Permit Ili rt
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELR2014-00007
TIGARD 13125 SW Hall Blvd..Tigard OR 97223 503.718 2439 Date Issued: 01/15/2014
Parcel: 2S101AC00800
Jurisdiction: Tigard
Site address: 7148 SW GONZAGA ST
Project: The Adrienne Subdivision: BEVELAND NO.2 Lot '4
Project Description: Low voltage for fire alarm
Contractor SAFE TECHNOLOGY GROUP INC Owner: ROGERS, ROY R
6400 NE HWY 99 STE G375 13690 SW TWELVE OAKS CT
VANCOUVER.WA 98665 TIGARD OR 97224
PHONE. 360-699-2130 PHONE
FAX 360-719-1527
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/15/2014 $75 00
12%State Surcharge-Electrical 01/15/2014 S9 00
Type of Use: COM
Class of Work: NEW
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls 0
CCTV 0 Clock Systems 0
Data&Telecommunications: 0 Fire Alarm: 1
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 S84 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 160 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 Th• a rules are set forth 'n OAR
952-001-0010 t g RR,952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 :*0. . •' 44
/� � 4- /
Issued By: J ��'-7 `9-r1 4 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.
RECEIVED
Electrical Permit Application l I}F: I ,1 > 1 I I I. ,I ,1 r I 1
City of Tigard JAN 0 7 2014 �e ! glrILE 3 Pcrroil No I14&6/ —00007
IIIIII
i " 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718 2439 Fax" �Q, DatdB : Other Permit: ,�S�/Y'+ S
i r t, Inspection Line: 503.639.41 1 TIGARD Date Ready/By: Juriv 0 Ser Pane 2 for
Internet: www.tigard-or.ggUILDINC DIVISION Noofied/Method. Suppleuse eltdwroation
•
TIME or WORK - PLAN REVIEW
INNew construction addition/alteration/replacement Please check all that apply(submit I sets of plans w/items checked below):
❑Demolition Other: ❑Service or reader 400 amps or more ❑Building over three stories.
❑ where the available fault current 0 Marinas and boatyards.
CATEGORY OP commtvaioN exceeds 10,000 amps at 150 volts or ❑Floating buildings.
Iris to ground.or exceeds 14,000 0 Commercial-use agricultural
❑ I-and 2-family dwelling ®Commercial/industrial D Accessory building amps for all other installations. buildings.
't-Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
AND LOCATION
0 Emergency system. larger separately derived system.
MI SITE INRATIi
❑Addition of new motor load of ❑"A" "E" °k-2""1.3",
Job no.: ' Job site address:7148 SW GONZAGA ST 1001[P or more. occupancy"
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:TIGARD OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name:THE ADRIENNE ❑Service or fader 600 amps or more. _ _
FEE SCHEDULE
Cross street/directions to job site: Deacriptte. I Qtr. I Fee. f Taal 1 •
- New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,00o sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 3392 1
Tax map/parcel no.: _ Limited
pt'residential 75.00 2
�OF wow( (with above sq.ft.) -
FIRE ALARM
Limited residential di above multi-family ft.) 7500 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
0 ntornair wawa l a TENANT 201 amps to 400 amps , 133.56 2
401 amps to 600 amps 200.34 2
Name:
. 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: relocation
services or feeders installation,alteration,and/or
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
Branch circuits-new,alteration,or extession, panel
Owner signature: Date: A.For for branch circuits with
gli APPLICANT TACT F�OIM above service or feeder fix, 7.42 2
each branch circuit
Business name:SAFE TECHNOLOGY GROUP INC. B.Fee for branch circuits warhoad
service or feeder fee,first 56.18 2
Contact name:JASON SWEET branch circuit
Each add'I branch circuit 7.42 2
Address:6400 NE HWY 99 SUITE G375 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP:VANCOUVER WA 98665 dwelling,service and/or reader -
Phone:(360)699-2130 Fax: :(360)719-1527 Reconnect only 67.84 ^2
Pump or irrigation circle 67.84 2
E-mail:SALES)SAFETECHNOLOGY.NET Sign or outline lighting 67.84 2
cormutcroa Signal circuit(s)or limited-energy
Business name: SAFE TECHNOLOGY GROUP INC. panel,alteration,or extension. t Paget 75 2
Each additional inspection over allowable in any of the above _
Address:6100 NE HWY 99 SUITE G375 Additional inspection(t hr min) 66.25/hr
City/State/ZIP:VANCOUVER WA 98665 Investigation(I hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
"
Phone:(360)699-2130 Fax:(360)719-1527 Inspections for which no fee is "�hr
specifically listed(V5 hr min)
CCU Lic.: 173731 1 Electrical Lic.: CLE79 Suprv.Lic.: 4272LEA ELECTRICAL PERMIT FEES 1
S iy Subtotal: 75'4'
Suprv. Electrician signature,required: / i�.ei -
Plan review(25%of permit fee):
Print name: JASON SWEET rr77 Date: i- Cj .1'-( State surcharge(12%of permit fa): 9_00
Authorized signature: / J.9�. �" TOTAL PERMIT FEE: d wi .
L+-� This permit rppticatioe aspires if a permit not obraised wittlie 180
�,/ days after it has been accepted as complete.
Print name: JASON SWEET - Date: /- bt- I • Number of inspections allowed per permit.
1.1Bu11ding\PamsrVF1.C-PermcApp.dec 0501/10 H0-4615T11 I/OS/COM/WEB
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ O• utdoor Landscape Lighting*
❑ Protective Signaling
❑ O• ther
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
1"RI ddmg,Permiu\ELC-PermiI App.doc 07/01/10
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11850 SW 95TH AVE, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
2014-01-27 (null)
ELC2014-00007
PASS - No C of O
Violation Summary:
Inspector Contractor