Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• ` COMMUNITY DEVELOPMENT Permit #: ELR2013 -00111
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2013
Parcel: 25101 DA00105
Jurisdiction: Tigard
Site address: 13009 SW 68TH PKWY A
• Project: Extended Stay Subdivision: VARNS ACRES Lot: 9
Project Description: (1) protective signaling
Contractor: OREGON PROTECTIVE SERVICES LLC Owner: BRE /HV PROPERTIES LLC
PO BOX 887 TAX DEPTARTMENT
LAKE OSWEGO, OR 97034 EXTENDED STAY HOTELS
100 DUNBAR ST
SPARTANBURG, SC 29306
PHONE: 971 - 246 -3655 PHONE:
FAX: 503 - 759 -4800
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/22/2013 $75.00
12% State Surcharge - Electrical 05/22/2013 $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: y
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: Permittee Signature: • — OA / ~
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 503.639.4176 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.
May 21 13 02:03p Brian Mills 5037594800 p.1
Electrical Permit Appiicatil4ECEh TED FOR OFFICE USE ONLY
City of Tigard d� Da e cB d t 0/ / // /
u 13125 SW I Tall 131vd., Tigard, OR 97� 0 21 .3.....,„ trI Permit No.:
g Review
' C Phone: 503.718.2439 Fax: 503.598.1 2013 Plan R DateBy: Other Permit:
TIGARD Inspection Line: 503.639.41 75 Date Ready/By: See Page 2 for
Internet: www.tigard- or.gov C ITY OF TIGARD Notitied/Melhod: Supplemental Information
TYPE
BU I g{ GDIvISION 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 0 Floating buildings.
dwelling 2-family CotttmerciaUindusttral less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ® ❑ 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 ", "l -T', '1 -3 ",
i
Job no.: Job site address: 13009 SW 68 th Parkway - 100H1' or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Extended Stay ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW Irving Street 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. fr. or less 168.54 4
Ea, add'I 500 sq. 1 or portion 33.92 I
Tax maplparcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
75.00 12
Install Low Voltage Dialer residential (with above sq. ft.)
Renewable Energy O See Page 2
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to I,000 amps 301.04 2
• Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation
200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168s4 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
i:4 APPLICANT ® CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: Oregon Protective Services each branch circuit
B. Fee for branch circuits without
Contact name: Brian Mills service or feeder fee, first 56.1 B 2
branch circuit
Address: PO Box 887 Each add'I branch circuit 7 42 2
City /State/ZIP: Lake Oswego, OR 97034 Miscellaneous (service or feeder not included) _
Each manufactured or modular 67.84 2
Phone: (971) 246-3655 Fax: (503) 759 -4800 dwelling service and/or feeder
63
Reconnect only 67.84 2
E - mail: ops@molalla.net Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Oregon Protective Services LL . Signal circuit(s) or limited I I
panel. alteration, or extension. Page 2 , 2
Address: PO Box 887 Each additional inspection over allowable in any of the above
Additional inspection (1 in min) 6625! hr
City /State/ZIP: Lake Oswego, OR 97034 Investigation (I hr min) 66251 hr
hone: (971) 246 - 3655 Fax: (503) 759 Industrial plant (l hr min) 78.181 hr
�f Inspections for which no fee is
90.001 hr
CCB Lic.: 187223 t e 0,41 3 Electrical Li : CLI 195 /pi �Suprv Lic.: pe$45131At1 specifically listed (7, hr min) _
(l � PP r� ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required: ./�"1z�- iof t I Subtotal: 75.00
Print name: Brian Mills I Date: 5/21/13 Plan review (25 %ofpermit fee): 1 State surcharge (12% of permit fee): 9.00 /
Authorized signature: \ — . TOTAL PERMIT FEE: 84.00
This permit application expires if a permit is not obtained within 180
Print name: Brian Mills Date: 5/21/13 i days after it has been accepted as complete.
• Number of inspections allowed per permit.
1: 1puildsnglPermitelELC _PvmilApp_t14u913.dsc 440.4615T(l II05;COMMEEB
May 21 13 02:04p Brian Mills 5037594800 p.2
for all other installations
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined 575.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
® Protective Signaling
n Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
1.1ftuadingT mlts'F-1.0 PennitApp_040913.doc