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Permit (137) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT s Permit#: ELR2016-00256 li ��'v COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/14/2016 TtO.' 9 Parcel: 1 S 136DD05300 Jurisdiction: Tigard Site address: 11850 SW 67TH AVE, STE#150 Project: American Family Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 9 Project Description: Low voltage for data telecommunications Contractor: DIVERSE COMMUNICATIONS SOLUTIONS INC Owner: PNWP LLC#2 PO BOX 3939 PNWP LLC HILLSBORO, OR 97123 6600 SW 105TH AVE#175 BEAVERTON, OR 97008 PHONE: 503-690-9107 PHONE: FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 11/14/2016 $75.00 Type of Use: COM 12%State Surcharge-Electrical 11/14/2016 $9.00 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 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 952-00 throug 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. IssuedBy C.e. CC/-1 Permittee Signature: /17,'/P" /' � / v 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 Applicata E E FOR of i I( is I 01I.1 City of Tigard Received 1/ /9 /� Permit#: g �jb►(O; 13125 SW Hall Blvd.,Tigard,OR 97,0 I V 1 4 2016 Dan/B : I (IV/Y� g Plan Review Related Permit#: Phone: 503.718.2439 Fax: 503.598.19.0 Date/B Inspection Line: 503.639.4175 CITY p Ready Date/By: Anis: 10 See Page 2 for T 1('ARD Internet: www.tigard-or.gov �r g��,��tv n IG I D Notified/Method: Supplemental Information E& I GDIVISIO PLAN REVIEW 0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Service or feeder 400 amps or more 0 Building over three stories. 0 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. 0 1-and 2-family dwelling i f Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. 0 Multi-family • Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived Job#: Job site address: I0 c51) .C711 Z------ Z ❑Addition of new motor load of system. /j D (/ 100HP or more. ❑"A" "E" "1-2" "l-3» City/State/ZIP: !({I /`�Q ❑Six or more residential units. occupancy. /// ( .C1...,ww" ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#: / Project name: /141 /C (i� 0 Hazardous locations. 0 Supply voltage for more than ❑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: Lot#: Includes attached garage. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK 1 // Limited energy,residential '� �j� /� �,e �_ _ �/ (with above sq.ft.) 75.00 2 AJ �[ 1'C �/l ,�^/,� Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy 0 See Page 2 0 PROPERTY OWNER 0 TENANT Services or feeders installation,alteration,and/or relocation Name: 200 amps or less 100.70 2 201 amps to 400 amps 133.56 2 Address: 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 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 PLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel A.Fee for branch circuits with Business name: N,�sr�j above service or feeder fee, 4lGf o `' '% each branch circuit 7.42 2 Contact name:* ri ?C. 1� {4j/f, - ( y CdA B.Fee for branch circuits without c9qe- 9service or feeder fee,first56.18 2 Address: branch circuit ty fid © q:IZ3 Each add'l branch circuit 7.42 2 City/State/ZIP: t Miscellaneous(service or feeder not included) Phone:(505 4f06, t Fax: :( ) Each manufactured or modular , � dwelling,service and/or feeder 67.84 2 Email: �GIiVI t e '•.C�� > r Y A✓` Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name. X 1 v Sign or outline lighting 67.84 2 Address: Signal circuit(s)or limited-energy ..�ee Page 2 7569 2 - panel,alteration,or extension. - , City/State/ZIP: FA(� d �l � Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:`� rir` < Orgt/,� Fax:( ) Investigation(1 hr min) 90.00/hr ✓� ��(",tf� �-�3� �Clit- Industrial plant(1 hr min) 78.18/hr Email: awl tr !V e4.-- *CZ.)��.�'S� Inspections for which no fee is CCB Lic.: I c7J-1"l� Electrical Lic.: 2 ,.:3," prv.Lic.: Ate 38iti specifically listed('%hr min) 90.00/hr ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: /i Subtotal: "7S o0 Print name: TF- C `, / Date: Av itt 2011:2 0 Plan Review Required(25%of permit fee): — `[— State surcharge(12%of permit fee): q.( O TOTAL PERMIT FEE: r41.66 Authorized signature: 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_ELRERE.doc Rev 0'6/17/2015 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 I Total I * 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: ❑ 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: n Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(1/2 hr min) COMMERCIALWORKO .,. �> CA. PERMIT N 'I u..,v * �_.n. PEESa,,, SubtotalEnteron 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 t/ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ 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:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015