Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111111 s COMMUNITY DEVELOPMENT Permit#: ELR2014-00178
T FGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2014
Parcel: 2S113B000600
Jurisdiction: Tigard
Site address: 16060 SW 85TH AVE
Project: Clean Water Services Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Fire alarm system for relocating annunciator.
Contractor: FIRE SYSTEMS WEST INC Owner: CLEAN WATER SERVICES
600 SE MARITIME AVE#300 2550 SW HILLSBORO HWY
VANCOUVER,WA 98661 HILLSBORO,OR 97123
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/05/2014 $75.00
12%State Surcharge-Electrical 08/05/2014 $9.00
Type of Use:
Class of Work:
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 kLopzo, e rulei or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 11
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
Iii City of Tigard Received
• City 7 g Date/By: 3 I:5/' t �3" ) Permit No.: L L L' 4 V i-1-Ut,:l ./
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review — J� �w
_ Phone: 503.718.2439 Fax: 503.598 rLO�� Date/By: Other Permit: r-P 'f--001 LS)
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: 7uris: la See Page 2 for
Internet: www.tigard-or.gov c_ 1.. feed/Method: Trcv Supplemental Information
\■ VCCe TYPE OF WORK \J' PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked below
❑New construction ddition/alteration/replt p 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
❑ I-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","1-2","l-3",
Job no.: Job site address:
1l)OHP or more. occupancy.
I 60VI L , A Qt ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: "--V` 3-2 2-2- ❑Health-care facilities. ❑Supply voltage for more than
ID Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: �� � l/VA�-2T ❑Service or feeder 600 amps or more.
SesJrcn3 Ar:, Ia"' ' t S t
Cross street/directions to job site: Description Qty. Fee. Total •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no Ea.add'1500 sq.ft.or portion 33.92 1
Limited energy,residential
75.00 2
.: - j 4 (with above sq. i.)'4 w F -, � ,„
Limited energy,multi-family
M.a_ r7 o u- r,)e /1.,�'t U, (aio! j_ A residential(with above sq.ft.) 75.00 2
1`�"'"" /'�]�U AJ` 1:J n S) T� Renewable Energy ❑ See Page 2
tJ 1 ( g
Services or feeders installationzalteration,and/or relocation
° t '�`°° "' t1 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:( ) I Fax:( ) relocation
200 amps or less 59.36 1 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
1 A.Fee for branch circuits with
';ii '"- R «a_ .� • a above service or feeder fee,
7.42 2
Business name: l I ,._��} each branch circuit
S � w'r-c�1 B.Fee for branch circuits without
Contact name: ,I 1" V p service or feeder fee,first 56.18 2
V t branch circuit
Address: 6'3() se at aC l( (14.e. 4 . i 3D J Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: VAAi GC1tj'Ix- W^ 9$6 Co ach manufactured or modular
Phone:( 3 ) -7 7(- 7 g S I Fax: :( ) lLJ dwelling,service and/or feeder
67.84 2
/.� Reconnect only 67.84 2
E-mail: /'ttee-I re S c,p2 sys4.4. �e_Si- c-O',•� Pump or irrigation circle 67.84 2
i _.. #, - W.,, ...0q .mg n :;, - '..','*'..,,,',::',1,,;-::.'A''':2, Sign or outline lighting 67.84 2
Business name: t t ca. t -t West- Signal lies t(s)or limited-energy See
��-+1y�� panel,alteration,or extension. Page 2 7�, 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: Investigation(I hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: (L97 3. Electrical Lic.: 32- (pSC�Ik Suprv. Lie.: 3 4ls.fr \A s thcaly listed('/=hr min)
Suprv. Electrician signature,required: ?-' — `` IC tI` P„„4.44,„ to: 5; yap :' a
2)._)..y._____ Subtotal: i
Print name: SEAJJ c e. ^ Date:alt 1201 / Plan review(25%ofpennit fee):
_ ` 4# f State surcharge(12%of pennit fee): ei.'
Authorized signature: TOTAL PERMIT FEE: 194,°v
_
This permit application expires if a permit is not obtained within 180
Print name: 1r clot S e rf'„ / Date: �v c1 c n'4 days after it has been accepted as complete.
j` 1 "'w w "( * Number of inspections allowed per permit.
1:1Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46151(11/05/COMIWEB
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
16060 SW 85TH AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
198 Low voltage final
PASS - No C of O
August 27, 2014 at 12:47:53
PM
ELR2014-00178
Jeff Grove
Violation Summary:
Inspector Contractor