Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�'! s COMMUNITY DEVELOPMENT Permit#: ELR2014-00171
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/30/2014
-F
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10218 SW WASHINGTON SQUARE RD
Project: Casual Male Big&Tall Subdivision: OAKBURG Lot: 9
Project Description: Low voltage for data
Contractor: SAFE TECHNOLOGY GROUP INC Owner: PPR SQUARE TOO LLC
6400 NE HWY 99 STE G375 PO BOX 847
VANCOUVER,WA 98665 CARLSBAD,CA 92018
PHONE: 360-699-2130 PHONE:
FAX: 360-719-1527
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/30/2014 $75.00
12%State Surcharge-Electrical 07/30/2014 $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: 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 in ance wiI- •proved 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. AT NTION. Oregon la requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 010 through OAR 952-0 1-0 u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu By: £ • / Permittee 5ignatur >'.'
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 Applic FOR(111:1(,_ I SI: ()NI.)
City of Tigard .i �� Ree`l`ed Permit No: �/p
t3 g DateBy: 7 3p /L, , C..l�`d{>t (7/
,111 • 13125 SW Hall Blvd.,Tigard,OR 9 233 0 2014 Plan Review
Phone: 503.718.2439 Fax: 503.5 9 Date/By: Other Permit:
-
T 1 G A R D Inspection Line: 9503.6399.4175 CITY �INfuIU Date Ready/By: luris H pSee Page 2 for
Internet: www.ti ard-or. ov ``++,,��yy��►► L! Notified/Method: Supplemental Information
TYPE AW M 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
Q� JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
/409/ a ❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address:-.16211TSw Washington Sq Rd IOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Casual Male Big&Tall ❑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'I 500 sq.ft.or portion 33.92 1-
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
----TM' ! 0 Limited energy,multi-family
T residential(with above sq.ft.) 75.00 2
Renewable Energy _ ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ 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
® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:SAFE TECHNOLOGY GROUP INC. each branch circuit •
B.Fee for branch circuits without
Contact name:JASON SWEET service or feeder fee,first 56.18 2
branch circuit
Address:6400 NE HWY 99 SUITE G375 Each add'I branch circuit 7.42 2
City/State/ZIP:VANCOUVER WA 98665 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(360)699-2130 Fax: :(360)719-1527 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:SALES @SAFETECHNOLOG.NET Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:SAFE TECHNOLOGY GROUP INC. Signal circuit(s)or limited-energy I See -7c-
panel,alteration,or extension. Page 2 _ 7S' 2
Address:6400 NE HWY 99 SUITE G375 Each additional inspection over allowable in any of the above
City/State/ZIP:VANCOUVER WA 98665 Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(360)699-2130 Fax:(360)719-1527 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 173731 Electrical Lic.: CLE79 Suprv.Lie.: 4272LEA specifically listed('V,hr min) _
�
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: , Subtotal: 7,,--..c°
Print name: JASON SWEET Date: 07/29/2014 Plan review(25%of permit fee):
91)4 State surcharge(12%of permit fee): 9'•a v
Authorized signature: TOTAL PERMIT FEE: e/00
This permit application expires if a permit is not obtained within 180
Print name: JASON SWEET Date: 07/29/2014 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46151(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 for all residential systems combined ... $75.00 FEE SCHEDULE
Dacription I Qty. I Fee I Total I •
Check Type of Work Involved• Renewable electrical energy systems:
• 5 kva or less 100.70 2
❑ Audio and Stereo Systems* 5.01 to 15 kva 133.56 2
n Burglar Alarm 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Garage Door Opener* 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
II00 kva(fee in accordance with
Heating, Ventilation and Air Conditioning >1OAR 918-309-0040) 552.26 2
System* Solar generation systems in excess of 25 kva:
❑ Vacuum Systems* Each additional kva over 25 7.42 3 .
(�
>100 kva—no additional charge 0.0 3
I 1 Other: Each additional inspection over allowable in any of the above:
Each additional inspection is
charged at an hourly(1 hr min) _ 66.25/hr 1
COMMERCIAL WORK ONLY:
Inspections li ted(=h hr fee is
specifically (, ) 90.00/hr
Fee for each commercial system $75.00 ELECTRICAL PERMIT FEES
(SEE OAR 918-309-0000) Subtotal:
Plan review,if required(25%of permit fee):
Check Type of Work Involved: State surcharge(12%of permit fee):
TOTAL PERMIT FEE:
nAudio and Stereo Systems This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
nBoiler Controls t Number of inspections allowed per permit.
n Clock Systems
® Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n 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.doc Rev 05/21/2013