Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I 7 COMMUNITY DEVELOPMENT Permit#: ELR2014-00164
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/21/2014
I t G A R.O 9 Parcel: 2S 113AA00400
Jurisdiction: Tigard
Site address: 16200 SW 72ND AVE B2
Project: Christensen Oil Subdivision: ROSEWOOD ACRE TRACTS Lot: C
Project Description: Low voltage for data
Contractor: TELECOMM MANAGEMENT INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 1293 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-639-8209 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/21/2014 $75.00
12%State Surcharge-Electrical 07/21/2014 $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: 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 in acco•. - ••roved 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. ATTE. ON: Oregon law quire 'ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-01 0 through OAR 952-001-00'I. You m- -in a copy of the rules or direct questions to OUNC by calling 503.232 7 or 1.800.332.234
Issue By: k_ ` ee_ '�/`/LdsLty 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 rFivFn FOR OFFICE USE ONLY
Received s���/ l l_y
City of Tigard Date/B : 7�� Pennit#: G —oo! to
IN • 13125 SW Hall Blvd.,Tigard,OR 972�2N3,� Plan Review
• Phone: •
503.718.2439 Fax: 503.598.t G. 2 >< 2 014 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready DateBy: furs H See Page 2 for
T I G A R" Internet www.tigard-or.gov CITY( 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):
❑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 less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ y g [� ❑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
Job#: Job site address: b ^� ❑Addition of new motor load of system.
L ZOO $ i 7?..a pit. 9 I00HP or more. ❑ A E„ l_2 , l_3"
City/State/ZIP: t ❑Six or more residential units. ❑Recreational Tonal vehicle parks
rtrl�RO �R q 7 ZZ� ❑Health-care facilities. P
s
Suite/bldg./apt #: Project name:Ciy .,Sp 0.�
I 6lal6 ❑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. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'1 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2-
I e9- Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
❑ PROPERTY OWNER
I ❑ TENANT Renewable Energy CI See Page 2
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:( ) 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 I
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 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per 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
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) 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: Fi14N,ay i.4. e, J�c- Sign or outline lighting 67.84 2
��°Cowlf� _
Signal circuit(s)or limited-energy UC
Address: Pr(f, /Ox (2A3 panel,alteration,or extension. L�See Page 2 75 ' 2
5 Each additional inspection over allowable in any of the above
City/State/ZIP: Lake- D sGt1lasd Off- 417.3 Additional inspection(1 hr min) 66.25/hr
Phone:(�p2 ) 634/ 8 20 ! Fax:( ) Investigation(1 hr min) 66.25/hr
Email:d+�.G�-S49 'd(0A4 6"4 , M\ n Inspsctionsfnrw which 78.18/hr
t.d� t Inspections for which no fee is
specifically listed '/:hr min) 90.00/hr
CCB Lic.: I35 ass II lectrical Lic.: 3-4i3 Suprv.Lic.: PSS y (
yy��Il4 . .� pb/t4 ELECTRICAL PERMIT FEES �r�
Suprv.Electrician signattre,required: ,J\'�) Subtotal: `71)
Print name: Ply:0( g 1(1S Date: 7-Z l-f y ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9.0e,
G Y
Authorized signature:
TOTAL PERMIT FEE: O
1 This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
r ' Number of inspections allowed per permit.
IiBuilding\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014 440-46151(I I/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
Description I Qty. I Each I 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 z J
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:
El Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning 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('/z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00
Subtotal(Enter Page 1):
y • Number of inspections allloweowed d per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
H Audio and Stereo Systems
El Boiler Controls
El Clock Systems
RI/
ata Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
n Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.dacx Rev 04/21/2014
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
16200 SW 72ND AVE B2, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
198 Low voltage final
PASS - No C of O
July 23, 2014 at 12:32:53 PM
ELR2014-00164
Jeff Grove
Violation Summary:
Inspector Contractor