Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
= 1 1 11 COMMUNITY DEVELOPMENT Permit#: ELR2015-00129
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/13/2015
Parcel: 1S136DB02400
Jurisdiction: Tigard
Site address: 11642 SW PACIFIC HWY 100
Project: The Herbary Subdivision: 2000-025 PARTITION PLAT Lot: 2
Project Description: Low voltage for camera&security alarm.
Contractor: SECURITY FIRST ALARM LLC Owner: CHAMPION, RONALD V& ROBERTA E
515 NW SALTZMAN RD#825 16449 LEXINGTON CT
PORTLAND, OR 97229 LAKE OSWEGO, OR 97034
PHONE: 503-296-9100 PHONE:
FAX: 503-672-7751
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/13/2015 $75.00
12%State Surcharge-Electrical 05/13/2015 $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: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 1
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. ATTENTI n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001 rough OAR 9 -0 0. You may obtain a copy of the rules or direct questions to OUNC by calling,693232.1987 or 1.800.332.2344.
Issue By: � �1 w�l' 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 FUR 0II1( 1 1 S1. ONI 1
City of Tigard Received ,r� •
• 13125 SW Hall Blvd.,'l'igard.OR 97223 Plan Review M i r•�'s'`5"!
11111 0 Phone: 503.718.2439 Fax: 503.598.1960 Date/By:
I i;,-\l;t) inspection Line: 503.639.4175 Date Ready/By: luris: la See Page 2 for
Internet: www.tigard-or.gov Notitied/Method: 1 201
Supplemental Information
TYPE OF WORK PLAN REVIEW
f ❑New construction ®Addition/alteration/replacement Please chuck all ��q�it)pps w/items checked below):
❑Service or Qf� 41}��N�p �{ilding over three stories.
❑Demolition ❑Other: where the�R E N�HnVI s and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 'Lproa�tmg buildings.
❑ I-and 2-family dwelling less to ground,or exceeds 14,000 ❑Commercial-use agricultural
y g ®Commercial/industrial ❑Accessory building 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"1- ". system.
El Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: I Job site address: 11642 SW PACIFIC HWY.STE.100 S or more. occupancy.
❑Six ix or a more residential units. ❑Recreational vehicle parks.
City/State/ZIP:TIGARD,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:THE HERBARY ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
1
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
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
75.00 2
LOW VOLTAGE CAMERA&SECURITY ALARM residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ® TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:THE HERBARY 401 amps to 600 amps 200.34 2
Address: 11642 SW PACIFIC HWY.STE. 100 601 amps to 1.000 amps 301.04 2
Over 1.000 amps or volts 552.26 2
City/State/ZIP:TIGARD,OR 97223 Temporary services or feeders installation,alteration,and/or
Phone:(503)705-8870 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
❑ APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit ,
B.Fee for branch circuits without
Contact name: service or feeder fee,first 56.18 2
branch circuit
Address: Each add']branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Phone:( ) Fax::( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:SECURITY FIRST ALARM,LLC Signal circuit(s)or limited-energy I See
panel,alteration,or extension. Page 2 2
Address:515 NW SALTZMAN RD.#825 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:PORTLAND Investigation(I hr min) 66.25/hr
Phone:(503)296-9100 Fax:(503)672-7751 Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 190582 E ec likCLE236 Suprv.Lic.: 3423LEA specifically listed(Az hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ' Subtotal:
Print name: RICK W AL 0' •P '"Ni.. ): e: 5-5-2015 Plan review(25°/n of permit fee):
—alikek State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: RICK WALD'OP Date: 5-5-2015 days after it has been accepted as complete.
a Number of inspections allowed per permit.
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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 °escnption I Qty. I Fee I_ Total I •
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
(7 Burglar 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 552.26 2
OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
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:
ElOther: Each additional inspection is
charged at an hourly(1 hr min) 6625/hr
Inspections for which no fee is
90.00/hr
specifically listed(V: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
ElAudio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit.
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
® Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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