Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 I: COMMUNITY DEVELOPMENT Permit #: ELR201300131
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/17/2013
Parcel: 1 S 136AD04000
Jurisdiction: Tigard
Site address: 11527 SW PACIFIC HWY
Project: Labor Works Subdivision: VILLA RIDGE Lot: 7
Project Description: Low voltage for data
Contractor: BRY -COM Owner: PACIFIC TERRACE COMMERCIAL LLC
14244 SE BUSH BY SMITH, EDITA M
PORTLAND, OR 97236 833 NW 170TH DR
BEAVERTON, OR 97006
PHONE: 503 - 761 -5156 PHONE:
FAX: 503 - 760 -7501
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/17/2013 $75.00
Type of Use: COM 12% State Surcharge - Electrical 06/17/2013 $9.00
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data & Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom /Paging: 0 Landscape /Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit '= ' ue• • -'-ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do : in accordance with : •prov- • •lans. This permit will expire if work is not started within 180 days of issuance, o if work is suspended f•r more the ;0
days ATTENTIIN: Oregon I. requir= •u to follow the rules adopted by the Oregon Utility Notification C; Thos= rules ar t forth CAR
952 601- 0010th •ugh OAR 9 -00 0090 You ay obtain a copy of the rules or direct questions to OUNC by calling 503.2 • • • or 1.800 = 2344
./
Is ued By: l 2/ �= ; 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 Applicati '1 _, hOlz c�rrlc„ Utih: OM.)
N City of Tigard I Date/By: \ `" / 7 / 3 •• Permit No.: ELIL.2 3 -66 15/
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Date/By: 503.718.2439 Fax: 503.598.19CM 1 7 2013 Datey: Other Permit: 6u p g 5- OCI /Il /
,
l' I G A R u Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD.' Notified/Method: Supplemental Information
TYPE OF �JING DIVISION PLAN REVIEW
Cl New construction I4ddition/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 �1 ommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
JOB .SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 100HP or more.
7'7 c /' r {� (j occupancy.
j/5 1 C/� `�( / ` . l '" ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: -77 v A�''r ❑ Health -care facilities. ❑ Supply voltage for more than
� yy"" � �� ❑ Hazardous locations. 600 volts nominal.
P
Suite/bldg. /apt. no.: Project name: 0 or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Oty. I Fee. I Total
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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) • 75.00 2
` s 11 t I ' e cAna
Limited energy, multi-family
,,(` �l L � l /�j v \ residential (with above ve sq.
ft.) 75.00 2
� 1
Renewable Energy 0 See Page 2
(
Services or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER I ❑ 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 1,000 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 to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits— new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first 56.18 2
branch circuit
Address: Each add'/ branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /Stale /ZIP: Each manufactured or modular
Phone: ( ) Fax: : ( )
dwelling, service and/or feeder 67.84 2
Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR , Sign or outline lighting 67.84 2
Business name: A � Signal circuit(s) or limited- energy See CO
111��� panel, alteration, or extension. ( Page 2 .. CO 2
Address: / l l 7 ! !��-5f.J Each additional inspection over allowable in any of the above
City/State /ZIP: C& c (2 3 ' Investigation ti inspection hr min) 66.25/ hr
Invs(1 (1 hr min) ) 66.25/ hr
Phone: (.3 96 f - s/ 57, Fax: ?0 X 73 3 7 Industrial plant (1 hr min) 78.18/ hr
g � / Inspections for which no fee is 90.00/ hr
CCB Lic.: (,y2/ y 2 ) Electrical Lic.: - --i /�J .: M. specifically listed CA hr mi)
ELECTRICAL ?PERMIT FEES
Sup. Electrician signature, required: / Subtotal: -� •ou
Print name: Y 9 � s s 1 r 0 (� � 11 . e: /n /3 Plan review (25% of permit fee):
17� State surcharge (12% of permit fee): q . GO
Authorized signature: TOTAL PERMIT FEE: g ( . Od
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
" Number of inspections allowed per permit.
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Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qtr. I Fee I Total I •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
El Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
El Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva (fee in accordance with 552.26 2
El Heating, Ventilation and Air Conditioning OAR 918 - 309 -0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva— no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/ hr
charged at an hourly (1 hr min)
Inspections for which no fee is 90.00 / hr
specifically listed (14 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918- 309 -0000) Plan review, if required (25% of permit fee):
State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
El Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
El Boiler Controls
El Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
El 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
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