Permit g, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2015-00047
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/19/2015
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 17
Project: Mizumi Buffet Subdivision: FREWING'S ORCHARD TRACTS Lot: 15
Project Description: Low voltage for fire alarm and monitor of hood suppression.
Contractor: AMERICAN SECURITY ALARMS, INC. Owner: ROIC OREGON LLC
5411 SE MCLOUGHLIN BLVD 8905 TOWNE CENTRE DR, STE 108
PORTLAND, OR 97202 SAN DIEGO, CA 92122
PHONE: 503-231-0303 PHONE:
FAX: 503-230-1044
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/19/2015 $75.00
12%State Surcharge-Electrical 02/19/2015 $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: 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 0 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 .
Issued By: Permittee Signature: f
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.
_ deal Permit Applica CEIVED 1•012 011 1( I I ..l: O\1.1
city of Tigard Received
Plan Review /7 �5 VI Permit No.: eh / 7
13125 SW Hall Blvd.,Tigard,OR 97 v D S— �
11 Phone: 503.718.2439 Fax: 503.597 17 2015 Plan Review
I I c n is I Inspection Line: 503.639.4175 Date/By:
Other Permit: SAD/S—0059,5".
Date Ready/By: /t a . luris: Supplemental See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Nabs.. ,..02 i S ,�f Supplemental Information
1 „ New construction tis
Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below). "F
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other:
4r where the available fault current Marinas and boatyards.•" r_ E , ; r 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
❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder
❑Other: 0 Fire pump. 0 Installation of 150 KVA or
•
r 0 Emergency system. larger separately derived system.
❑Addition of new motor load of
❑..A., .,E„ ..I 2.. .,1 3„
Job no.: Job site address: /3530 �y,/ /l�.c.r .G 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ,(i/7t 1 7 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations 600 volts nominal.
Suite/bldg./apt.no.: Project name: t,2.0 t,!! .5 tAFFF.�-- - ❑Service or feeder 600 amps or more
Cross street/directions to job site: F t q.L' 'F
Description Qty. Fee. Total •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea.add'I 500 sq.ft.or portion 33.92 I
s _
Limited energy,residential
75.00 2(with above sq. )a
C _^ ry Limited energy,(with above it 1--
��/ � r�J r`� `— '—' 'I' t-"f'`7 r�° residential(with above sq.ft.) 75.00 12
DI , � �rr 'A' �,ss. Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
�p� 200 amps or less I 100.70 2
i�,a..;• T .._;. .. ,s, - i ,. ..,.,cx's?ix JJ[.3�"3�."�?st� x''3A;e1� l .. � _..,...o,.e,:a7
Name: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Phone:( ) I Fax:( ) 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: 401 amps to 599 amps 168.54 2
Date: Branch circuits—new,alteration,or extension,per panel
,t
3 L..., ..w alt A.Fee for branch circuits with
+maJr� -''J above service or feeder fee,
Business name: 17 , % 7 c each branch circuit 7 42 I Z c r B.Fee for branch circuits without
Contact name: �t i(„ �'
, t� - service or feeder fee,first
branch circuit 56.18 2
Address: 5-2p, re A.KG //,- 3 4�w r Each add'I branch circuit 7.42 2
City/State/ZIP: /< -s--/7 "KC— l 2-0 r? Miscellaneous(service or feeder not included)
Each manufactured or modular
Phone:(5 3 ) Z3 f 0 3 3 I Fax: :(s��) Z3 i7 / (3'4.4 dwelling,service and/or feeder 67.84 2
E-mail: ff�u e �5 , - ra›,,� Reconnect only 67.84 2
r �>y l 5 -� Pump or irrigation circle
irr. 67 84 2
v "' "'" i % ��i ^'e: u. .;t.:r" Sign or outline lighting 67.84 2
Business name: - •1,—r(4.--H — r Signal circuit(s)or limited-energy See
_ / U'
Address: 5- CCU / / panel,alteration,or extension, ,! Page 2 JS. 2
J 2 g( YE'
t jt f� .- Each additional inspection over allowable in any of the above
City/State/ZIP: a' '''7'-/ /` � OZ 9.7 Ze Z Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(S33) 23 e 036-3 I Fax:(573) 230 /O y f/4 Industrial plant(1 hr min) 78.18/hr
CCB Lic.: 5-5010 Electrical Lic.: 21.-.1g3 Suit-v.Lic.: 12.I ( LEA Inspections for which no fee is
s. ificall listed %n hr mm 90.00/hr
Suprv. Electrician signature,required: /�, 'j. /c/t / v: 1 . J�; �{i u,,,.�!i„�L' „� . ',w .•
/J / N Subtotal: -75-.e.'
Print name: air-4s /T r�< 4/ /"/,f�-'v Date: 2-/ 7 •I i Plan review(25%of permit fee):
State surcharge permit fee): . .42ca Authorized signature: /leftli// MIP6 /(CJ � TOT AL PE RM IT FEE: 8.e7. cc)
/ ///_Print name: Ir/PJ //CI /
-4.-( Date: )_—/'"/ ,//,. This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Number of inspections allowed per permit.
11Building\Permits\ELC PermitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(I1/05/COM/WEB
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
13500 SW PACIFIC HWY 17, TIGARD, OR,
97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00047
Jeff Grove
Violation Summary:
Inspector Contractor