Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111111 COMMUNITY DEVELOPMENT Permit#: ELR2015 00055
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/26/2015
Parcel: 2S113AB00800
Jurisdiction: Tigard
Site address: 15995 SW 74TH AVE 150
Project: Excel)Orthodontics Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Low voltage for HVAC
Contractor: SIGNALING SYSTEM SOLUTIONS Owner: DUNCAN, JOHN ARTHUR&JANICE LEE
13504 NE 84TH ST#103-160 1001 NW LOVEJOY#812
VANCOUVER,WA 98682 PORTLAND, OR 97209
PHONE: 360-694-9199 PHONE:
FAX: 888-511-7734
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/26/2015 $75.00
12%State Surcharge-Electrical 02/26/2015 $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: 0
HVAC: 1 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 $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTE •• : • -•on law re.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules a rth in OAR
952-001-'.10 through OAR •-2-04 -.0=0. Y•u may obtain a copy of the rules or direct questions to OUNC by calling 503. 3 .19$yc 2.234
Iss k ed By: - - 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 A licatiol ECEIVED ' I11t t11 ' 't ' ' s' ()NI 1
City of Tigard Da vea ;'i�� Permit#: iG,Qap 5- --
13125 SW Hall Blvd.,Tigard,OR 97223 FEB 2 6 2015 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 FEB : Related Permit#:
Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: tuna: 65 See Page 2 for
Ill ,J■P Internet: www.tigard-or.gov Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit/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.
ID 1-and 2-family dwelling ,t�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 INFORMATION AND LOCATION ❑Emergency system. larger separately derived
-p st ❑Addition of new motor load of system.
Job#: 1 Job site address:1 S 9 q S f 7t 6 /9 100HP or more. ❑"A","E","I-2","1-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
ty / G, LQ el P ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: 23 ?/j OcJ72 ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 741 72-A ,f `DjA,l,.v,.-` FEE SCHEDULE r
Description I Qty. I Each I Total I
•
New residential single-or multi-family dwelling unit.
Subdivision: I Lot 4: 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
n_3 n S 2�// � y 4 �� jT (with above sq.ft.) 75.00 2
/��/ ��/G / tj' /J Limited energy,muhi-family
/ residential with above ft. 75.00 2
�G
1 `"��V � Renewable Energy ) _ ❑ See Page 2
Ull PROPERTY OWNER I ❑ 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:( ) I Fax:( ) Over 1,000 amps or volts 552.26 L
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, Cr 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
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR —s _ Pump or irrigation circle 67.84 2
Business name: .5 t T`r4.-P 4 5 t5' /r.,•••- (3 e , Sign or outline lighting 67.84 2
l Signal circuit(s)or limited-energy ee Page 2 2
Address: /3 50 of /rid y� sT 0,3.—l6 O panel,alteration,or extension. g
City/State/ZIP: v ,IGQC) // 2 6j 1 0 6 x _ Each additional inspection over a owable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(go) 9 I / ? 7 I Fax:( ) Investigation(1 hr min) 66.25/hr
Email: f`1-3 s 2 s5Sc_p 1e fo, C�j Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 17;3.2:7(I Electrical Lic.< L - 76 I Suprv.Lic., /64 , specifically listed(/z hr min)
//chi" �� l ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: �� �,_,/�� No 07 Subtotal: 75
!
Print name: A/L 5/7�/ Date: Z--2_0--/5 ❑Plan Review Required(25%of permit fee): —�
State surcharge(12%of permit fee): 9. 0c
Authorized signatur
TOTAL PERMIT FEE: g 4,"
This permit application expires if a permit is not obtained within 180
�"G
Print name: / Date: 1{5— days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permita\E _ermitApp_ELR_ERE.doc /2112014 440-4615TO1/05/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
Fee for all residential systems combined: $75.00 Description I Qty. I Each I Total
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 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
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr l
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(V hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1): I
Fee for each commercial system: $75.00 + Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
all■ VAC
MI Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\BuildinglPermits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014