Permit Support Document VIA
r
CITY OF TIGARD 2,t Z�. LECTRICAL RESTRICTED ENERGY PERMIT
_ ' COMMUNITY DEVELOPMENT Permit#: ELR2021-00012
Date Issued: 2/5/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136CD02000
Jurisdiction: Tigard
Site address: 7805 SW DARTMOUTH ST
Project: Tigard Auto Zone Subdivision: None Lot: None
Project Description: Security Low Volt cable install. 2/11/21: REPRINTED permit to include fire alarm system.
Contractor: APPLIED TECHNICAL SYSTEMS INC Owner:
7015 SW MCEWAN RD
LAKE OSWEGO, OR 97035
PHONE: 503-684-9611 PHONE:
FAX: 503-598-0498
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/05/2021 $75.00
12%State Surcharge-Electrical 02/05/2021 $9.00
Type of Use: COM Restricted Energy Permit 02/11/2021 $75.00
Class of Work: NEW 12%State Surcharge-Electrical 02/11/2021 $9.00
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: 1 Other: 0 Total $168.00
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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Hal �VavviD ege Permittee Signature: 0wAf}f'"7� �
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 ++ / tt R OFI I( h t Sl ON1.y
City of Tigard V 11/ De""`d y
Ill ■ 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review e m i,� 7S
II Phone: 503.718.2439 Fax: 503.598.1960 qnq Da- : AIII
Inspection Line: 503.639.4175 FEB 11. Z021 Ready Date/By. Jude RI See Page 2 for
TI G.A RI. Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF woRCaY OF TII(3AFL PLAN REVIEW
EL-New construction ❑Addition/alterat8424MeatBIVISION Please check all that apply(submit 2 sets of plum w/items checked)'
❑Demolition El Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRU " i ,Z exceeds 10,000 amps at 150 volts or ❑Fleabag buildings.
❑ 1-and 2-family dwelling Commercialfmdustnai r i,.f` *). r - less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
El Multi-familyEl Master builder ElOther:�/r ,; ❑Fire pump, ❑Installation of 150 KVA or
JOB SITE INFORMATION AND L a -. • ' ❑Emergency system larger separately derived
['Addition of new motor bad of system
Job#: (5 9 '7 Job site address: 7,j 6 .,$W 04R-T wtvwT if' 57— 100HP or more. ❑"A^."E."l-2 "l-s^.
City/State/ZIP: a e 7 7 2-2 3 0 Six or mom residential units. occupancy.
'T( ff� ❑Health-care facilities. ❑Recreational vehicle parks.
❑Supply voltage for more than
SuBefbldg./apt #: Project rlame:�1' �(� /} �, 2a�ei ❑Servicdorfeedeoas. aoovoltanominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Descrtpdoa I Qty. I Each t Total 1 •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.fl.or less 168.54 4
Tax map/parcel#: Ea.add'i 500 sq h.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
r�n /j (with above sq.ft.)
/¢' }� l- X r 5 T-• �, I e!�s'N'c Limited energy,multi-family 75.00 2
,,/ _ residential(with above sq.it.)20 Z. "001-2_ r/l•� rs't' c'" r•r't'�`} X Renewable Energy ❑ See Page 2
0 PROPERTY OWNER 0 TENANT 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 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
0 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
/ /- A.Fcc for branch circuits with
Business name: ,/.?.dP/r.e �t' jMG✓L� S S yea--„f above service or feeder fee, 7.42 2
�/ /L ,/74( y Feeh branch circuit
Contact name: G,fi ,(� H. for branch circuits without
'/ service or feeder fee,taut 56.18 2
Address: '70 (5— 54...1 jtvi.L EWE Pr. branch circuit
City/State/ZIP: L4_(6. Usa„el a a 57035 Eachadd'l branch circuit 742 2
Miscellaneous(service or feeder not included)
Phone:(5v3 ) '71? — 747/3Lr Fax::(jO))S'yj,-oyy'£y Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
iNl/Vt•I('V 5 G c4T 016 - 't- . coir-� Reconnect only 67.84 2
` CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
/ Signalnl,atctention,
or limited-energynso . See Page 2 2
Address: r(1L1"(s-/v panel, or extension.
City/State/ZIP: Each additional inspection over a o able in any of the above
ty Additional inspection(1 lu min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 In min) 90.00/la
Email: Industrial plant(1 hr min) 78.18/In
Inspections for which no fcc is 90.00/hr
CCB Lie.: e7j`/r Electrical Lie.:Z-7/C LC Suprv.Lie.:291,716w. specifically listed(•h hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: -7�— Subtotal:
Print name: �,.-f- PLl,,(,/lam( Date: 2rt t l 2. 1 ❑Plan Review Required(25%of permit fee):
7 State surcharge(12%of permit fee):
Authorized signatu re: ... TOTAL PERMIT FEE:
I This permit application expires if a permit is not obtained within 180
Print name: 0."...„„. ' Pt. [ 5 Date: Z/l it/z t days after it Inn been accepted as complete.
I • Number of inspections allowed per permit.
I:lBaildinglpermitilELC PermilApp_ELR_ERE.doc Rev 06/1 015 440-4615T(11/05/COMnt'ED
1
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Dra •
Fee for all residential systems combined: $75.00 en wa ption I e I ash I Total I
R
y Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to 151rva 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
❑ Garage Door Opener* Sao:to 100 kva 552.26 2
>1001rn(fee in accordance
55552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 Ian:
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 any of the above:
❑ Other: Faeh 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 eh hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: S75.00 Subtotal(Enter on Page I):
y • Number of inspections allowed per permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n B• oiler Controls
n C• lock Systems
❑ Data Telecommunication Installation
i`I Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ P• rotective Signaling
❑ Other:
Total number of commercial systems: 4.
*No licenses are required. Licenses are required for all
other installations
1:1BuildinalpermitstELC PeemitAPp_ELR_ERE_doe Rev 06/17/2015