Permit (7) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Iii I •� COMMUNITY DEVELOPMENT Permit#: ELR2014 00236
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/23/2014
Parcel: 25101 BB01400
Jurisdiction: Tigard
Site address: 12010 SW GARDEN PL
Project: BMW Subdivision: CROW PARK 217 Lot: 2
Project Description: Data telecommunications system.
Contractor: BRY-COM Owner: WALTON CWOR PARK BC 8 LLC
14244 SE BUSH BY EQUITY OFFICE MANAGEMENT LLC
PORTLAND, OR 97236 PO BOX A-3879
CHICAGO, IL 60690
PHONE: 503-761-5156 PHONE:
FAX: 503-760-7501
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/23/2014 $75.00
12%State Surcharge-Electrical 10/23/2014 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 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: 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 suspend d for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Ce r. Those rules a let forth f OAR
952-001-0010 through OAR 952-001-0090. You ma obtain a cop ules or direct questions to OUNC by calling 503.23 . 9 r 1.800. .234 A /
Issued By: Ls+ � Permittee Signature: �� ii,_
._
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 Applicat 'CEj IVEJ) I O K(11 Ill I 1 s,1 11\1 1
City of Tigard Received D `,
;� • • 13125 SW Hall Blvd.,Tigard, 9849 It �` ,+ ` �"
g c l}H6 Plan Review
Phone: 503.718.2439 Fax: 503.5 02 3 2014 Date/B : Related Permit j`' a
... ..(1 _
Inspection Line: 503.639.4175 Ready Date/By: , See Page 2 for
I I:I) Internet: www.tigard-or.gov CITY OF T��IA� Notified/Method: FAMII Supplemental Information
TYP �,�` PLAN REVIEW `
❑New construction ❑Addition/alteration/repfaceIlf Please check all that apply(submit/sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 4 Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑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: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION �,[� � ❑Emergency system, larger separately derived
5-613 G j��^CO1C t- ❑Addition of new motor load of system.
Job#: I Job site address: L G- IOOHP or more. ❑"A","E","l-2","I-3",
City/State/ZIP: `�}CAKi t>b ❑Six or more residential units. occupancy.
❑
J ( ❑Health-care facilities. Recreational vehicle parks.
Suite/bldg./apt.#: I Project nam g60 ��/�`( '/��, ❑Hazardous locations. 0 Supply voltage for more than
T / ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: I 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 1
DESCRIPTION OF WORK Limited energy,residential
//` r J )r, ,Y C9�q�/��/7 / /L�j (with above sq ft.) 75.00 2
` �� 1"T�� �(/I�6 �CiLI�Y(�T Limited energy,muhi-family 75.00 2
i , residential(with above sq.ft.)
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:( ) 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
❑ APPLICANT I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: PSign or outline lighting 67.84 2
Address: /Lag/ S G�"c Signal circuit(s)or limited-energy ❑ See Page 2 / 2
�,� / panel,alteration,or extension.
City/State/ZIP: /"` 7�' (t C7�3 Each additional inspection over allowable in any of the above
/ Additional inspection(I hr min) 66.25/hr
Phone:e i (p(- 5-75-4, I Fax: -) 7 4„D.r 7 J 7 Investigation(1 hr min) 66.25/hr
Email: CC9la 901 7 1401_ ,(0-/P Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 3 I Electrical Li •Z&.1 ,,, rt upry Lic.: -f Sok- specifically listed(/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Elect 'clan signature,required: f��� ,, Subtotal:
Print name: t 1 ate. ❑Plan Review Required(25%of permit fee): ���_
State surcharge(12%of permit fee): t,.ad
Authorized signature: TOTAL PERMIT FEE: yt_ tare
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.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. i Each 1 Total •
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 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:
n 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 552.26 2
with OAR 918-309-0040)
❑ 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
charged at an hourly(1 hr min) 6625/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(%]hr min) _
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter
Fee for each commercial system: $75.00
y ' Number of inspections allowed per permit.
Page I):
.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
I Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
C\Building\Permi ts\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014