Permit 1y CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
14 ' COMMUNITY DEVELOPMENT Permit#: ELR2015-00227
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09129/2015
Parcel: 2S101BCO2800
Jurisdiction: Tigard
Site address: 8250 SW HUNZIKER RD,STE#C
Project: Horizon Distributors Subdivision: 1990-082 PARTITION PLAT Lot: 1
Project Description: Data telecommunications system.
Contractor: WEST COAST BUSINESS COMMUNICATIONS INC Owner: SEVERSON,JAMES A& ROBIN 0
10005 SE STARK 29404 SW HEATER RD
PORTLAND, OR 97216 SHERWOOD, OR 97140
PHONE: 502-465-9222 PHONE:
FAX: 503-489-1806
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/29/2015 $75.00
12%State Surcharge-Electrical 09/29/2015 $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 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 cokof the ru- or direct questions to OUNC by calling 503.232 1987 or 1.800.332.2.
Issued By: e�T'i�..- � 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 FOR OFFICE USE ONLY
tV Received City of Tigard ��N 1 A -!ice Permit n: ,.- .!L . ii
Date/B't 13125 SW Hall Blvd.,Tigard,OR Plan Review
Phone: 503.718.2439 Fax: 503.59' Dateat : Related Permit#:
Inspection Line: 503.639.4175 ^ 5 Ready Date/By: Jul 0 See Page 2 for
TIGARD Internet: www.tigard-or.gov C� LO� Notified/Method: �/%� Supplemental Information
i
TYPE OF WORK" ' lw PLAN REVIEW
El New construction 0 Addition/alteratiop/ It AN`�IS1 Please check all that apply(submit/ors:ts of plans w/Hems checked):
l (� V ❑Service or feeder 400 amps or m ❑Building over three stories.
❑Demolition ❑Other: S'1! where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSVO�ON exceeds 10,000 amps at 150 volts or ❑Floating buildings.
El 1-and 2-family dwelling 0 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
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
Job#: Job site address: ❑Addition of new motor load of system.
$2 5 0 Sy./ l-1 n1 z 1 KEd& gel 100HP or more. ❑"A","E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: 'r 1(o ART)1 0 R ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: t Project name: H.0 2.1Z0,J b,..-1-0. ❑Hazardous locations. ❑Supply voltage for more than
�/ �' 't ❑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
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 75.00 2
(with VO)C. G 1- vATA CAaLl "t‹. itd nege, ftJ
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER ❑ 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:( ) 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
❑ APPLICANT I ❑ CON"TACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
-
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
WEST CD AST Bu.g/nJeSf C.OMrYs°Al1CATlo.a�
Address:
Signal circuits)orlimited-energy ee Page 2 75,4P----
, 2
000 s SE $r' 2v... ST panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:
pp„LT-LA ij O i O/Z 91 21 ic. Additional inspection(I hr min) 66.25/hr
Phone:(s03) 3 0 q 3 0 4. 1 ,e c l I Fax:(5b 5 ) ,5-1 --. 0 O Z 5 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: S ertV 1 Le w e S#Cs.)A5i 61C., NC f Inspections for which no fee is
90.00/hr
CCB Lie.: 1-1�1 1 SO Electrical Lie.:C Le 8 ) Suprv.Lie.: 3240 LEA
specifically listed(''/z hr min)
/o ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:./ ,.. idif/7 Subtotal: 15.`4=;--
Print name: Date: ❑Plan Review Required(25%of permit fee):
ST1/c RE 9/7z/is State surcharge(12%of permit fee): ei ,s-
TOTAL PERMIT FEE: '
Authorized signature: 8 y.
This permit application expires if a permit is not obtained within 180
Print name: ,57-4-v6-4) gE c/o 0 Date:9/2 s ii- days after it has been accepted as complete.
f • Number of inspections allowed per permit.
I.\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/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 ��y. �_ Each Total j
3' Renewable electrical energy systems:
Check Type of Work Involved: s kva Drless 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25 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
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:
❑ 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('/,hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 • Number of inspections allowed per pennit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
hQ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\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
8250 SW HUNZIKER RD STE C, TIGARD, OR,
97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00227
Jeff Grove
Violation Summary:
Inspector Contractor