Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 �, Permit#: ELR2015-00159
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/18/2015
T i G a�KD Parcel: 2S101 BCO2401
Jurisdiction: Tigard
Site address: 12650 SW HALL BLVD
Project: Snyder Roofing Subdivision: TIGARDIA TERRACE Lot: 3
Project Description: Low voltage for data,(12)cables.
Contractor: DC TECH INC Owner: JFK PROPERTIES OREGON LLC
2280 SE IMLAY AVE 12650 SW HALL BLVD
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503-356-5700 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/18/2015 $75.00
12%State Surcharge-Electrical 06/18/2015 $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 cordan - h approved plans. This permit will expire it work is not started within 180 days of issuance, or if work is suspended for more the 180
days. TENTION: Oregon requir-s you to follow the rules adopted by the Oregon Utility Notification Center. Those rule are set forth in OAR
952- 1-0010 through OAR 952-00 •••0. ou -y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.8 0.33 44.
Is ed By: .� III _ 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.
•El ctrical Permit Application
FOR OFFICE USE ONLI'
City of Tigard Date/B Le„ea :�� Permit No.:Filac/.5-'"cei dr
. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
! Phone: 503.718.2439 Fax: 503.598.196t ' 8 9015 Date/B : Other Permit:
TIGARD Inspection Line: 503.639.4175 ` Date Ready/By: ]uns BI See Page 2 for
Internet: www.tigard-or.gov ta7
Notified/Method: Sup
plementalInformation
a 1 4A, -m r t t t t .1TYPE Ctk �4tt s '. : IAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below).
❑Service or feeder 400 amps or more ❑Building over three stories.
LI Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.: Job site address: 12650 SW Hall Blvd 100HP or more. occupancy.
❑Six or 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: 50VDfi 491.::'/A/ 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. f Total
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'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
Install(12)Cat 5e cables. residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER l ® TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Snyder Roofing 401 amps to 600 amps 200.34 2
Address: 12650 SW Hall Blvd 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)6205252 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 ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:DC TECH Inc. each branch circuit
B.Fee for branch circuits without
Contact name:Dwayne Campbell service or feeder fee,first 56.18 2
branch circuit
Address:2280 SE Imlay Ave. Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Hillsboro OR 97123 Each manufactured or modular
Phone:(503)5236491 Fax: :( )
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
E-mail:dctech @ymail.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: DC TECH Inc. Signal circuit(s)or limited-energy J See
panel,alteration,or extension. Page 2 '7S �,
' 2
Address:2280 SE Imlay Ave. Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP: Hillsboro OR 97123 Investigation(1 hr min) 66.25/hr
Phone:(503)5236491 Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 195391 Electrical Lic.: CLE378 Suprv. Lic.: 3413LEA specifically listed(%2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: v Subtotal: 7 5--<''0
Print name: Dwayne Campbell Date: 6/17/15 Plan review(25%of permit fee): -- .--
State surcharge(12%of permit fee): 1.0°
Authorized signature: TOTAL PERMIT FEE: g(1,0e
This permit application expires if a permit is not obtained within 180
Print name: Dwayne Campbell Date: 6/17/15 days after it has been accepted as complete.
* Number of inspections allowed per permit.
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I
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 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
n A• udio and Stereo Systems* 15.01 to 25 kva 200.34 2
n B• urglar 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
❑ Heating,Ventilation and Air Conditioning
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
n V• acuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%z 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
[� A• udio and Stereo Systems days after it has been accepted as complete.
Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
N Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
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