Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t1- COMMUNITY DEVELOPMENT Permit#: ELR2014-00129
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/09/2014
Parcel: 2S 113AB00700
Jurisdiction: Tigard
Site address: 16255 SW UPPER BOONES FERRY RD
Project: The Circuit Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Installing SK-5208 and FRS radio with pull station and smoke detector.
Contractor: FIRST RESPONSE SYSTEMS INC Owner: COLEMAN BOULDERING LLC
4970 SW GRIFFITH DR#100 ATTN:ANDY COLEMAN
BEAVERTON, OR 97005 16255 SW UPPER BOONES FERRY RD
TIGARD, OR 97224
PHONE: 503-207-5300 PHONE:
FAX: 503-207-5301
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/09/2014 $75.00
12%State Surcharge-Electrical 06/09/2014 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
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 thr 0 )52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by callir a2,32.1987 or 1.800.332.2344.
Issued By /�� ( 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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard �` 'B ���/�, 4-377—
Permit No.: — ,�� 14 e.• l ,
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' I ' Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: ■ t go 1 if...f 00 fl J
7 I Li A It I Inspection Line: 503.639.4175 Date Ready/By: n ® See Page 2 for ,i� _l
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement 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.
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.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.: 130113850 Job site address: 16255 SW Upper Boones Ferry Rd f or more. occupancy.
❑Six x o or r more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Circuit Boldering Gym ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I 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'l 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential 7500 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family 75.00 2
Install SK-5208 and FRS Radio with pull station and smoke detector. residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 00 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 I
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 ❑ 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'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: 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: First Response Systems Signal circuit(s)or limited-energy I See 75 00
panel,alteration,or extension. Page 2 2
Address:4970 SW Griffith Dr Ste 100 each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Beaverton OR 97005 Investigation(1 hr min) 66.25/hr
Phone:(503)641-6795 Fax:(503)207-5301 Industrial plant(1 hr min) 78.18/hr
CCB Lie.: 111713 Electrical Lie.' '�4, `_�L�e Inspections for which no fee is 90.00/hr
`s*GGSuprv.Lie.: 0 L 4 specifically listed('/z hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: . ! Subtotal: 5.
Print name: Dan Duggan Date: Plan review(25%of permit fee):
G /9/0.(
State surcharge(12%of permit fee): O .(.A
Authorized signature: — TOTAL PERMIT FEE: w...4-,
This permit application expires if a permit is not obtained within 180
I Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
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WALL DISPLAY- 72 SQ. FT. - .
1 SCALE: 1/2" = V-0"
ALLOWANCE 16'h x 60'w = 960 x .15 = 144sf SIDE VIEW DATE: 05/16/14
J SCALE: 1/2" = 1'-0" PAGE#: 2 OF 3
OTENANT IDENTIFICATION -WALL DISPLAY
Scale. 1/2" = 1-0" DRAWING#:
14-JF206r3
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
16255 SW UPPER BOONES FERRY RD,
TIGARD, OR, 97224
Commercial - Electricial Limited Energy
198 Low voltage final
PASS - No C of O
ELR2014-00129
Chip Barnett
Violation Summary:
Inspector Contractor