Permit p CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2014-00165
T i GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/24/2014
Parcel: 251 01 8801 500
Jurisdiction: Tigard
Site address: 12244 SW GARDEN PL
Project: Colossae Church Subdivision: CROW PARK 217 Lot: 3
Project Description: Adding telephone line for fire alarm
Contractor: BRY-COM Owner: WALTON CWOR PARK BC 8 LLC
14244 SE BUSH BY EQUITY OFFICE MANAGEMENT LLC
PORTLAND, OR 97236 PO BOX A-3879
CHICAGO, IL 60690
PHONE: 503-761-5156 PHONE:
FAX: 503-760-7501
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 07/24/2014 $75.00
Type of Use: COM 12%State Surcharge-Electrical 07/24/2014 $9.00
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 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: 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 i - -• •- -- with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspend• for more 180
days. , ENTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Ce. > Those rules a . -et fo • OAR
952-0.1-0010 through OAR 95 'U '.90. You may obtain a copy of the rules or direct questions to OUNC by calling 503 .r 1.800.3234.
I
Is i ued By: I ,r j Permittee Signature: L Li .4 Ar
fp%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 Applica FOR OFFICE USE ONI.I
Cl of Tigard Received permit#. -aG
IIIIII Date/B : 7 Aria= ELLVO /G s
- 13125 SW Hall Blvd.,Tigard,OR 9 � 2 4 2 014 Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.59 . Plan R
Inspection Line: 503.639.4175 Ready Date/By: Juris: 0 See Page 2 for
l_I("A R 1) Internet: www.tigard-or.gov CITY OF 11GAH[ Notified/Method: Supplemental Information•TYPE�Ar10Rf[7 I PLAN'maw .
❑New construction r.Addition/alteration/replacement Please check all that apply(submit I sets of plans ay/items checked):
❑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.
❑ 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
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
Job#: 1 Job site address: /2 gif 5 �-/��/ i/ ❑Addition of new motor load of system.
1 wbe�`7`-' L' I OO ti or more. ❑system.
City/State/ZIP: 'T/Cl'ici Ull� ❑Health-care or more residential units. ❑Recreational vehicle parks.'/ ❑Health care facilities. P
Suite/bldg./apt.#: I Project name: W�s j-/}� e itizeiF- ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty.1 Each I Total 1 "
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OP WORK Limited energy,residential
`� / �i �Ay'{//��� /�,c( (with above sq.ft.) 75.00 2
/�` ' �/r��' L ,`max—� I �" Limited energy,multi-family 75.00 2
ri t C. At 'q residential(with above sq.ft.)
If. `" l Renewable Energy ❑ See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,Qer panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit _
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.l8 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: pEj'w'c Sign or outline lighting 67.84 2
/l /J See Page 2 2 Signal circuit(s)or limited-energy
Address: � T� s Q S panel,alteration,or extension. g
City/State/ZIP: 977,g Each additional inspection over a Towable in any of the above
6 ,( � �� Additional inspection(1 hr min) 66.25/hr
Phone:( 762 (—575 I Fax:(0 3)` J7 /)c-73 3, Investigation(1 hr min) 66.25/hr
n„q_/ two g /y/t�t e q' `-"" Industrial plant(1 hr min) 78.18/hr
Email: -tJ(Il,( ( r(fJ C f�/"i Inspections for which no fee is
P7 L/L/L(3 I g.(j� ,1j p /3941,14 specifrcall listed V2 hr min) 90.00/hr
CCB Lic.: l!� ( I ( 3 Electrical L' •�" J y S� rv.Lic.: y (
ELECTRICAL PERMIT FEES
Suprv.Electr(�ian signature,required: / 1/1 Subtotal: '76
Print name: �/}J /}�tg� t'ate: 7--Z/1411 ❑Plan Review Required(25%of permit fee):
�" State surcharge(12%of permit fee): .CO
Authorized signature: TOTAL PERMIT FEE: 8(.1 Od
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: ;, FEE SCHEDULE
Description i Qty. I Each Total I "_
Fee for all residential systems combined: $75.00 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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
Garage Door Opener*g p >100 kva(fec in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >IOOkva—noadditionalcharge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min) _
Inspections for which no fee is 90.00/hr
specifically listed('/]hr min)
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 + Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
H Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
` ata Telecommunication Installation
ire Alarm Installation
❑ HVAC
❑ 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.docx Rev 04/21/2014