Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2013-00214
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/27/2013
Parcel: 2S 112AA00600
Jurisdiction: Tigard
Site address: 6713 SW BONITA RD 200
Project: Central Distribution Subdivision: MILLMONT PARK Lot: 49
Project Description: Installation of low voltage for security/burglar alarm system
Contractor: METRO SAFETY&FIRE INC Owner: WALTON CWOR NELSON 13 LLC
PO BOX 33650 BY CTMT-WALTON RE TAX
PORTLAND, OR 97068 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
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PHONE: 503-231-2999 PHONE:
FAX: 503-256-4691
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 08/27/2013 $75.00
12%State Surcharge-Electrical 08/27/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
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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: 1 Other: 0 Total $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is • -• ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don- accordance wi -.proved plans. This permit will expire if work is not started within 180 days of is uance, or if work is suspended for more the 180
day. ATTENTION: Oregon la re. you to follow the rules adopted by the Oregon Utility Notificati., -nter. Those rules are set forth in OAR
95 -001-0010 through OAR 952-00 •090. Y. • ay obtain a copy of the rules or direct questions to OUNC by calling 50 c4 987 or 1.800.33 4.
ssued By: Permittee Signature: 41 j d �t i
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 Application roll OFFICE US F ONLY
City of Tigard RECEIVED Received a / 2 A
7 0-6 Permit No.: / 3 iv'��
q 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1 RQ6Q" .) 7 i i 3 Date/By: Other Permit:
Inspection Line: 503.639.4175 P. Date Ready/By: kris: ® See Page 2 for
T l G A h D Notified/Method: Supplemental Information
Internet: www.tigard-or.gov ('ITv Oc,ri�.I�pn pp
TYPE Oki Ris i NlGn>�►t1IiS1�oN PLAN REVIEW
❑New construction Addition/alteration/replacement
eration/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 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 ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","l-2","I-3",
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Job no.: I Job site address: (7 13 S co a 0 N t` •- a C. ❑I ix or or m residential R occupancy.Recreational p
Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 1--; ,,1/4,..b, t7 p 7 zZy' � ❑Health-care facilities. ❑Supply voltage for more than
1 f� l r ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Pte, ,ca/4 I . ..s.4. su,,, ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.R.)
Limited energy,multi-family 75.00 2
��t residential(with above sq.ft.)
�ti Oc, of o�RC-v2t l�..�c, S Renewable Energy ❑ See Page 2
/ll ! Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I TENANT 200 amps or less 100.70 2
I201' 11 !� 201 amps to 400 amps 133.56 2
Name: �OR�ANla as t, att.,,,,. ^ CS tRPd —J5�• o L - ' 401 amps to 600 amps 200.34 2
Address: 197 13 s.' '3,N v�JJJJJ B.rd( c S.,41-c, Z5:0 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: 'T,S ` 0k• Gi 1 z z-y Temporary services or feeders installation,alteration,and/or
Phone:( )97 i_f 7 Z,'2,- 3 i 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,per panel
rib APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
Czl-�v SAFE/°� �t R�I'NL B.Fee for branch circuits without
Contact name: SA L CAS my service or feeder fee,first 56.18 2
branch circuit
Address: 143Z-1" SE S ek Si . Each add'I branch circuit 7.42 2
City/State/ZIP: �y� Miscellaneous(service or feeder not included)
Foal AND 0 - q 7 za3 Each manufactured or modular 67.84 2
Phone:(310) a3+_�5'f I Fax: :(Sl3) 2 y-jo_ Mt t dwelling,service and/or feeder
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Reconnect only 67.84 2
E-mail: /14Il-2L Qs a .TPDSiiFety 4A-to RAE. Cow" Pumporirrigationcircle 67.84 2
CONTRAC/rOR Sign or outline lighting 67.84 2
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Business name: SA„,„,c.. ' Signal circuit(s)or limited-energy I See p9�
Pt panel,alteration,or extension. Page 2 75 2
Address: Each additional inspection over allowable in any of the above
City/State/ZIP: Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 1�,36S� I Electrical Lic.:�_llyy"e Suprv.Lic.:�1 specifically listed(G hr min)
�V” ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: M A�� �r, Date. O.` 1. zoo
Plan review(25%of permit fee):
State surcharge.(I2%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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.
1:\Building\Perrnits\ELC_PermitApp_ELR ERE.doc Rev 05/21/2013 440-4615T(11/05/COM/WEB
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 04'. 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 Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
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❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
•OAR 918-309-0040)
El Heating,Ventilation and Air Conditioning
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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%s hr min)
r 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.
El Boiler Controls
❑ Clock Systems
• El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems . •
El Landscape Irrigation Control*
❑ Medical
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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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I:\Building\PermilsEELC_PermitApp ELR_ERE.doc Rev 05/21/2013 •