Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
III s COMMUNITY DEVELOPMENT Permit#: ELR2014-00125
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/02/2014
T[�"`�Ft O g Parcel: 1 S 133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Project: Westgate Baptist Church Subdivision: CHAPARRAL Lot: 1
Project Description: Fire alarm.
Contractor: ADVANCED SECURITY&FIRE Owner: WESTGATE BAPTIST CHURCH
2218 NE SUNRISE LN 12930 SW SCHOLLS FERRY RD
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-519-4550 PHONE: 503-524-3500
FAX: 503-643-0848
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/02/2014 $75.00
12%State Surcharge-Electrical 06/02/2014 $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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503. 987 or 1.800.332.2344.
Issued By• i - .411. Permittee Signature: /47 V .
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 FOR OFFICE USE ONLY
City of Tigard s Received p J�'' Permit No f
•J g c) ,� Dacteive 5. i�i , � e d, �d/IZ
13125 S W Hall Blvd.,Tigard,OR 9722 9 �-� Plan Review / V�/
'� s Phone: 503.718.2439 Fax: 503.598.19 MPS • `.aate/By: Other Permit: /4/app.]_c�o a
I I t ,1 P.I Inspection Line: 503.639.4175 \�I` j0G a Ready/By: J°ds H See Page 2 for
Internet: www.tigard-or.gov 01,` %IN%;°t'totified/Method: T Supplemental Information
•
TYPE OF WORK..,i IIIIIt, PLAN REVIEW
—
❑New construction '• Addition/alteration/ -.1.} t 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.
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 Ibuilding / amps for all other installations. buildings.
❑Multi-family ❑Master builder %Other:C n a rc h ❑Fire pump. ❑Installation of 150 KVA or
, ❑Emergency system. larger separately derived system.
AND LOCATION ❑Addition of new motor load of ❑"A" "E" "1-2" "]-3"
Job no.: Job site address: ) 1/, L 1o0HP or more. occupancy.
/4 /J` . �� ,3 i✓IA ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than
Project ��s�QR ���'I'' C`�
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Pro ect name: s3 J ❑Service or feeder 600 amps or more.
►r a
Cross street/directions to job site: ip 'o - "'ice' ''�
J Description I Qty. 1 .�Fee.� ��1 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'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
,Q DESCRIPTION OF WORK (with above sq.ft.)
/ d d f 1 , o n to F/i /1{A r in S V§"�@ ro ,
Limited energy,multi-family a e . 75.00 2
/ 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: 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 .
jia APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
usiness name: Ad v,9 n c e.,5 See a p :/D' )� F j re each branch circuit 742 2
B.Fee for branch circuits without
Contact name: n A yid /)o rfl vi ` service or feeder fee,first 56.18 2
`I V / ', branch circuit
ddress: / '7 1 y O GCJ 4 ;n d A 2.o Each add'I branch circuit 7.42 2
I City/State/ZIP: U e/�v ef' f-d n /q Q�j Miscellaneous(service or feeder not included)
Each manufactured or modular 67 84 2
Phone:(503) 5J LI 55-e Fax. .(Sod) 6 U ^� L S dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: i9Gd I/4/1 ed s ec 7re.10 from /e r
� CB n'] Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
•_- �� ',4 ^� Signal circuit(s)Business name: v r� gn ( )or limited energy See dZ
,S u,....--11 ,V panel,alteration,or extension. Page 2 —75--• 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:
Investigation(1 hr min) 66.25/hr
Phone:( ) j all 11 l` I Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.:/ 6 / 74, Electrical Lic.: p,E- O Suprv. Lic.:‘//4 EA specifically listed('/:hr min) , 80.00/hr
Suprv.Electrician signature,required: ELECTRICAL. PERMIT FEES
�AJC(� Subtotal: s, ui
Print name: Di()v t'd / ' !o r/9 v/k Date: 5/'4 ii Plan review(25%of permit fee):
State surcharge(12%of permit fee): q, 0
Authorized signature: TOTAL PERMIT FEE: �( .
A' A- This permit application expires if a permit is not obtained within 180
Print name: D/9.v%ct /)D/"19 v/ n Date: 9,'&Q/1 days accepted complete.
s after it has been acre red as corn fete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC PermitApp_ELR_ERE doe Rev 05/21/2013 440-4615T(I I/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Fee for all residential systems combined ... $75.00 Description Qty. � Fee Total l •<�t
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n 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
n Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
n 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
Inspections for which no fee is 90.00/hr
s. cificall listed(4 hr )
min
CO Q -M Y: _ y.0 � f *us
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
nAudio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
Fire Alarm Installation (19dd;liOn )
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other /
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
L\Building/Permits\ELC_PermttApp_ELR_ERE doc Rev 05/21/2013