Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
311! COMMUNITY DEVELOPMENT Permit#: ELR2013 00193
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/06/2013
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 350
Project: Williston Finacial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Low voltage for data
Contractor: BRITTINGHAM ENTERPRISES INC Owner: PACIFIC REALTY ASSOCIATES
857 SW THEATER DR ATTN: N PIVEN
BEND, OR 97702 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 541-382-5563 PHONE:
FAX: 541-323-3513
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/06/2013 $75.00
12%State Surcharge-Electrical 08/06/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 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 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 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. ATT N: Oregon la e.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through OAR 952-01 '990 •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
aro
I sued By: — 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 Applicationiu EIVED FOR OFFICE USE ONLY
• City of Tigard Date/B : 01 �`j Permit No.: eL/1-ap/?j-Z7)f/��j
III
13125 SW Hall Blvd.,Tigard,OR 97223 AUG 6 2013 Plan Review
•.' 0 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
'��( 'p/?j O6/7 S•
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
-F I GA l D p CITY OF TIGARD g
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
. BUILDING DIVISION .
TYPE OF WORK ' PLAN REVIEW
El New construction ■ ', .ddition/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 El 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 El Accessory building amps for all other installations. buildings.
❑Multi-family El Master builder El 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","1-2","1-3",
I00HP or more. occupancy.
Job no.: Job site address: 17-9,01 v3 -Tm P v...( ry ❑Six or more residential units. ❑Recreational vehicle parks.
Ci /State/ZIP: / ❑Health-care facilities. ❑Supply voltage for more than
/0.)t9- 2 7 z Z ❑Hazardous locations.
600 volts nominal.
uite ldg./apt.no.: 5?) Project name: tLL t �N � f ) ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 11201 Description I Qty. I Fee. I Total I •
7 New residential single-or multi-family dwelling unit.
0 FF D 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 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
/ �� 1;2671- Limited energy,multi-family 75.00 2
•,OTA1 /J O[. 704-6! O d Pet_ `74 )46 L!/,j e, residential(with above sq.ft.)
Renewable Energy ❑ 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: Z4)/e.G I Si p A) F ,..,„,,,J e,,a . 401 amps to 600 amps 200.34 2
Address: /1909 cTit/ 6� - t� Kir' 601 amps toI,000amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: 77-7e 1, Q /i , 9 7 Z 3 Temporary services or feeders installation,alteration,and/or
L../3 relocation
Phone:(��') �� Fax:( ) 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 '131f CONTACT PERSON. A.Fee for branch circuits with
-- above service or feeder fee,
7.42 2
Business name: _ each branch circuit
c rT 1' •(' )J it'''s L�7b-Y�Y?I S CC J�P• B.Fee for branch circuits without
Contact name: Lc l 7T 1 - V service or feeder fee,first
branch circuit 56.18 2
Address: rS `Uzi `�a s-0,t3`1•—et 1-ec , Each add'I branch circuit 7.42 2
City/State/ZIP Miscellaneous(service or feeder not included)
C^N O Q r?—2 O 2_ Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone:.6-1-1 1 ) Z"-556 Fax: :(Sip))
Z .35 Reconnect only 67.84 2
E-mail: t--'W 12 j '7'77/'216 &yyl A t t ■ C- v-- Pump or irrigation circle 67.84 2
CONTRACTOR' Sign or outline lighting 67.84 2
Business name: `Q• Signal circuit(s)or limited-energy D See `171"
LM.,
1 t\ �Bl�qQ t s� u panel,alteration or extension. ( Page 2 J 2
Address: . ---7-hf_e„At. q- iL-_ Each additional inspection over allowable in any of the above
City/State/ZIP: ^� Additional inspection(1 hr min) 66.25/hr
�) m ` (3 �. ? ??C Z— Investigation(1 hr min) 66.25/hr
Phone:(' ) X} s�. �6 3 Fax:( ��!) �Z� 3,!3 Industrial plant(I hr min) 78.18/hr
/�� Inspections for which no fee is 90.00/hr
CCB Lie.. Electrical Lic.: 4c 1t/gi Suprv.Lie.:qzczoict specifically listed(/r hr min)
_ ELECTRICAL PERMIT FEES - '
Suprv.Electrician signature,required: Subtotal: '7s. co
Print name: st , — Date; 1 /3 Plan review(25%of permit fee):
I State surcharge(12%of permit fee): ! ,
Authorized signaturttar. '�-. TOTAL PERMIT FEE: 04.O!�
0/3 This permit application expires if a permit is not obtained within 180
Print name'• A.-- 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 Qt'. 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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>l00 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
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
specifically listed(%l 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
❑ Audio and Stereo Systems days after it has been accepted as complete.
" Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
/el 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
•
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013