Permit I4 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
��11 COMMUNITY DEVELOPMENT Permit#: ELR2021-00095
T f C;A li t) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/7/2021
Parcel: 2S 103DC01000
Jurisdiction: Tigard
Site address: 11265 SW GAARDE ST
Project: Gaarde Christian School Subdivision: None Lot: None
Project Description: I ceiling horn strobe
Contractor: FIRE PROTECTION SERVICES Owner: TIGARD ASSEMBLY OF GOD
9950 SW ARCTIC DRIVE 11265 SW GAARDE ST
BEAVERTON, OR 97005 TIGARD,OR 97223
PHONE: 503-590-3732 PHONE:
FAX: 503-628-6214
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/07/2021 $75.00
Type of Use: COM 12%State Surcharge-Electrical 09/07/2021 $9.00
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: 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 f 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: Hollyt7awD,3,14t3,3u Permittee Signature: 0 rti A pplicattan
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'N 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.
8\t-h`zt- F..
Electrical Permit Application Fou OFFICE:USE ONL1
. Citya Tigard Received \ ,t Z`
f g q\ Permt#:E��fw����ttJ
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Dated; eiJr-
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : RelatedPemut#:' s'ZOt-�'W0�1
Inspection Line: 503.639.4175 Ready Date/By: tuns: ® See Page 2 for
TICiAR D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK",t PLAN REVIEW &.
❑New construction ®Addition/alteration/replacement Please check an that apply(submit 2 sets of plans wdtems checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
. ,. GATE ORY,;Of CONSTRUCTIQN,,, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1-and 2-familydwellingrO Commercial/industrialless to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of ISO KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system larger separately derived
Job#: Job site address: 11265 SW Gaarde St. ❑Addition of new motor load of system.
100HP or more. ❑"A" "E" "1-2" "1-3"
❑Six or more residential units. occupancy.
City/State/ZIP: Tigard,OR 97224 ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: Gaarde Improvment ['Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
Description I Qtr. 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'I 500 sq.ft.or portion 33.92 I
W _ ...DESCRIPTION OF WORK Limited energy,residential
Installation of 1 Ceiling Horn Strobe in downstairs portion of the church (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq ft)
tr, Renewable Energy 0 See Page 2
❑ Y;O]YsltigT<q.hla�,ir 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
Ctty/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I 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
44 000NTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: Fire Protection Services,Inc. above service or feeder fee, 7.42 2
each branch circuit
Contact name: David Phipps B.Fee for branch circuits without
Address: 9950 SW Arctic Dr, service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Beaverton,OR 97005 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503) 590-3732 Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Fire2112@,ymail.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Fire Protection Services,Inc. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 9950 SW Arctic Dr. panel,alteration,or extension. ® See Page 2 2
City/State/ZIP: Beaverton,OR 97005 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( 503 ) 590-3732 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Fire2112@ymail.com
Industrial plant(I hr min) 78.18/hr
Inspections for which no tee is 90.00/hr
CCB Lie.: 154333 Electrical Lie.: LEA4120 Suprv.Lic.: specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: David Phipps �� ate: 8/17/21 0 Plan Review Required(25%of permit fee):
��%- State surcharge(12%of permit fee):
Authorized signatu ' /" TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: David Phipps Date: 8/17/21 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:1Building1Permits\ELC_PernutApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(t i/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
ambisetat WORK ONLY: FEE SCHEDULE'
Description I Qty. I Each Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
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* >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
❑ 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
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V2 hr min)
�� � - ELECTRICAL PERMI S 11.1.1
COMMERCIAL WORK 6INLY:
Subtotal(Enter on Page 1)•
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
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n 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 ABuilding'Pern ils\ELC PerealApp_ELR_ERE.don Rev 06/17/2015