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Permit 1111 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: ELR2015-00202 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2015 Parcel: 1 51260000300 Jurisdiction: Tigard Site address: 9644 SW WASHINGTON SQUARE RD G13 Project: Brighton Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S Project Description: CCTV system. Contractor: AVID TECHNOLOGIES LLC Owner: PPR WASHINGTON SQUARE LLC 6804 SE HENRY ST PO BOX 847 PORTLAND, OR 97206 CARLSBAD, CA 92018 PHONE: 503-349-8308 PHONE: FAX: FEES Description Date Amount I Specifics: Restricted Energy Permit 08/31/2015 $75.00 12%State Surcharge-Electrical 08/31/2015 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 1 Audio&Stereo: 0 Boiler Controls: 0 CCTV: 1 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: 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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of -rules BT'difect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. J Issued B t : - 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 �r� 14m ll ()11 I l I I. .1 t 1N 1 N City of Tigard �j Received or e f g Date/B : i ' / /.1��iliNirM IN • 13125 SW Hall Blvd.,Tigard,O� Plan Review L Phone: 503.718.2439 Fax: 503. 1G� Date/13 : / �, �;• Inspection Line: 503.639.4175 Q ` `l� Ready Date/By: 0 See Page 2 for 1 I 1,,\I:I) Internet: www.tigard-or.gov n`\� 11 > �� Notified/Method: �, Supplemental Information TYPE OF WORK t��`Q}` l�� PLAN REVIEW ®New construction ❑Addition/alteral iii S v�� Please check all that apply(submit 2 sets of plans w/items checked): v EIService or feeder 400 amps or move ❑Building over three stories. ❑Demolition ❑Other: �`l N1;0 " where the available fault current ❑Marinas and boatyards. CATEGORY OF CO rm, CTION exceeds 10,000 amps at 150 volts or ❑Floating buildings. ❑ I-and 2-family dwelling ®Commercial/industrial ❑Accessory building tens to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMA �i� 1) LOCATION ❑Emergency system. larger separately derived ❑Addition of new motor load of system. Job#: Job site address. ASHINGTON SQUARE RD I00HP or more. ❑"A, "E" "I-2" "1-3" City/State/ZIP:TIGARD OREGON 97223 ❑Six or more residential units. occupancy. ❑ealth-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.#:413 Project name:BRIGHTO ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: FEE SCHEDULE Description I Qty. I each I Total j • New residential single-or multi-family dwelling unit. Subdivision: Lot#: includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: Ea.add'/500 sq.ft.or portion 33.92 I DESCRIPTION OF WORK Limited energy,residential INSTALLATION OF CCTV SYSTEM (with above sq.ft.) 75.00 2 Limited energy,multi-family 75.00 2 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER II TENANT Services or feeders installation,alteration,and/or relocation Name: BRIGHTON COLLECTABLES 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:( ) 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 r 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,per panel A.Fee for branch circuits with Business name:AVID TECHNOLOGIES LLC above service or feeder fee, 7.42 2 each branch circuit Contact name:JERRY DEUEL B.Fee for branch circuits without Address:6804 SE HENRY ST branch i feeder fee,first 56.18 2 branch circuit _ City/State/ZIP: PORTLAND OR 97206 Each add'I branch circuit _ 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)349-8308 Fax::(503)296-2145 Each manufactured or modular 67.84 2 Email:CLEANMAN@COMCAST.NET dwelling,service and/or feeder Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 Business name:AVID TECHNOLOGIES LLC Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy [7 See Page 2 j 2 Address:6804 SE HENRY ST panel,alteration,or extension. City/State/ZIP:PORTLAND OR 97206 Each additional inspection over allowable in any of the above Additional inspection(I hr min) 66.25/hr Phone:(503)349-8308 Fax:(503)296-2145 investigation(I hr min) 90.00/hr Email:CLEANMAN@COMCAST.NET Industrial plant(t hr min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lie.: 199602 t��j �1 Electrical Lie.: CLE344 t/ll Suprv.Lie.: 4284LEA specifically listed('h hr min) / u 7/ W/f II 7 ELECTRICAL PERMIT FEES Suprv.Electrician signature.required: / Subtotal: 75^1 Print name: JERRY L DEUEL Date: 8J31/2015 ❑Plan Review Required(25%of permit fee): — State surcharge(12%of permit fee): 1:`43 Authorized signature: TOTAL PERMIT FEE: �y, This permit application expires Ka permit is not obtained within 180 Print name: JERRY L D Date: 8/31/2015 days after it has been accepted as complete. Number of inspections allowed per permit. I.\Building\Permits\ELC_PcmitApp_ELR_ERE.doe Rev 06/17/2015 440-461ST(I1/05/CfM/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 Qty. Ewch Total aI 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 I I Garage Door Opener* >100 kva(fee in accordance with OAR 918-309-0040) I I 552.26 I 2 Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 I I Vacuum Systems* >100 kva—no additional charge 0.0 3 Each.additional inspection.over allowable in.any,of the above: I I Other: Each additional inspection is 66.25/hr 1 charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed(Y:hr min) COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page I): 75 * Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work'Involved: Audio and Stereo Systems Boiler Controls Clock Systems ❑ Data Telecomnuuticatietanstailation ❑ Fire Alarm Installation I 1 HVAC Instrumentation .❑ Intercom and Paging Systems 17 Landscape Irrigation Control* 7 Medical ❑ Nurse Calls El Outdoor Landscape Lighting* ❑ Protective Signaling ® Other: CCTV Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC PennitApp_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 9644 SW WASHINGTON SQUARE RD G13, TIGARD, OR, 97223 Commercial - Electrical Limited Energy 198 Low voltage ﬁnal PASS - No C of O ELR2015-00202 Jeff Grove Violation Summary: Inspector Contractor