Permit liPalCITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
8 COMMUNITY DEVELOPMENT Permit#: ELR2015 00099
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/08/2015
Parcel: 1 S135BD00200
Jurisdiction: Tigard
Site address: 9785 SW SHADY LN
Project: Starbucks Subdivision: ASHBROOK FARM Lot: 5
Project Description: Data telecommunications system.
Contractor: CCV TECHNOLOGY LLC Owner: NORED, STANLEY D&AUDENE C
833 SE MAIN ST STE 102 511 NE 21ST PL
PORTLAND, OR 97214 CANBY,OR 97013
PHONE: 503-476-5682 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/08/2015 $75.00
12%State Surcharge-Electrical 04/08/2015 $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: 1 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 o ' su- ce, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notif .ti• ` enter. Those rules a et forth in 0
952-001-0010 through OAR 952-001-0090. You may obtain a�ules or direct questions to OUNC by callin, 503. 3 .198 or 1.800.332. 44.
Issued By: Permittee Signature: ii l_ii
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 O11•I( I 1 ti1 0\1.1
Received _ �� /�j
14 City of Tigard DateB : • / , , Permit No.. e �Y�� mo t./
13125 SW Flail Blvd.,Tigard,OR 97223 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 ' DateBy: Other Permit:/ difif. 7 7
I I G,,‘R a Inspection Line: 503.639.4175 GE,��1 Date Ready/By: Juris %i,�® Page 2 for
Internet: www.tigard or.gov ��V ��c, Notified/Method: y Supplemental Information
TYPE OF WORK roR A ® PLAN REVIEW
❑New construction Addition/alteration/rep'lace rl ,.`..' O� Please check all that apply(submit 2 sets of plans w/items checked below):
G\ M O V\S` ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: C,G ` where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTSVIRION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-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 STPE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","I-3",
Job no.:' �Cj Job site address: C1/.55,5-24 / ,I 1 ix or or more. occupancy.
S trr bu N✓ ❑Six or more residential units. ❑Recreational vehicle parks.
❑Health-care facilities. ❑Supply voltage for more than
City/State/ZIP: " -' a C�� ^� 3
��A'-�` � � 3 El Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: J�,,�' ,/ ❑Service or feeder 600 amps or more.
.��t'��`, FEE SCHEDULE
Cross street/directions to job site: 1 r few 6 e rS Description I Qty. I Fee. I Total I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
�aT & a- T e t Y G nw-..aA v r+ I CA-t` r�1.7 residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
0 PROPERTY OWNER i cEtTENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Ste•of' \.- (,) e.,- 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:( ) Fax:( ) relocation
200 amps or less 59.36 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
0 APPLICANT. I j] CONTACT; PERSON A.Fee for branch circuits with
above service or feeder fee, 7 42 2
Business name: —} NO each branch circuit
I 1fJV� U V�, (— S B.Fee for branch circuits without
Contact name: Do service or feeder fee,first
J branch circuit 56.18 2
Address: Each add'l branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: � C V i G 1N o L 0 5 Y Signal circuit(s)or limited energy r See •7
J panel,alteration,or extension. Page 2 /-7 2
Address: g3 3 SE rY' 1� I )3 E so 1'tc_ /e '2 Each additional inspection over allowable in any of the above
` T \T C. Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: pc.) r I 0 ft C 1. 2./ L.( Investigation(I hr min) 66.25/hr
Phone:( o3) (�-) L, ,5c Fax:( ) Industrial plant(1 hr min) i 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lic.:0264g6, 1 Electrical Lie.: C L-C 3gtl Suprv.Lic.? /// ,,et specifically listed('/z hr min)
Suprv. Electrician signature,required: Subtotal: —7 .
Print name: Date: .i p is Plan review(25%of permit fee): _...-
C Q r l t or Y/ State surcharge(12%of permit fee): q_
Authorized signature: / 1 1.4c . TOTAL PERMIT FEE: 751.f.
��//Da This permit application expires if a permit is not obtained within 180
Print name: S vf � ( Date: %f'(
r\ ( days after it has been accepted as complete.
• Number of inspections allowed per permit.
1\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(II/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 Qe'. I Fee I Total
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
nBurglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with
OAR 918-309-0040) 552.26 2
❑ H• eating, Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ V• acuum Systems* >ioo kva—no additional charge 0.0 3
111 Other: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
Inspections for which no fee is 90.00/hr
specifically listed('/s hr min)
COMMERCIAL WORK ONLY ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
nA• udio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per pennit.
I7 B• oiler Controls
n Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: l
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
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
9785 SW SHADY LN, TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00099
Jeff Grove
Violation Summary:
Inspector Contractor