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Permit
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT _ COMMUNITY DEVELOPMENT Permit#: ELR2020-00111 Date Issued: 10/21/2020 T I G A Ii D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102BC08700 Jurisdiction: Tigard Site address: 12855 SW GRANT AVE Project: Charles F.Tigard Elementary Subdivision: None Lot: None Project Description: Romove IFP1000 board&IFP1000 door, install 5820XL board&5820XL door,replace FAA, program,test as needed. Contractor: PERFORMANCE SYSTEMS INTEGRATED Owner: TIGARD-TUALATIN SCHOOL 7324 SW DURHAM RD DISTRICT 23J PORTLAND, OR 97224 6960 SW SANDBURG ST TIGARD, OR 97223 PHONE: 503-641-2222 PHONE: FAX: 503-641-1464 FEES Description Date Amount Specifics: Restricted Energy Permit 10/15/2020 $75.00 12%State Surcharge-Electrical 10/15/2020 $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: 1 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. 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 OAR1952�-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: �.iC-� Permittee Signature: CIYN C1c �-,t citio� U 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. RECEIVED Electrical Permit Application e FOR OFFICE I sI:ONLY City of Tigard . AUG 3 1 2020 4 Dateive .09-0/-202a t/l Permit#: fLazaze-00et III • 13125 SW Hall Blvd.,Tigard,OQi�{i'�F Plan Review a Phone: 503.718.2439 Fax:o5 J3' L�@Sl TIGARD DateBy. Related Permit M: Inspection Line: 503.639.41 I I DIVISION Ready Date By: ions: HI See Page 2 for TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE OF WORK �',.. PLAN REVIEW ❑New construction 0Addition/alte ratio n/rcp1 acetneft 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 D Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION , .11Z'rniV,l. exceeds 10,000 amps at 150 volts or ❑Floating buildings. less to ground,or exceeds 14,000 ❑Commemial-use agricultural ❑ 1-and 2-family dwelling E Commercial/industrial ❑Accessory building amps for all other instanations buildings. Multi-family ❑Master builder 0 Other: ['Fire pump. 0 Installation of 150 KVA or JOB SITE. INFORMATION AND.LOCATION 0 Emergency system. larger separately derived ❑Addition of new motor load of system. JOB#:109395 Job site address:12855 SW Grant St 100HPormore. ❑"A","E","1-2","1-3", ❑Six or more residential units. occupancy. City/State/ZIP:Tigard, OR 97223 ❑Health-care facilities. ❑Recreational vehicle parks. ❑Hazardous locations. 0 Supply voltage for more than Suite/bldg./apt.#: Project name:TTSD— Charles F. Tigard 600 volts nominal. ❑Service or feeder 600 amps or more. Cross street/directions to job site: Elementary 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'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF.WORK Limited energy,residential 75.00 2 (with above sq.ft.) Remove IFP1000 board, remove IFP1000 door, install 5820XL board, Limited energy,multi-family 75.00 2 install 5820XL door, replace FAA, program,test as needed residential(with above sq.ft.) Renewable Energy 0 See Page 2 ❑ PROPERTY OWNER 1 ❑ TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 -- - _- 201 amps to 400 amps 133.56 2 Address: 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 Branch circuits—new,alteration,or extension,per panel ® APPLICANT la CONTACT PERSON A.Fee for branch circuits with Business name:Performance Systems Integrated above service or feeder fee, 742 2 each branch circuit Contact name:Katie Harbaugh B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address:7324 SW Durham Rd branch circuit City/State/ZIP:Portland, OR 97224 Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone: ( )5036412222 Fax: :( )5036411464 Each manufactured or modular 67.84 2 dwelling,service and/or feeder Email:katieh©psintegrated.com Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:Performance Systems Integrated Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy ® See Page 2 2 Address:7324 SW Durham Rd panel,alteration,or extension. Each additional inspection over allowable in any of the above eiTy/State/ZIP:Portland, OR 97224 Additional inspection(1 hr min) 66.25/hr Phone:( )5036412222 Fax:( )5036411464 Investigation(1 hr min) 90.00/hr Industrial plant(1 hr min) 78.18/hr Email:katieh since rated.corn Inspections for which no fee is @p 9 P 90.00/hr CCB Lic.:227526 Electrical Lic.:C prv.Lie.:4 A specifically listed(Y hr min) _ ELECTRICAL PERMIT FEES Suprv.Electrician signatut�gp Ifed Subtotal: Print name: Michael Brooks J Date:8/25/2020 ❑Plan Review Required(25%of permit fee). State surcharge(12%of permit fee): TOTAL PERMIT FEE: Authorized signature: /� WQJ 0I This permit application expires if a permit is not obtained within 180 Print name:Katie Harbaugh Date:8/25/2020 days after it has been accepted as complete. ` Number of inspections allowed per permit. I:1Batldmg\Permits\ELC_PermltApp ELR_ERE.doc Rev O6/1//2015 440-46 15T(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 SCHEDULE Fee for all residential systems combined: $75.00 Description Qty. I Each I Total * 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 I Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 n Garage Door Opener* 50.01 to 100 kva 552.26 2 >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 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(I hr min) Inspections for which no fee is 90.00/hr specifically listed(Y hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Paget): (SEE OAR 918-309-0000) ` Number of inspections allowed per permit. Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ✓ Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n 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:1BuildinglPermttslELC_PermitApp_ELR_ERE.doc Rev 06/l7/2015