Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN R COMMUNITY DEVELOPMENT Permit#: ELR2014-00275
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/01/2014
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.
Contractor: NORTHWEST FIRE SUPPRESSION INC Owner: CLEAN WATER SERVICES
15385 SW BEAVERTON CREEK CT 2550 SW HILLSBORO HWY
BEAVERTON, OR 97006 HILLSBORO, OR 97123
PHONE: 503-644-7720 PHONE: 503-547-8150
FAX 503-644-8289
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/01/2014 $75.00
12%State Surcharge-Electrical 12/01/2014 $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 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 a copy of the rules or direct questions to OUNC by calling 503.232.198 1.800.332.2344.
Issued By: — — ti 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 1OR O1 II( I I "I ()NI 1
lig ACity of Tigard Received
Date/B : l Permit#: F ,
.01 •, ••
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 B Date : Related Permit#: �C Ai _
Inspection Line: 503.639.4175 Ready Date/By: Ed See Page 2 for
i i`' \r,i' 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 l 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 /2 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 El Emergency system. larger separately derived
Job ❑Addition of new motor load of system.
ob#: Job site address:ddress: !
IO 060 cW t5�,�c✓.t,4✓_e 100HP or more. ❑ A„ E„ I-2„ 1.3„
) n
❑Six or more residential units. occupancy.
City/State/ZIP: 1 1's G r r (� 0 Health care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: J /? ❑Hazardous locations. ❑Supply voltage for more than
UeL+n wCw/�T l✓/L e5 lzLf�K��'1 ❑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 I •
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'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
�L I' / ) (with above sq.ft.) 75.00 2
tee.10CSe (.N+OKf Cle-leC` ots opt e l4v�r" 5 Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: C4a el l)/Crier 5ervi ec /✓&,r'!'t Oeln 200 amps or less r 100.70 2
h 201 amps to 400 amps 133.56 2
Address: g 060 5 w vg /1v-e, 401 amps to 600 amps 200.34 2
City/State/ZIP: J Q(—I/ lc 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 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 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel -
A.Fee for branch circuits with
Business name: fVLi pS-I) t" s(c/J 55/bn Zv1 C. above service or feeder fee,
7.42 2
(6 . / 1f) . J / Fee branch branch circuit
Contact name: B.Fee for branch circuits without
Address: 'Yoe; N A-9/4 4�'e S u, e branch it feeder fee,first 56.18 2
C.O V branch circuit
City/State/ZIP: Yom' ve,r�-o,1 or g7006 Each add'I branch circuit 7.42 2
/ v Miscellaneous(service or feeder not included)
Phone:KO ) 'qq- 77a-C) Fax: (503 ),(L/y- 1. Each manufactured or modular
67.84 2
� dwelling,service and/or feeder
Email: �j,/•a ." e ,W'l"//j--e .(�)0/1 Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:/144i -/• fire s(.� fe%,0.4, „1 L, Sign or outline lighting 67.84 2
r 1 Signal circuit(s)or limited-energy —... Page 2 �`� 2
Address: f'00 f '( I/-(' S1, !e Ci (Z) panel,alteration,or extension. U°
City/State/ZIP: ny� ^�/�/^� "`1 Each additional inspection over allowable in any of the above
ty G VP r • / O t ! (Jl l Additional inspection(1 hr min) 66.25/hr
Phone:(S D3)(y L/-7 7a0 Fax:(s l3) IL/- sad_' ' Investigation(I hr min) , 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Email: `Q1fAvt ,, f l�l4• [7✓I/1 Inspections for which no fee is 90.00/hr
CCB Lic.:l ' '6j a_C c I Elec ical Lic..,,,,. , _;I Suprv.Lic.: 401-31,14" specifically listed(%s hr min)
•/tk ii ELECTRICAL ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: "51704€ Subtotal: "7S--:t
Print name: era,,t tio.n. R,,,,,--ifixe Date: /' //l�j ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): if kX
Authorized signature/� TOTAL PERMIT FEE: ,* '
/��� This permit application expires if a permit is not o tained within 180
Print name: Al!�w0/ e��'/. (' Date: days after it has been accepted as complete.
'` • Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-4615T(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 SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva orless 100.70 2
5.01 to 15 kva 133.56 2
El 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
CI _
Garage Door Opener* 50.01 to 100 kva 552.26 2
>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 over25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V2 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:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El 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\Perrnits\ELC_PermitApp_ELR_ERE.doc 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
16060 SW 85TH AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
198 Low voltage final
PASS - No C of O
ELR2014-00275
Chip Barnett
Violation Summary:
Inspector Contractor