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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 114 q COMMUNITY DEVELOPMENT Permit#: ELR2014-00077 T tGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/01/2014 Parcel: 2S102CC03301 Jurisdiction: Tigard Site address: 13950 SW 104TH AVE Project: Specialized Housing Subdivision: FRELEON HEIGHTS Lot: 1 Project Description: Fire alarm. Contractor: LIMITED ENERGY NW Owner: SPECIALIZED HOUSING INC P.M.B. 190 4140 SW 109TH AVE 3439 NE SANDY BLVD. BEAVERTON, OR 97005 PORTLAND,OR 97232 PHONE: .503-810-7331 PHONE: FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 03/25/2014 $75.00 12%State Surcharge-Electrical 03/25/2014 $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: 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 $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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5' .• . 987 or 1.800.332. 344 IL Issued By: \\\ 7/ CL "C b rr7 Permittee Signa /. �.sr 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 Applicatim CEj IVED FOR OFFICE USE ONLY City of Tigard >a<�ed allr ' , , , Permit No.: 04RaDi �L • 13125 SW Hall Blvd.,Tigard,OR 972231a Plan Review �+ Z I Phone: 503.718.2439 Fax: 503.598.19 R 2 5 2014 DateBy: Other Permit/ / 'T-v' - _nom 1 1.1 Inspection Line: 503.639.4175 Date Ready/By: Juris: 65 Seepage 2 for I Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: 7- 5 Supplemental Information TYPE 011WINKNG DIVISION PLAN REVIEW El construction El 'tion/alteration/replacemcnt 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 ther: tt�(piCF /.der /`KT!/1-'*— where the available fault current ❑Marinas and boatyards. CATEGORY OF (;UNSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. less to ground,or exceeds 14,000 ❑Commercial-use agricultural Q•i!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","1-2","1-3", Job no.: Job site address: /..1j1114 �/3!{ _ii�n y?y Six or or more. occupancy. /-�" ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: 2 �A41/4/J ❑Health-care facilities. ❑Supply voltage for more than �� ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more. Cross street/directions to job site: As``,/A/f /J FEE SCHEDULE /�`f✓ ,O�/tf�L� '- ��J�t ,e,-7-1.__ Description I Qty. I Fee. I Total New residential single-or multi-family dwelling unit. _C�'n car/ 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.) Limited energy,multi-family 75.00 2 itr �J e- 4/, - �`7r�s� �_ 5c16-"`, residential(with above sq.ft.) Y /' �/y Renewable Energy ❑ See Page 2 Services or feeders installation,alteration,and/or relocation ❑ PROPERTY OWNER I ❑ 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:( ) 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 ❑ APPLICANT I Al CONTACT PERSON A.Fee for branch circuits with above service or feeder fee, 7.42 2 /�A� ,5,/4� Ai 4/yt zre-.e each branch circuit Business name: .CG / 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 City/State/ZIP: Miscellaneous(service or feeder not included) Each manufactured or modular 67.84 2 dwelling, Phone:(3253) 9/t) 2 33 / Fax: :y,66 ) S.v 6 3 j 2 2 Reconnect o lye and/or feeder 67.84 2 E-mail: fi8L) Ci-mfc, f5 T. if-e-1 Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: Eeluitck7 <9 7‘,/," Signal circuit(s)or limited-energy } See panel,alteration,or extension. 1 Page 2 2 Address: ,t 4' /7 ivJ y- ,', — 5,y e-s> Lai. Each additional inspection over allowable in any of the above City/State/ZIP: / l Additional inspection(1 hr min) 66.25/hr �,�'( /l�9a.if ©,e 72.,,2 J Investigation(1 hr min) 66.25/hr Phone:(3'0) c/o )3 t Fax. ).5-576, ,7 Tzy-� Industrial plant(1 hr min) 78.18/hr 38'.94__j Inspections for which no fee is CCB Lic.: j3�6 ff Electrical Lib 3/2 cef Suprv.Lic.: specifically listed(%hr min) `��/hr Suprv.Electrician signature,required: �!����, / /0/l ELECTRICAL PERMIT FEES ll Subtotal: Print name: r�� n / fc..,g�, Date-/Z��Ij"/ Plan review(25%of permit fee): �'�/ U ,� "' State surcharge(12/o of permit fee): Authorized signature: � TOTAL PERMIT FEE: ek4y.C � This permit application expires if a permit is not obtained within 180 Print name: Eiu4i/( „0. ` ...4R7A44,9 Date:r/" 5- �,3/,e/ days after it has been accepted as complete. /� • Number of inspections allowed per permit. 1:\Building\Permits\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 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 I=1 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 ❑ 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 1 Inspections for which no fee is 90.00/hr specifically listed(A 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 ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC Fl 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 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 13950 SW 104TH AVE, TIGARD, OR, 97223 Commercial - Electricial Limited Energy 199 Electrical final 2014-04-03 00:00:00 ELR2014-00077 PASS - No C of O Violation Summary: Inspector Contractor