Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a: COMMUNITY DEVELOPMENT Permit #: ELR2013 -00082
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/15/2013
T [ Ca AR 9 Parcel: 2 S 101 DA00105
Jurisdiction: Tigard
Site address: 13009 SW 68TH PKWY A
Project: Extended Stay America Subdivision: VARNS ACRES Lot: 9
Project Description: (1) low voltage to add camera and cable to laundry add power supply swap camera and monitor add DVR
Contractor: APPLIED TECHNICAL SYSTEMS INC Owner: BRE /HV PROPERTIES LLC
7015 SW MCEWAN RD TAX DEPTARTMENT
LAKE OSWEGO, OR 97035 EXTENDED STAY HOTELS
100 DUNBAR ST
SPARTANBURG, SC 29306
PHONE: 503 - 684 -9611 PHONE:
FAX: 503 - 598 -0498
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/15/2013 $75.00
12% State Surcharge - Electrical 04/15/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: Y 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: 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 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 OAR 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.
Issued By: A JCX & Permittee Signature: ) A PPL /64- 712
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 A M plication i ( I I ; ( 1 I . I I (I No ',1 4097 1 1 P. 2
F RECEIVE �
Cif o Ti aT'd ROCtived Perm No.:
h g APR 1 ? p oats : 4 C`L 2 )OI3 �xN�fs�—
I� = 4 13125 SW Hall Blvd., Tigard, OR 97223 0 - �� Plan Review
Phone: 503.7182139 Fax: 503.598.19 Date/13 . Other 10°i�
i I t lnspeeiion Line: 503.639.4175 CI OF TIGARD Date Ready/By: el sea Pa�a2 for
Intem*t: www,ligard -Or,gOV BUILDING DIVISIO Naified/Method: / I62 Supplemental Information
TYPE OF WORK • PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 3 Beta of plant w /items checked below):
❑Demolition El Other: O Service or reeder 400 amps or more ['Building over three stones,
where the available fault current ❑ Marinas and boatyards.
CA'T'EGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Flowing buildings.
kw 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 0f75KVAor
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ 'A', "B', "1
Job no.: 9352 Job site address: 13009 SW 68 Parkway 10OHPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parka.
City /State/Zl • • " ga . i ' 972.3 ❑ Health Facilities_ El Svooly wttage for more than
['Hazardous locations. 600 voila nominal.
Suitc/bls :Japt_ 1o.: A Project name: Extended Stay America 0 ScMcc or feeder 600 amps or more.
FEE SCHEDULE •
Cross sired/direction • o)ob site: ' oeaeriptiac I Qtr. I Fitt- I 'thtel I
New residential .Ingle- or multi - family dwelling unit. ■
Includes attached garage. .
Subdivision: Lot no.: 1,000 sq. ft, or less 168.54 4
Eat. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK • (with above sq. n.) .
Add Camera and cable to laundry add power supply swap camera and monitor add Li mited energy, multifamily 00 2
DVR residential (with a sq. tt)
75
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
[I PROPERTY OWNER f CI 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
200 amps or less 59.36 1
Phone: ( ) tax: ( ) 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 r 168.54 2
Intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits wrrh
T
above service or feeder fee,
® APPLICANT ❑ CONT PERSON each branch circuit 7.42 2
B. Pee for branch circuits without Business name: Applied Technical Systems service or feeder fee, first
Contact name: Matt Phillips
branch circuit 56.18 2
Each KIWI branch circuit 7.42 2
Address: 7015 SW McEwan Rd Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State/ZIP: Lake Oswego, OR 97035 dwelling, service and/or feeder
Reconnect only 67.84 ' 2
Phone: (503) 6849611 Fax: : (503) 5980498
Pump or irrigation circle 67.84 2
E-mail: mphillips®atsdata.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) orlimitedtmcrgy r
Business name: SAME panel. alteration, or extension. 1 _ Page 2 , 75 2
Each additional inspection over allowable In any of the above ,
Address. Additionalinspedion(1 hr min) 66.25/hr
Investigation (1 hr min) 66,25/ hr
City/State/ZIP Industrial plant (1 hr min) 78,18/ hr
Phone: ( ) Inspections for which no the is
( ) Fes specifically listed (ti hr min) 90.00/ lir
CCI3 Lie.: 89511 Electrical Lk... 2 -71CLE I Suprv. Lie.: 2997LEA ELECTRICAL PERMIT FEES •
_ Subtotal: 75
Suprv. Electrician signature, required: ".. Plan review (25% of permit fcc):
Print name: Matt Phillips Date: 4/10/13 State surcharge (12% of permit fee): 9
TOTAL PERMIT PER 84
Authorized signature: 7 / This permit appliralion expire if a permit 1a not obtained avItIs n 180
1",a days ■tier it baa been accepted as complete.
Print name: Matt Phillips Date: 4/10/13 • Number of inspections allowed per permit.
r: fBaadieateennitnI3 .C- PenohApp.doe ent Inn 44o- 4615T(11/05!COMAVEB
Apr. 10. 2013 8:47AM No. 4097 P. 3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee fot l residential systems combined . $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Ait 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
❑ Dire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other CCTV
Total number of commercial systems; 1
*No licenses are requited. Licenses are required
for all other installations
13.0a'ddinpeimilaLC-PamitApp,doa 07/01/10