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CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
` COMMUNITY DEVELOPMENT Permit#: ELR2022-00077
Date Issued: 7/18/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S110AC01101
Jurisdiction: Tigard
Site address: 11290 SW BULL MOUNTAIN RD
Project: Jacksons Food Stores 530 Subdivision: None Lot: None
Project Description: Limited energy for protective signaling.
Contractor: ALARMCO Owner: PACWEST ENERGY LLC
1675 N MITCHELL ST 3450 COMMERCIAL CT
BOISE, ID 83706 MERIDIAN, ID 83642
PHONE: 208-376-9731 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/18/2022 $75.00
12%State Surcharge-Electrical 07/18/2022 $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: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 1
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 toe rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
il 952-001-0010 through OAR - 1-0090. You may./... . x the rules or direct questions to OUNC by calling 503.232.1 7 or 1.800.332.2344. t
. Ate,.: �r /��7f�Issued By: I �' Permittee Signature: . `f t
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.
Electrical Permit Application FOR OFFICE USE ONLY
• City of Tigard RECEIVE-. e/Be� ,r %a %�►' i a.
13125 SW Hall Blvd.,Tigard,OR 97223 JUL1 Plan Review �`
Phone: 503.718.2439 Fax: 503.598.1960 8 7022 Date/B : Related Permit#:
i'ICARD /v Inspection Line: 503.639.4175 yry�/� Ready Date/By: .turfs ® See Page 2 for
Internet: www.tigard-or.gov vI I 1 OF TlG,RLi Notified/Method: Supplemental Information
TYPE OF WORK ' r' ',1 :--.':- yj- PLAN REVIEW
❑ New construction ❑..Additionialteration replacement Please check all that apply(submit 2 Nets at plan,vr'itena,checkedr
0 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.
❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
r ❑Addition of new motor load of system.
Job o. Job site address: j 1 2 ,---/� x ) i 7 / 100HP or more. ❑"A","E' "l-2„ "1.3„
City/State/ZIP: �— / �7 � � 0 Six or more residential units. occupancy.
Si r G✓� e�7�_ 22 „f�tn�> �1�. 0Recreational vehicle arks.
y // ` ❑Health-care facilities. P
Suite/bldg./apt.#: Project name: SG-GZ� ❑Hazardous locations. 0 Supply voltage for more than
.Sri �� 0 Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I QIN. 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energ
y,residential 75.00 2
(with above sq.ft.)
.-7:7?5'ftznc// 5 t=4 c-.- " Sy S'24c 0..E Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER .TENANT Services or feeders installation,alteration,and/or relocation
Name: 'J i A 5vtev S 'T ✓ 200 amps or less 100.70 2
Address: j, 1'7O S cam ) ��// ,7.�cii fi-2,--, O e 201 amps to 400 amps 133.56 2
/�r� 401 amps to 600 amps 200.34 2
City/State/ZIP: T,, (.4./j ("-7Q• C7 7-2_Z Y 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
}APPENANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: mc-isid rT.,, above service or feeder fee, 7.42 2
(yam each branch circuit
Contact name: [,- Fi f 1 I t5 Pi B.Fee for branch circuits without
seAddress: 16 1-S , C_/ e/1 s 1 branche it feederitfee,first 56.18 2
z �-�� branch circuit
City/State/ZIP: /� Each add'1 branch circuit 7.42 2
�3nI' / 2-: �� � Miscellaneous(service or feeder not included)
Phone:(2 ) , y... 10) Fax: :( ) Each manufactured or modular 67.84 2
J dwelling,service and/or feeder
[mail:
�C/ -,i /1 /,-"f�c," , t v!`:_,'7 './.../.) , C c.+�7 Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ,4.-//�� Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: /‘ 7') /�/. 772,k_g��7 - panel,alteration,or extension. ee Page 2 / 2
City/State/ZIP: i5�/ , 3 Each additional inspection over allowable in any of the above
96
- Additional inspection(1 hr min) 66.25/hr
Phone:( G} --- Fax:( ) Investigation(1 hr min) 90.00/hr
l Industrial plant(1 hr min) 78.18/hr
Email: ., /' c s//2L ",yrJ• c-„",
la bb.j Inspections for which no fee is
CCB Lic.: j 21 cat Electrical Lie.:L'L 7 Suprv. Lie.: 32S1-2./4- specifically.listed( hr min)
90.00/hr
Suprv. Electrician signature,required: (:1
ELECTRICAL PERMIT ES
E--t Ltr c c.. Subtotal:
Print name: L 0 6_,His, ` ft ifs 1 A.A. Date: 2 /,j,-ZZt 0 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: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE-doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical permit Application—City of Tigard
Paga2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description QI I I-adi I "Dotal
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s 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
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
I 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 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
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
so-cificall listed %z hr min
COMMERCIAL WORK ONLY: )` `
���� . 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
❑ HVAC
❑ Instrumentation
E Intercom and Paging Systems
E Landscape Irrigation Control*
E Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
V. Protective Signaling
E Other:
Total number of commercial systems: t
*No licenses are required. Licenses are required for all
other installations
1.\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015