Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR201500219
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/16/2015
Parcel: 1 S 134CA03700
Jurisdiction: Tigard
Site address: 11770 SW NORTH DAKOTA ST
Project: Forrester Subdivision: BURLWOOD NO.2 Lot: 10
Project Description: Low voltage for audio/stereo
Contractor: OWNER Owner: FORRESTER, BRIONA L&TIMOTHY J
TIM&BRIONA FORRESTER 11770 SW NORTH DAKOTA ST
11770 SW NORTH DAKOTA ST TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-828-5363 PHONE: 503-828-5363
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/16/2015 $75.00
12%State Surcharge-Electrical 09/16/2015 $9.00
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio&Stereo: N
Security Alarm: N
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: Total $84.00
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 accord-• 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 ON: Orego aw re. ' -s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-•010 through OAR 952-0 0 0090. o may obtain a copy of the rules or direct questions to OUNC by calling 503.232. •'7 or 1 •+0.332 344.
Iss ed By: I_'/� _ Signature: _____
y: Permittee Si nature: i Ii.�
OWNER INSTALLATION ONLY
The installation is being made on property •• e or rent.
OWNER'S SIGNATURE: i� 11f P / Date: 9/o/
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 OFFICE USE ON1.1
Received Q� �
- City of Tigard DateB / Permit : S—�� r S
IN
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit li:
Inspection Line: 503.639.4175 Ready Date/By: luris ® See Page 2 for
T I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items 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.
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
Fires for mall other installations. Installation❑ Multi-family ❑Master builder ❑Other:
❑Fire pump. ❑ nstllation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 11770 SW North Dakota St. IOOHP or more. ❑"A","E","I-2",`t-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW 117th FEE SCHEDULE
Description 1 Qty. 1 Each 1 Total 1
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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
k_, I (with above sq.ft.) 75.00 2
V � Limited energy,multi-family
75.00 2
residential(with above sq.ft.) ,
® PROPERTY OWNER I TENANT Renewable Energy 0 See Page 2
_Services or feeders installation,alteration,and/or relocation _
Name:Tim&Briona Forrester 200 amps or less 100.70 2
Address: 11770 SW North Dakota St. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:(503)828-5363 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 m.•e o property that I own which is not 200 amps or less 59.36 I
intended for sale,lease 3 ' ch. -j•t rdi ; o ORS 447,449,670, 70 201 amps to 400 amps 125.08 2
Owner signature' e Date: /6— 401 amps to 599 amps 168.54 2
OW" Branch circuits—new,alteration,or extension,per panel
❑ : • I ANT ❑ CONTACT PERSON A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Ow 2 Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy aj
Address: panel,alteration,or extension. ❑ See Page 2 �� 2
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(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: Electrical Lie.: I Suprv.Lie.: specifically listed('i2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 75X'
Print name: Date: ❑Plan Review Required(25%of permit fee): --
7-1).1 State surcharge(12%of permit fee): 9-d 0
Authorized signature'' TOTAL PERMIT FEE: 04/.0a
,,� This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• 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
Description 1 Qty. I Each I Total
y Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56
)4 2
Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ 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 552.26 2
with OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of25 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:
❑ Other: Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1.\Building'Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015