Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT
Permit#: ELR2022-00084
Date Issued: 8/31/2022
TIGAR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S126DC00901
Jurisdiction: Tigard
Site address: 9660 SW GREENBURG RD
Project: Terrace Glen Apartments-East Building Subdivision: TERRACE GLEN APARTMENTS Lot: None
Project Description: Security and Access Control systems.
Contractor: ASSET PROTECTION PARTNERSHIP LTD Owner: GETHSEMANE EVANGELICAL
PO BOX 349 LUTHERAN CHURCH
FOREST GROVE, OR 97116 9640 SW GREENBURG RD
PORTLAND, OR 97223
PHONE: 503-359-4344 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/08/2022 $150.00
12%State Surcharge-Electrical 08/08/2022 $18.00
Type of Use: MF
Class of Work: ALT
Total Number of Systems: 2
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: 0
Security Alarm: 1 Other: 1 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 requir,5- you to fo low the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 95 -001-009 You,y ob-'• - •ry of the rules or direct questions to OUNC by calling 503.232 987 or 1.800.332.2344.
Issued By: � Permittee Signature:
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 RECEIVE I FOR OFFICE USE ONLY
City of Tigard Received
g 13125 SW Hall Blvd.,Tigard,OR 97223 AUG S 1022 plan Review I. Phone: 503.718.2439 Date/B : . f ilt
�ITY OF TIGARDReady kris: -lE See Page
TIGARD Email: Tigard : 50 .639 41 is@Tigard-Or. 41O, No fi Date/hod: Supplemental Information
Inspection Line: 503.639.4175 Intern&lsl t A-1.gat(!-
(/, TYPE OF WORK .PLAN REVIEW
u 1 lew construction 0 Addition/alteration/replacement -Please check all that apply(submit 2 sets or lans w/items checked):
❑Service or feeder 400 amps or more arBuilding over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
0 1-and 2-family dwelling ❑Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
'Multi-family ❑Master builder 0 Other: 0 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#: Job site address: 9 66o 54 G:---e,-y_,``i, Kg 100HP or more. ❑"A "E "I-2","1-3"+
223 ❑Six or more residential units. occupancy.
City/State/ZIP: ' I/? ❑Health-cam facilities. ❑Recreational vehicle parks.
�' P J l
Suite/bl /a t.#: Jt VVV���CCC"Project name:`f ,4'1'4 cto Gies-- ❑Harardous locations. ElSupply voltage for more than
CIService or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 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'!500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
�•LL•n 129 gi- lirc,c-N.V CTy.I7r2,/ ,5f.+(61trreV. 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: 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:( ) 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
APPLICANT C1 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
ff�� A.Fee for branch circuits with
�ck � J 1� vaL,efj�t`c above service or feeder fee,
Business name: l}V�Qi` ` 7.42 2
rrrr������ , each branch circuit
Contact name: 1 IA a c B.Fee for branch circuits without
1 `n i I� ervice or feeder fee,first 56.18 2
Address: L 1 branch circuit
ty 4 / __ ._ ` / Eac ella branch circuitvic 7.42) 2
City/State/ZIP:/State/ZIP: (,(ZN'e giltl0
n Miscellaneous(service or feeder not included)
Phone: ) /( 264` q 7 ` Each manufactured or modular 67.84 2
t �bi �n ^ +J\ dwelnnge servyi and/or feeder
Email: ` ` odl �J Reconnect onl 67.84 2
A CO CTO - Pump or irrigation circle 67.84 2
Business name: L1e,S,d' �J \ex., ts-d—�s 0 Sign or outline lighting 67.84 2
/ L (I Signal circuit(s)or limited-energy
Address: � `Z l V panel,alteration,or extension. El/See Page 2 I r0. 2
City/State/ZIP: c f° (w� / ( ��1« Each additional inspection
n(I hr ram over allowable in any of the above
Additional i ion(I hr min) 66.25!hr
Phone:( ) Investigation(1 hr min) 90.00/hr
Email: r Industrial plant(I hr min) 78.18!hr
(�,t1` - _ Inspections for which no fee is
to �77 rJi aor- specifically listed(%hr min) 90.00/hr
CCB Lic.: 1 VVVV���o I Electrical Lic.: Sup Lic.:J(� X 1 ,
r/A ELECTRICAL PERMIT FEES.
Suprv.Electrician si afore,required: Subtotal: ire/2—
Print
name: eA (,,,k Date: V-6-'732 2 0 Plan Review Required(25%of permit fee):
Y`Ot v State surcharge(12%of permit fee): 16,'
Authorized si afore: TOTAL PERMIT FEE: it.5�
1 rt This permit application expires if a permit is not obtained within 180
Print name: � 1 vo J 1 Date: g�-� �(� h days after it has been accepted as complete.
` * Number of inspections allowed per permit.
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