Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 '' COMMUNITY DEVELOPMENT Permit#: ELR2013-00246
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/10/2013
Parcel: 1 S135BC00202
Jurisdiction: TIGARD
Site address: 10763 SW GREENBURG RD 120
Project: Subway Subdivision: HILLSBORO Lot: PTS 1-2
Project Description: Burglar alarm
Contractor: PROTECTION ONE ALARM MONITORING Owner: BELANICH, ROGER M
15500 SW 72ND AVE 22020 17TH AVE SE#200
PORTLAND, OR 97224 BOTHELL,WA 98021
PHONE: 503-624-0244 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/10/2013 $75.00
12%State Surcharge-Electrical 10/10/2013 $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: 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: 1 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 9 - 01 . You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.:0■.332.2344.
Issued By: .1 C _ Permittee Signature:
Y� 9 �� lam- cr3SLL�
OWNER INSTALLATION ONLY 4 00 LE79-
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 FOR OFFICE USE ONLY
Cl of Tigard \"\---+-8�\ �� ! Received /0 /0 �1� Permit No.SZ 43 "l 9.•
" 13125 SW Hall Blvd.,Tigard,OR: V.4\._ , \ DateBv:
Tigard, �y. Plan Review
Phone: 503.718.2439 Fax: 503. O\� Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 � Date Ready/By: 10 See Page 2 for
Internet: www.tigard-or.gov oC: Notified/Method: I Supplemental Information
. TYPE OF WORKf,..��y ca Q �� PLAN REVIEW
nC'� l-
k4iir °' Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction [•]Addition/alterati {
�, 0 Service or feeder 400 amps or more 0 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.
El A Addition of new motor load of ❑"A","E","I-2","I-3",
Job no.: Job site address: I00HP or more. occupancy.
!3o5 3 9 2 33 10-7(0 3 S�v �l R r1r $J 2(7 Q� ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 'r"f ei ❑Health-care facilities. ❑Supply voltage for more than
take_o, 0/2� Z ZZ3 ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: � /p��Prroject name: 5 0 gwpty ❑Service or feeder 600 amps or more.
i1 FEE SCHEDULE
wilt.Cross street/directions to job site: 51AJ S O y L'$3 Description f 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'I 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.)
/3 Limited energy,multi-family 75.00 2
1?>0 Qin L-4 -' ' A'1_,F-2Ak l tJ /ILL.
ST residential(with above sq.ft.)
Ii Renewable Energy ❑ See Page 2
!!J�11 Services or feeders installation,alteration,and/or relocation
b El PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
,n Name: sv aw ArY 401 amps to 600 amps 200.34 2
S Address: 1 0-1(0 3 SIA) Fl.e_tryj to 96 ie..D 4-IDD 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: T1 6,442_6 0& 11 2-7.-3 Temporary services or feeders installation,alteration,and/or
Phone:(503 )'l'4 vO.( Fax:( ) relocation
{
Z 200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not
201 amps to 400 amps 125.08 2
Jv 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
UQ ❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name: -CT10 N N O E each branch circuit 7.42 2
�� ..c r
B.Fee for branch circuits without
�
. Contact name: r ;L r",,,,,C Se service or feeder fee,first 56.18 2
0 branch circuit
b., Address: 1,Z 1 Z 5 1tJ 0 u kg_N A(A p Each add'I branch circuit 7.42, 2
1 City/State/ZIP: PO(- N t6 0,(. '1-T ZZ k4 ach manufactured Miscellaneous or(service or modular
not included)
M L Each manufaced or modular 67.84 2
dwelling,service and/or feeder
Pv.1 Phone: ( 5u3 ) if 43 2.`72 z Fax: :( Fitv(v) 2 2_3 q 9 Zr Reconnect only 67.84 2
E-mail: Joh..0'3rttfv' @ praA-ec{lon oae. (Awl Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: P,OTEGTI O A) oS/J C Signal circuit(s)or limited-energy I See
panel,alteration,or extension Page 2 r3 i' 2
Address: '1312 s "o U 1Z,‘I-A-M (2_6 Each additional inspection over allowable in any of the above
City/State/ZIP: lPO(e.:11....., � C O 2 �I '1 2' `-I
Additional inspection hrimi() hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(503 ) 44S 2.612.2. Fax:(Z(0(6,) Z,23 e(9 2S- Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: +( (03 25 Electrical Lic.: 3 4 %.4-j (LE Suprv. Lie.: 'Z(Ot.D it k specifically listed(/z hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: t02 Subtotal: LS �''
Print name: Date: Plan review(25%of permit fee):
S V`r 0 « 1 V�4/13 State surcharge(12%of permit fee): qt
Authorized signature: Q TOTAL PERMIT FEE: O !-.itj.-
Y p This permit application expires if a permit is not obtained within 180
Print name: ..) v ji N Q 8r!Cr-) Date: /0/97/3 days after it has been accepted as complete.
. Number of inspections allowed per permit.
1.\Building:\Permits\ELC_Permit App_ELR_ERE.doc Rev 05/21/2013 440--46151(1 I/0S/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 . 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 onR91s-3o9-ooao)
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(I hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(%: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.
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems ,
•
❑ Landscape Irrigation Control*
•
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Q Other Al arm 1 vdt oatvckl O
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC_Permi1App_ELR_ERE,doc Rev 05/21/2013