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Permit �� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT III ' COMMUNITY DEVELOPMENT Permit#: ELR2015-00027 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/26/2015 Parcel: 2S101AC01600 Jurisdiction: TIGARD Site address: 7150 SW HAMPTON ST 201 Project: EBS Subdivision: BEVELAND NO.2 Lot: 18-19,P Project Description: data telecommunications. Contractor: OWEN WEST ELECTRIC Owner: NEIMEYER,JOHN 8310 NW REED DR 15 82ND DR STE 210 PORTLAND, OR 97229 GLADSTONE, OR 97027 PHONE: 503-297-6375 PHONE: FAX: 503-297-6375 FEES Description Date Amount Specifics: Restricted Energy Permit 01/26/2015 $75.00 12%State Surcharge-Electrical 01/26/2015 $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 Notific bon Center. Those rules are set forth in OAR 952-001-0010 through OAR 2-001-00 You may obtain a copy of the rules or direct questions to OUNC by calling 5 .232.1987 72.2344. 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. KEC IVEP Electrical Permit Application FOR OFFICE USE ONLY City of Tigard JAN 2 6 2015 Received / #: .. 024,75.Dm 7 111‘ • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revi Related Permit#` n I Phone: 503.718.2439 Fax: 503.598.4�Y OF 1IGARl) Date/I3 : _�. �� Dw� Inspection Line: 503.639.4175 Ready Datc/By: RI See Page 2 for T I 1. 1 I:O Internet: www.tigard-or.go - BUILDING DIVISION Notified/Method: Ar Supplemental Information E OF WORK PLAN REVIEW ❑New construction Addition/alteration/replacement Please check all that apply(submit a 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. CATE OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. 12 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or — JOB SITE 1QRMATION AND '1'ION ❑Emergency system. larger separately derived Job#: Job site address: �//� h /,� J ,, r/ ❑Addition of new motor load of system. / C'" _SW -jevnl l- �{( 100HP or more. ❑ A , E l_2„ l_3„ City/State/ZIP: / / ( ❑Six or more residential units. occupancy. �7— ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#: Project name: l i (1 ❑Hazardous locations. 0 Supply voltage for more than 0 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. Tax map/parcel#: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 1 DESCRIPTION OF WORK . , ..• Limited energy,residential 1/ -)/761 .) e___ (with above sq.ft.) 75.00 2 �� (1 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER � ❑ 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:( ) 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 ❑ 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'l 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 --r- Pump or irrigation circle 67.84 2 Business name: /�7 L/ /? 4.4.../r'5' l€�t Sign or outline lighting 67.84 _ 2 l� 1�� 7 Signal circuit(s)or limited-energy ❑ See Page 2 2 Address: /Q panel,alteration,or extension. g City/State/ZIP: c.'y .v ep/ Q 729- 7 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(�rf • ..--g K-'.� 7 5- Fax:( ). -o'11 E_ Investigation(1 hr min) 66.25/hr Email: ``��// ` Industrial plant(1 hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: ?4/9 2. Electrical Lic.:✓6-39 7< Suprv.Lic.: j'�'�S specifically listed(V hr min)) ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: CC,`i.,' 2 t_ Subtotal: ,25-,Q9 Print name: 0 e— ) L LL) ] Date: J"—a-3- (s ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): qt CV Authorized signature: CGV e-rI., TOTAL PERMIT FEE: may,al) 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. I:\Building\Permits\ELC_PennitApp_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 systems combined: $75.00 Description 1 Qty. I Each T Tool I • Fee for all residential s Y Renewable electrical energy systems: Check Type of Work Involved: 5 kva or Tess 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* >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 allow able 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 901)0/hr specifically listed(/2 hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES I Fee for each commercial system: $75.00 Subtotal(Enter on Page I): • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems e l Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical p Nurse Calls ❑ 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 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 7150 SW HAMPTON ST 201, TIGARD, OR, 97223 Commercial - Electrical Limited Energy 198 Low voltage ﬁnal PASS - No C of O ELR2015-00027 Jeff Grove Violation Summary: Inspector Contractor