Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
al
s . ' COMMUNITY DEVELOPMENT Permit#: ELR2014-00090
13125 SW Hall Blvd.,Ti Date Issued: 04/10/2014
Tf<:,'1C�i:7 and OR 97223 503.718.2439 Tigard 2S113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Project: Copytronix Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Security system.
Contractor: ADVANCED SECURITY&FIRE Owner: PACIFIC REALTY ASSOCIATES
2218 NE SUNRISE LN ATTN: N PIVEN
HILLSBORO, OR 97124 15350 SW SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-519-4550 PHONE: 503-624-6300
FAX: 503-643-0848
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 04/10/2014 $75.00
Type of Use: COM 12%State Surcharge-Electrical 04/10/2014 $9.00
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: 1 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 Notifica..r1 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 32.1987 1.800.332.2344.
Jt.
Issued B . �_ - - • ee Signature: 1 c 101
411111%. 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 [Mt OI 1.1( I 1 `,I ()\1 1
City of Tigard Received Date/B : E / Permit No.: —
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review i ` a
Phone: 503.718.2439 Fax: 503.598.19 v\/6% Plan Other Permit: ar /P AO j ct_ ,e
i I Inspection Line: 503.639.4175 r\l . Date Ready/By: Janis: &1 See Page 2 for
Internet: www.tigard-or.gov Q 4 $ otified/Method: ` Supplemental Information
TYPE OF ��� ` PLAN REVIEW
❑New construction g Addition/alteration/re�ila� � Please check all that aPP1Y(submit 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 CONSTRU , , 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","1-2","1-3",
Job no.: Job site address:/ ,,4,2-/O s a) 7 c2 f) 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: fr. 'f'7(//9 ,-, -',f 9 7 6?<,2 I ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: �0,j-/--/-,,,r) /x ❑Service or feeder 600 amps or more.
�J FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
_I.) 671.9// S e e u r,.1y Sys fe residential(with above sq.ft.)
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: /0/9 C. 77-,,,,i 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 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: Each add'l branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) 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:/9c,V/9/-)C a se C u r,71 rt re_ Signal circuit(s)or limited-energy I See d W
`
panel,alteration,or extension. Page 2 /J7 Z
Address: 'LI l zi 0 526 , I ndA t n , Each additional inspection over allowable in any of the above
City/State/ZIP: 8`0 i9 yC'1' /-O f1 ,nQ f 7 QQ,�,
Additional gat inspection(1 hr (1 hr min) 66.25/hr
�y 4'13 c, Investigation(1 hr min) 66.25/hr
Phone:(S03 -5 19_ L/ 5 5U Fax:(.5-.03- ' D b .q ' Industrial plant(1 hr min) 78.18/hr , _
Inspections for which no fee is 9000/hr
CCB Lic.:I/6h J 7.4 Electrical Lic.: e E- g Suprv.Lic.:z ii LE/9 specifically listed('A hr min) _
ELECTRICAL PERMIT FEES• "
Suprv.Electrician signature,required: 7)2.atecud Subtotal: —6'7 A-,
Print name: 64 y i d r-' )e if)Ne k Date: 4.1//0/// Plan review(25%of permit fee):
State surcharge(12%of permit fee): 7,
Authorized signature: TOTAL PERMIT FEE:/p ✓ _
M • This permit application expires if a permit is not obtained within 180
Print name: D�v d `Y)6/n/9 v/ k Date: 1.002./ days after it has been accepted as complete.
///// * Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-46157(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
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 OAR918-309-0040)
* Solar generation systems in excess of 25 kva:
System
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(1/2 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
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outd Landscape Lighting*
Protective Signaling
❑ Other
Total number of commercial systems: J
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013