Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2013 00070
T ['G'ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/25/2013
Parcel: 1S 126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 220
Project: Ninpro Subdivision:: CONDO, THE SUPPLEMENTAL PLAT Lot: 25-4
Project Description: (1) low voltage for protective signaling
Contractor: HSI SECURITY SYSTEMS INC Owner: WISCO REAL ESTATE EQUITY FUND I
3424 NE 35TH AVE 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97212 PORTLAND, OR 97205
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PHONE: 503 - 287 -4604 PHONE:
FAX: 503 - 287 -1345
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/25/2013 $75.00
12% State Surcharge - Electrical 03/25/2013 $9.00
Type of Use: COM
Class of Work: ALT
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Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV:. N' Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: ' N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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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- 001 -0010 through OA 952- 001 -0090. You A_PCII may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. .
Issued By: �p Pe rmittee Signature: DIV- 711 `-v4 4 ./ (0kL
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 Applica CEIVED FOR OFFICE USE ONLY
Received (, :O 40[ y - C O °f/�
City of Tigard i," i' 2 5 2013 Dateiv ?..� i 3 Q 1 Permit No.: 7 /v
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
t :: Phone: 503.718.2439 Fax: 50 � Date/B : Other Permit:
TIS AKD Inspection Line: 503.639.4175 i+ + VF TIGIilIL Date Ready/By: Juris 121 See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Ilk,. Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E ". 't -2", °1 -3",
I00HP or more. occupancy.
Job no.: 21302 Job site address: 9020 SW Washington Sq. Road 0 vehicle parks.
❑ Six or more residential units. P
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 220 Project name: Ninpro ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Eliander Lane Description I Qty. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Behind Embassy Suites Hotel Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 168.54 4
Ea. add'! 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
(with above sq. ft.) 75.00 2
DESCRIPTION OF WORK ( 4
Limited energy, multi - family 75.00 2
Security system 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
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: 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
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I CONTACT PERSON above service or feeder fee.
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or nodular 67.84 2
Y dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: HSI Security Systems, Inc. panel, alteration, or extension. I Page 2 75.00 2
Each additional inspection over allowable in any of the above
Address: 3424 NE 35th Ave. Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Portland, OR 97212 Investigation (1 hr min) 66.25/ hr
Phone: (503) 287 -4604 nil IIC Fax: (503) 287-1345 ' /
( t 3 Industrial plant (1 hr min) 78.18/ hr
CCB Lic.: 42140 14-s,(1/ Electrical Lic.: 26 - 755C Suprv. Lic.: 3778S Inspections for which no fee is 90.00 / hr
specifically listed (% hr min) .
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES
Print name: / t Yry ad�V IV ii. Date: 3 -Z 3- /3 Subtotal: 75.00
i �n a ��.. Plan review (25% of permit fee):
Authorized signature: _ICE, , 00 1 . % State surcharge (12%ofpennit fee): 9.00
TOTAL PERMIT FEE: 84.00
Print name: ii O • A n t y Date:
t:\ Building \Pemrils \ELC- Pem,itApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB
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*
n 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:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \PeTmiIs\ELC- PemutApp.doc 07/01/10