Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 COMMUNITY DEVELOPMENT Permit#: ELR2020-00128
T IGAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2020
Parcel: 1 S136DC00300
Jurisdiction: Tigard
Site address: 11600 SW 72ND AVE
Project: 72nd&Baylor Apartments Subdivision: 72ND&BAYLOR APTS Lot: 19
Project Description: Fire alarm system controls.
Contractor: LA LONDE ELECTRIC Owner: TIGARD TRIANGLE LIMITED PARTNERS
PO BOX 2220 125 NE ALBERTA ST
ESTACADA, OR 97023 PORTLAND, OR 97211
PHONE: 503-969-8491 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/09/2020 $75.00
12%State Surcharge-Electrical 11/09/2020 $9.00
Type of Use: MF
Class of Work: NEW
Total Number of Systems: 1
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 OAR 952-001-009 You mayl obtaino a copy of the rules or direct questions to OUNC by calling 503.232.1987' or 1.800.332.2344.
Issued By: il" It/•'!/ C ,1 ) Permittee Signature: OW 7 L/ 6,7npx,/
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 Applicati►onRECEIvE R FOR OFFICE USE ONLY
City Tigard NOV 0 5 2020 Da'eBy: i i,(a/'Lo <O() Penni's:ELL Zo zo+—OUl Zd'
• 13125 SWW Received Hall Blvd.,Tigard,OR 97223 Plan Review
III 0 Phone: 503.718.2439 Fax: 503.598.1960 I.ITY OF TIGARD Date/By: Related Permit s:
Inspection Line: 503.639.4175 Ready Dale/By: Avis: 0 Ste Page 2 for
I1s'AI`D Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: /f�(.'/w. C. Supplemental Information
TYPE OF WORK _ t ' PLAN REVIEW
Fa New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans whims 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 0 Floating buildings.
❑ I-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
El.Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOS SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address: ,t ens 5vi A.2.No � Io0HP or more. ❑"A","E",
/C occupancy.
City/State/ZIP: ❑Six or more residential units.
ty �t(S�wQ p Q2 �}`Z33 Q Healthcare facilit es. 0 Supply Recreational vehicle parks.
0 Supply voltage for mote than
Suite/bldg./apt.#: I Project name: Tk,iaRD Trupc Q Hazardous locations. 600 volts nominal.
CI Service or fader 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Desert non I . Each Total •
Sw -4 2 wan i- Stn1 '(3q�b.GR., LJC 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#:
Fa add'I 500 sq.ft.or portion 33.92 1
ON OF WORK Limited energy,residential 75.00 2
e"# 4s 1-1 d it with above sq.a.)
G
NEVI (0 .t tn'QV1. ' B9Fr Limited energy,multi-family I
� n M . '^ 75.00 1j," 2
, �/LT'/iS1v7 6L Sii- idential(with above sq.ft.)
r 1 -InA +T'i` ' \C Renewable Energy 0 See Page 2
0 PROPERTY OWNER ❑ TENANT &tvkea 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 i I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps I 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
0 APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: \ tk ui1.3Slit. 'Le c...1..RaL above service or feeder fee, 7.42 2
each branch circuit
Contact name: B cu,LE L..'--O Lsi,E. B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: Irltr1 KW ('AtAt,J,E,-cE (':C 6I.AIKE A branch circuit
.ri'CPl-An1A 02. (I-462 �, Each add'I branch circuit 7.42 2
City/State/ZIP:
Miscellaneous(service or feeder not included)
Phone:(Sp3)4114 _IsiAck 1 Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: '?,tt.ia� Q Lptl..A1.JAEE.I-E54z-►C.,-Cora. Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: L1P. um,....06 Et.sd.[..\f.. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy 0 See Page 2 2
Address: `mb tiV1,k 1 `p-Akt.te C , L`'C S1ArTE tit panel,alteration,or extension.
Each additional inspection over allowable In any of the above
City/State/ZIP: E•I,iv%,t♦JA O . q-4.ras Additional inspection(1 hr min) 66.25/hr
Phone:(spy) de.ig9_(Nei t I Fax:( ) Investigation(I hr min) 90.00/hr
Industrial plant(I hr min) 78.18/hr
Entail: ��aAr F LALO E E� �, ', ��/� Inspections for which no fee is
specifically fisted 1'�:hr mint 90.00/hr
CCB Lie.:I�'485H Electrical Lie.:Qrlip I S ic.: 2.ORI�S
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 44;6_
Subtotal: l o,pe
Print name: 5 � Date: t, `E 1"2.0 O Plan Review Required(25%of permit fee):
State surcharge(12%ofpermit fee): q.00
TOTAL PERMIT FEE: .tie
Authorized signature: ` This permit application expires If a permit is not obtained within 180
Print namor"h .-2- 5- Date: %i,, 2,0 days after it has been accepted as complete.
• Number or inspections allowed per permit.
ttaa6dop'nP nsw.Et.C_PenwApp_ELR ERE.doc Rev 06:17'2015 440-4615T111'ONCOM'WE8
Electrical Permit Application —City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
o«dptwn II . 1 Each _ Total .
j Fee for all residential systems combined: $75.00 Renewable electrical energy syslems:
5 lesskva°'
Check Type of Work Involved: 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 or 25 kva:
❑ Burglar Alarm 25.01 to 50 kva
--_ 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* > DO kva(fee in accordance 2
with OAR 91 t1-309-00401 552.26
❑ 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 an of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly I I hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/,hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 • 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:
*No licenses are required. Licenses are required for all
other installations
Illuildine\Permas\ELC Permit App_ELR_ERE.doc Rey D6.17:2015