. Y. may obtain a copy of the rules or direct questions to OUNC by calling 503. 2.1987 or :800.332.2344.
•
• A:41111111,Issued By: // /. . Permittee Signature: / j v'
OWNER INSTALLATION ONLY f `
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 FOR OFFICE USE ONLY
City ofTigard
and Recei"ed /`
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13125 SW Hall Blvd.,Tigard,OR 972 EC E IvE® PlanDate/B
Reviewy: L IMIIMMIIMMIIII
IIPhone: 503.718.2439 Fax: 503.598. 9 0 Date/By: —y: Related Permit#: -ig..a2,
Inspection Line: 503.639.4175 9 2019 Read Date/BYJuris: ® See Page 2 for
T 1 G A RD Internet: www.tigard-or.gov APR Notified/Method: Supplemental Information
,,.i,. .,.,:, Y ' , r-,w- TYPE.t :ypp{11'`, .
. TI,,, '! r -¢i ,. , PLAN,REVIEW ,_ ,
ID New construction ®Addition/alteraE3 11I - P1 • Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
. „CATEGORY OFICONSTRUCTION =, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family Commercial/industrial/f5
�y g ® ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
:, JOB SITE_INFORMATION AND LOCATION Emergency system. larger separately derived
Job#: Job site address: 13221 SW 68th Parkway 100HP❑A HP o of orw motor load of system.
or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:300 Project name:Centene 3rd Floor ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE-SCHEDULE . i` `x=
Description I Qty. I Each I 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
-'-'''''T-47:5`
.`DESCRIPTION OF WORK;f
Limited energy,residential 75.00 2
Relocate existing thermostats and sensors to accommodate new wall layout (with above sq.ft.)
Limited energy,multi-family 75.00 2
Install controls for(1)new VAV unit residential(with above sq.ft.)
Renewable Energy 0 See Page 2
"fa ❑ 'PROPERTY;,OWNER ,, ' ® 'TENANT Services or feeders installation,alteration,and/or relocation
Name:Centene Corporation 200 amps or less 100.70 2
Address:7711 Carondelet Avenue 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:St Louis,MO 63105 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 1 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
PLICANT: 0 ;CONTACT ER ON Branch circuits-new,alteration,or extension,per panel
�'4 ,_ PE h A.Fee for branch circuits with
Business name:Oregon-Aire,Inc above service or feeder fee, 7 42 2
each branch circuit
Contact name:Jamey Curry B.Fee for branch circuits without
Address:7715 NE 33rd Drive Suite Aservice or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Portland,OR 97211 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)335-2222 Fax: :(NA) Each manufactured or modular 67.84 2
Email: 'curr ore dwelling,service and/or feeder
y@ gon-aire.com Reconnect only 67.84 2
=4 .e y 3 :,. CONTRACTOR., ` ' , , Pump or irrigation circle 67.84 2
Business name:Oregon-Aire,Inc Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 }� 2
Address:7715 NE 33rd Drive Suite A panel,alteration,or extension.
City/State/ZIP:Portland,OR 97211 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)335-2222 Fax:(NA) Investigation(1 hr min) 90.00/hr
Email:jcurry@oregon-aire.com ( /j/ /
( , ` Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 64235 Electrical Lie. Z�i Suprv.Lic.: 3471LEB specifically listed('/z hr min)
:
G�Z ,ELECTRJGAL::PERMIT-FEES `'
Suprv.Electrician signature,required:
G oL o Subtotal: `7$'^
Print name: Jamey Curry Date: 4/09/2019 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 47,`44-
Authorized signature: TOTAL PERMIT FEE: ' r.L
rThis permit application expires if a permit is not o tamed within 180
Print name: Jamey Curry 94a1.A.4.4)---
Date: 4/09/2019 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:�Building�PermitsiELC_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 SCHEDi .E....! . ,,,,
Description Qty I Each I Total I a
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s 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*g p >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
[I Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
EI Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
COMlVIERCIAL WORK ONLY ELECTRICALPERMIT FPage
1)
Fee for each commercial system: $75.00
Subtotal per(Enter t.oPage 1).
y * Number of inspections allowed permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
C Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ 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 06/17/2015
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
13221 SW 68TH PKWY 300, TIGARD, OR, 97223 May 3, 2019 at 9:07:48 AM
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2019-00066
Inspection Type: Inspector:
198 Low voltage final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor