Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2013-00211
-It GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/22/2013
Parcel: 2S113AB00500
Jurisdiction: TIGARD
Site address: 16083 SW UPPER BOONES FERRY RD 310
Project: Sterling Bank Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Data telecommunications system.
Contractor: TELESPHERE Owner: G&S FC LLC
449 SW ALDERWOOD 16083 SW UPPER BOONES FERRY RD,
WEST LINN, OR 97068 STE
TIGARD,OR 97224
PHONE: 503-880-9412 PHONE:
FAX: 503-638-9286
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/22/2013 $75.00
12%State Surcharge-Electrical 08/22/2013 $9.00
Type of Use: COM
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 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 I.. equires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR . 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.
Ale
Issued By: P / 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:
CONTj2..CTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' 4:4:: � /�/ Date: gam-2 a
LICENSE NO. LL S s•( L (�
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 Application .orFlcl; USE ONLY
City of
Received ,v.-.'Tigard DateB : 0 / WiS Permit No.: 4 .
'c a 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review I (3_0_6 a`/
• p , Q) Other Permit:
Phone: 503.718.2439 Fax: 503. 1 1, Date/By:
:FIG A R II Inspection Line: 503.639.4175 \CCl,� O� Date Ready/By: luris: S See Page 2 for
Internet: www.tigard-or.gov `' V`, S� Notified/Method: - T'7—co Supplemental Information
. • TYPE:OF'WOR Qjc�� PLAN,REVIEW
•❑New construction ❑Addition/alteratio•.' -,l*rient Please check all that apply(submit 2 sets of plans w/items checked below):
❑Demolition ❑Other: 'Q�
111��� ❑Service or feeder 400 amps or more ❑Building over three stories.
�1~ 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 21-Commercial/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' 0 Emergency system. larger separately derived system.
. ❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: I Job site address: { 6 0/ 3 Sul ttl Per Chi 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: f" a f) (, 2- ❑Health-care facilities. ❑Supplyly home for more than
❑Hazardous locations.
Suite/bldg./apt.no.: 3 f O I Project name: �-ec',y� r3q AK ❑Service or feeder 600 amps or more.
`/ J J FEE SCHEDULE
Cross street/directions to job site: Descriptioo 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
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.)
Limited energy,multi-family 75.00 2
A374 I I D A cc. Lot KS lj 9S� !�� residential(with above sq.ft.)
Renewable Energy I ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
• ' '❑ PROPERTY OWNER .I ' Et-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:( ) I 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, er panel
• APPLICANT ' I .❑ CONTACT PERSON' ' , A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: j. s-- 6c.....t 45 (3(p f„.) each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP:
Each manufactured or modular 67.84 2
Phone:( ) I Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
. - CONTRACTOR ., Sign or outline lighting 67.84 2
Business name: er,e4
Signal circuit(s)or limited-energy See
�0� e✓`� l 7S
panel,alteration,or extension. Page 2 2
Address: I:' K PI .5k) A I ',Awe. I✓ - Each additional inspection over allowable in any of the above
City/State/ZIP: F t= t, e5 2 q?d 6 Investigation gat inspection(1 hr min) hr min) 66.25/hr
r I Investigation(I hr min) 66.25/hr
Phone:Sn3) ff t2 9 T.2_ Fax:(501)63/ q Z g'6 Industrial plant(1 hr min) 78.18/hr
I.:.'ctions for which no fee is
'CCB Lic.: 1 till (561 . Electrical Lic.1 LE 1(is Suprv.Lic.:15S/L 65; specifically listed(%:hr min) 90.00/hr
e ELECTRICAL rPERMIT,FEES Suprv.Electrician signature,required: Subtotal: 75. 'Y'" '
Print name: 1� ' I Date: V,Z Z- 13 Plan review(25%of permit fee): • .
" 1• �-U t State surcharge(12%of permit fee): 7_
Authorized signature: TOTAL PERMIT FEE: -il
/ This permit application expires if a permit is not obtained within 180
Print name: 4 Ike__ 0Y co r(c fit I Date:8- 2 7/ 3 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 QtY. 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
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
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
ElOther: additional inspection over allowable in any of the above: _
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%s 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
sue❑ Clock Systems
,�,Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting* .
El Protective Signaling
El Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013