Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2013 -00076
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/09/2013
Parcel: 1 S 135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY 250
Project: Jo -Ann Fabrics Subdivision: METZGER ACRE TRACTS Lot: 9
Project Description: Replacement of security /fire alarm panel.
Contractor: SECURITY PROFESSIONALS Owner: COMMERCIAL ENTERPRISES LLC
911 MAIN ST, SUITE 101 8320 NW HWY 99
VANCOUVER, WA 98660 VANCOUVER, WA 98665
PHONE: 360 - 574 -5329 PHONE:
FAX: 360 - 571 -8715
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/09/2013 $75.00
12% State Surcharge - Electrical 04/09/2013 $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: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: Y 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 and all other applicable law. All work will
be done in - • •ance wi . , •roved 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. • ENTION: Oregon law -sires ou to follow the rules adopted by the Oregon Utility Notification Center. Those rulesra t •rth in OAR
952 -0• -0010 thr' ugh OAR 952 -08 S 6.90. Youu-
y obtain a copy of the rules or direct questions to OUNC by calling 503.232. 7 or 1.800 ..�aY 3.4 ,
sued B i 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' 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 Appli 8CELVED FOR OFFICE 1SE OyI.v
City of Tigard Received T /
9 " /1l O 9 2013
Date/By:
Al ' Permit No.: E// 7 '
• 13125 SW Hall Blvd., Tigard, OR 3 Plan Review
' ■ Phone: 503.718.2439 Fax: 50 Date/By: Other Permit:
TI G K D Inspection Line: 503.639.4175If TIGARD Date Ready/By: Iuris: H See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction j 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.
CATEG 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 C ommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
100HP or more. occupancy.
Job no.: Job site address: 1199.5 01/4-.4 f1■-(9 ❑ Six or more residential units. parks.
❑ Recreational vehicle
City/State /ZIP: 1&��� 4 7 a a 3 ❑ Health -care facilities. ❑ Supply voltage for more than
+f''I� ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ,.2_5 Project name: w i 1 S # t 3 ( j ❑ Service or feeder 600 amps or more.
y��`� FEE SCHEDULE
t
Cross street/directions to job site: - ‘( --C-- Description I Qty. 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
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
F-eitAcrit,--ev- v7 t save-a-1 i Pt ( A LAC c residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
Pte' E. (. 200 amps or less 100.70 2
❑ PROPERTY OWNER I lecTENANT 201 amps to 400 amps 133.56 2
Name: JQ 4..i- .i S 401 amps to 600 amps 200.34 2
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
tY 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
PPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: sEco 12- cr'-r P C �.:_ s (G,v,fvLs B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: , w✓l C�L(_O+vQ - -( branch circuit
Each add'l branch circuit 7.42 2
Address: '/ (( KAA ( 1 ( Miscellaneous (service or feeder not included)
z� Q ` 6 Each manufactured or modular
City /State /ZIP:
VP » \i. C, - I V0 dwelling, service and/or feeder 67.84 2
Phone: act ) q�� 0,96 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: 2 (T'-( 7 PQ SS �0j C & panel, alteration, or extension. Page 2 2
<7
Each additional inspection over allowable in any of the above
Address: L t,( fr1/1At g 5 ( Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: , V ` ( J" 5 D Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (99G ) , 9„5„).._ 1.1 � L Fax: ( ) 1) 14 31 i� h l 1, 1 t Inspections for which no fee is
specifically listed (Y hr min) 90.00/ hr
CCB Lie.: i 3 3 1 ' 4 \ 1 lectrical Lic.: LEA Suprv. Lic.: ELECTRICAL PERMIT FEES
Nv I (s� Subtotal: 7 S ,
�
Suprv. Electrician signa e, required: (Z
Plan review (25% of permit fee): �—
Print name: . ) Y Date: –( e 13 State surcharge (12% of permit fee): C . C o
�/ G TOTAL PERMIT FEE: g L f , ' c
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.
Num of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doe 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*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
n Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ BuildingTennitAELC- PermitApp.doc 07/01/10