Permit q CITY OF TIGA ELECTRICAL RESTRICTED ENERGY PERMIT
1 I: '. COMMUNITY D EVELOPMENT Permit #: ELR2013 00044
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/04/2013
Parcel: 2S113AC01201
Jurisdiction: Tigard
Site address: 17003 SW 72ND AVE
Project: Twig's Bistro & Martini Bar Subdivision: COUNCIL VIEW ACRES (LOTS 1 -20) Lot: 18
Project Description: Low voltage for fire alarm
Contractor: WESTERN STATES FIRE PROTECTION Owner: BV CENTERCAL LLC
13896 FIR ST STE B ATTN: FRED BRUNING
OREGON CITY, OR 97045 7455 SW BRIDGEPORT RD
TIGARD, OR 97224
PHONE: 503 - 657 -5155 PHONE:
FAX: 503 - 657 -5182
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/04/2013 $75.00
12% State Surcharge - Electrical 03/04/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: Y
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N 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 -nd all other applicable law. All work will
be done ccordanc- • ith approve. plans. This permit will expire if work is not started within 180 days of issuan - -, or if ork is suspended for more the 180
days ATTENTION: Orego law eq ires you to follow the rules adopted by the Oregon Utility Notification enter. Those rules are set forth in OAR
95 001 -0010 thr- ugh OAR 952 r • 1 -009 ' . Y • . ay obtain a copy of the rules or direct questions to OUNC by calling 503. 32.1987 • 1.81.332.2 44.
•
ssued By: �� Permittee Signature: �_ ✓. L L
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 Application ; • FOR OFFICE USE O NLY. '
City of Tigard , � � Received
lig Date /B Permit No.: E4�(�/5 DDOy
• 13125 SW Hall Blvd., Tiga ■, ti 7 "° • Plan Review
C • Phone: 503.718.2439 Fax: 503 \ 8 960 4 2013 Date /B : Other Permit:
l' I G A R D Inspection Line: 503.639.4175 MAR Date Ready /By: tuns: ® See Page 2 for
Internet: www.tigard - or.gov Notified /Method: Supplemental Information
CITY OF TIGARD PLAN REVIEW
Please check all that apply
❑ ® TYP 1---LE
` p�S1O�? (submit 2 sets of plans w /items checked below):
New construction Additlo erat r acement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I - "I - ".
Job no.: LA0893 Job site address: 17003 SW 72 nd Ave. IOOHP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Twigs /Bridgeport Village ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Bridgeport Village/ Lower Boones Ferry Description I pry. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or ponion 33.92 • 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Replacing fire alarm devices. Like for like. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ® CONTACT PERSON • above service or feeder fee 7.42 7
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Duston W. Vacapin branch circuit
Each add'I branch circuit 7.42 2
Address: 13896 Fir St, Suite B Miscellaneous (service or feeder not included)
City /State /ZIP: Oregon City, OR 97045
Each manufactured or modular 67.84 2
dwelling, service and /or feeder
Phone: (503) 657 - 5155 Fax: : (503) 657 - 5182 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: duston.yacapintwsfp.us
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Western States Fire Protection panel, alteration, or extension.. I Page 2 875.00
Each additional inspection over allowable in any of the above
Address: 13896 Fir ST., Suite B Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Oregon City, OR 97045 Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 657 -5155 ax: (503) 657 - 5182 Inspections for which no fee is 90.00/ hr
specifically listed (' /: hr min)
CCB Lie.: 104570 E trica ic.: f E 18 Suprv. Lie.: 3860LEA ELECTRICAL PERMIT FEES
Subtotal: 75 .0C) Suprv. Electrician signature, equired
`. Plan review (25% of permit fee): �—
Print name: Duston W. Y Capin Date: 3/1/2013 State surcharge (12% of pennit fee): (, 60
TOTAL PERMIT FEE: J / ,V0
Authorized signature: _ T his permit application expires if a permit is not obtained within 180
Print name: Duston W. Yaca in Date: 3/1/2013 days after it has been accepted as complete.
p * Number of inspections allowed per permit.
I: \Building \Permits \ELC- PermitApp.doc 07/01/10 440- 4615T( 1 1105 /COMM'EB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(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
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I: \Buildin \Permits \ELC- PermitApp.doc 07/01/10
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
17003 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
199 Electrical final
03/28/2013 00:00
ELR2013-00044
PASS - No C of O
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
17003 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
135 Low voltage
03/26/2013 00:00
ELR2013-00044
CNCL
Job incomplete will be rescheduled
Violation Summary:
Inspector Contractor