Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2019-00205
Date Issued: 11/04/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S 126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD
Project: One Embassy Centre Subdivision: None Lot: None
Project Description: Limited energy for HVAC.
Contractor: LATIMER HVAC LLC Owner: TOWMAN ONE EMBASSY CENTRE LLC
11230 SW MORGEN CT BY TOWMAN LLC
TIGARD, OR 97223 25425 BASCOM AVE STE 230
CAMPBELL, CA 95008
PHONE: 503-290-1085 PHONE: 503-294-0400
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/04/2019 $75.00
12%State Surcharge-Electrical 11/04/2019 $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: 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 may obtain a copy.ef-the.rules or direct questions to OUNC by calling 503.232.1987 or 1 00.332.2344.
Issued By: Cam-- r�✓�. Permittee Signature:
L
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,m, ECEIVED /,, r /FOR OF1I( E 1 SI. 0y1_)
4J f g Datemya( cv3 l L I ' ! j G-,_(!.�:/
City o Tigard ��C T 2 8 2019 �� Pe
III - a 13125 SW Hall Blvd.,Tigard,OR 97223 f Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#:
T I G A R D Inspection Line: 503.639.4175 i TY OF TI GAR D Ready Date/By: Juris: Ei See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction t4Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling It Commercial/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 ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
,.t ❑Addition of new motor load of system.
Job#: (A- (t 13- Job site address: a/�l(}1 Sj w cuw t V1 SG too, l OOHP or more. ❑"A","E","1-z","1-3",
City/State/ZIP: /ny f!A p� _ Six or more residential units. occupancy.
4v1 d " f .3El Recreational vehicle parks.
Ul j ��� 0 Health-care facilities.
Suite/bldg./apt.#: Project name: kit)*9.‘cS 1I C i4A-f 4'y 0 Hazardous locations. 0 Supply voltage for more than
J 0 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'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
1 t I y p'0(f m y ylV (with above sq.ft.)
(i V v1/ v V !I Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
PROPERTY OWNER ❑//TENANT Services or feeders installation,alteration,and/or relocation
Name: t'� W�1\�llnjytvv\ S/he afc, L l! V.{!t1,c''�( 200 amps or less 100.70 2
V 6 V' 2�0 I 201 amps to 400 amps 133.56 2
Address: 401 amps to 600 amps 200.34 2
City/State/ZIP: (A t S V)wl 1 � �- 1 2,014 601 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 I
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
APPLICANT CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
0A.Fee for branch circuits with
Business name: 1 0 ,1 v„( ]-i'IA C I ,j f, above service or feeder fee, 7.42 2
�l t V"�' each branch circuit
Contact name: c A n 0.\- i s \ /� B.Fee for branch circuits without
Address: \I If")1) ' `' 0qp (\ � br aan I- 1 sence or feeder fee,firstch circuit 56.18 2
"�"
City/State/ZIP: ¶` i ip Q � Each add'l branch circuit 7.42 2
�/� 0 I � Miscellaneous(service or feeder not included)
Phone:`"!'I ) 1H f 31 Fax: :( ) Each manufactured or modular 67.84 2
\, dwelling,service and/or feeder
tT" .
Email: n,I; ("k ( V A(tAVt2 , � /t. Reconnect only 67.84 2
v v CONTRACTOR Pump or irrigation circle 67.84 2
Business name: C) 0%.}i C.`D V' Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ee Page 2 2
Address: panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I 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.:'2ZZV&3C1 Electrical Lic.:W j.f D4 Suprv.Lic.:(1 il specifically listed eh hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: A Subtotal:
Print name: 6 r el aAt Date: t 017/4
1 11 ❑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
Print name:l.A°(‘t`., 1 hv/vy Date: I 0 I�L (1 days after it has been accepted as complete.
* Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description I Qty. I Each I Total 1
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
nB• urglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
n V• acuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n O• ther: Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
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
Ti Clock Systems
❑ Data Telecommunication Installation
• Fire Alarm Installation
�HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
T Landscape Irrigation Control*
E Medical
n N• urse Calls
n O• utdoor Landscape Lighting*
n P• rotective Signaling
n 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