Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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s COMMUNITY DEVELOPMENT Permit#: ELR2015-00176
T t GAjz D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2015
Parcel: 25101 BD00200
Jurisdiction: Tigard
Site address: 8005 SW HUNZIKER RD
Project: Tigard Distribution Center Subdivision: 1994-025 PARTITION PLAT Lot: 2
Project Description: Low voltage for fire sprinkler.
Contractor: FIRE SYSTEMS WEST INC Owner: TIGARD DISTRIBUTION CENTER LLC
600 SE MARITIME AVE#300 4800 SW MACADAM, STE 120
VANCOUVER,WA 98661 PORTLAND, OR 97239
PHONE: 360-693-9906 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/27/2015 $75.00
12%State Surcharge-Electrical 07/27/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
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. ATT ION: Ore••n law -•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 010 through OAR •.2-.01-00 0.• may obtain a copy of the rules or direct questions to OUNC by calling 503.2321 987• 1.800.332.2344.
Issu By: ) ` • , Permittee Signature: ■A�
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.
,1
Electrical Permit Applica 'H it LEIVEp
, FOR OFFICE I SE ONLY
Received / ` ^ _ '
City of Tigard Date/B 7 i J7'� Permit#: h c9Q 5_60/7
Mill 13125 SW Hall Blvd.,Tigard,OR._47. 23 9 7 20 f5 Plan Review
Phone: 503.718.2439 Fax: 503.598.19 Date/B : Related Permit#:
Inspection Line: 503.639.4171'[T,l Ready Date/By: Suns: El See Page 2 for
TIGARD Internet www.tigard-or.g IJ II OF f�GA(j Notified/Method: Supplemental Information
`'� ` Qa U PLAT REVIEW $,
Please check all that a} 1 (submit 2 sets of plans w/items checked
❑New construction ❑Addition/alteration/replacement apply p 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.
❑ 1-and 2-family dwelling commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
El Multi-family Master builder ❑Other: ❑Fire pmnp. ❑Installation of 150 KVA or
.1104-SITE INFORMATION..:AN I OG TIiON ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address: go(u S i4,1 _- 100BP or more. ❑"A° "E" "1-2" "1-3"
City/State/ZIP: �i ei p d a ( - ci 7ZZ-s J ❑Six or more residential units. occupancy.
V ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 1–;�,u,� ' e_t kli ko, L- ,- O Hazardous locations. ❑Supply voltage for more than
"r Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE'SCHE,DULE- ,'r Z fl- -_
Description I Qty. I Each I Tptat 1 .
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#:
Ea.add'I 500 or less ft or portion 33.92 I
P
�a ,,1�_ DESCRIPTION OFD WORK ` . .;. t _,, Limited energy,residential 75.00 2
ii /� ( (with above sq.ft.)
Zret/Jkt #4.A0eii 6'. ("""1 1 Limited energy,multi-family
75.00 2
residential(with above sq.f1J
Renewable Energy ❑ See Page 2
(t PROPERTY OWNER I 0 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 2
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
Branch circuits–new,alteration,or extension,per panel
❑APPLIC►NT ' -; 7.1 :0 CONTACT PERSON _.
A.Fee for branch circuits with
Business name: i,f� Sys'(.ei 4a W e-S 7.42 2
above service or feeder tee,
�/� each branch circuit
Contact name: ►�6 ,( e1h.r-t- B.Fee for branch circuits without
�� �� 1 A�� ��, service or feeder fee,first 56 l8
Address: max,-),,,..1/4_e_ /1 /lv branch circuit
City/State/ZIP: vat, c 0 ti JI,f 1A'/\ iti'46i( Each add.I blanch c1ICUII 7.42
Miscellaneous(service or feeder not included)
Phone:( ID ) 7 ( 78 3s Fax: :( ) Each manufactured or modular
67 84
2
Email: �i sfre s 7"°_`s 4v(C4, (kyX,_
Rcconncct only 67.84 2
CONTRACTOR. Pump or irrigation circle 67.84 2
Business name: "II r/'Q- 51/54.-?....Z 5 �� 5-1— Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ee Page 2 -161e-1 2
Address: panel,alteration,or extension. g -161e-1 j
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 49 7 3 2 I Electrical Lic.:37 1 ^ Suprv. Lic.: s- rid C� specifically listed('/:hr min)
����J✓ ELECEWCAL PERMIT FEES y''';
Suprv. Electrician signature,requirech p, / Subtotal: 75--
Print name: A.N ���' �' Date: �I Z /Z�)/S ❑Plan Review Required(25%of permit fee): O
1 ( State surcharge(12%of permit fee): 9- 1';'
Authorized signature:
TOTAL PERMIT FEE: 8'i/-
/� This permit application expires if a permit is not obtained within 180
Print name:fl�� G {_4_ / -- Date: 777 1'S days after it has been accepted as complete.
�� � ' Number of inspections allowed per Permit-
1\Building‘Permits\ELC_PermitApp_ELR_ERE.doc Rev 06,17'2015 440-4615T(t 105 CON{WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY;_, FEE SCHEDULE
Description p I Qty. I Each I_ 'Total •
Fee for all residential systems combined: $75.00 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:
I I 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
Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
I Other: Each additional inspection is 66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed('',hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00
Subtotal Emtcr Page 1):
'
(SEE OAR 918-309-0000) Number of inspections allowed per permit.t.
Check Type of Work Involved:
n Audio and Stereo Systems
I I Boiler Controls
I I Clock Systems
n Data Telecommunication Installation
CI " ire Alarm Installation
❑ HVAC
❑ Instrumentation
I I Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Pmnits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015
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
8005 SW HUNZIKER RD, TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00176
Jeff Grove
Violation Summary:
Inspector Contractor