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Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT : 2 . COMMUNITY DEVELOPMENT Permit#: ELR2015 00235 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/05/2015 Parcel: 2S102BD02600 Jurisdiction: Tigard Site address: 12955 SW PACIFIC HWY Project: Cricket Subdivision: NORTH TIGARDVILLE ADDITION Lot: 37 Project Description: CCTV system. Contractor: ZENITH SECURITY SOLUTIONS LLC Owner: KIM, PENNEY 4270 BROME ST 395 NW SILVERADO DR IDAHO FALLS, ID 83401 BEAVERTON,OR 97006 PHONE: 866-722-3666 PHONE: FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 10/05/2015 $75.00 12%State Surcharge-Electrical 10/05/2015 $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 $84.00 Other Desc: Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is su •ende• •re the 18• '� days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those fro,---- set forth '• •AR 952-001-0010 through OAR 952-001-0090. You may obtain a cop les or direct questions to OUNC by calling 503.232.1987 or 1 •_:,.' Issued By: v �' y: Permittee Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Application FOR OFFICE USE ONLY City of Tigard +� Received I'ennit#: II 8� `�� Date/By: !t J 5— /5--! — C Lk2 a b 1 S.--4)6/;1--j„5-- -' 13125 SW Hall Blvd.,Tigard,OR 97223 G �� O�", Plan Review Related Permit#: Phone: 503 Line: 439 Fax: 503.59$ Date/By: Inspection Line: 503.639.4175 `uv fa il. Ready Date/By: Juris: El See Page 2 for TIGARD Internet: www.tigard-or.gov �` f�Qtified/Method: { Supplemental Information TYPE OF WORK O t��5 PLAN REVIEW ❑New construction ddition/alteration Please check all that apply(submit/sets of plans w/items checked): ❑ Demolition 0 Other: ,` ❑Service or feeder 400 amps or more ❑Building over three stories. Q��]�V where the available fault current ❑Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings. El I-and 2-family dwelling 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 q ❑Addition of new motor load of system. Job#: Job site address: /K'9 S S S G.) ps e r 1 c f-(t,,,•� 100HP or more. ❑"A","E"."l-2"."l-3", 9 r ❑Six or more residential units. occupancy. City/State/ZIP: 7-e' t(t O t2- ( 72 2 3 ❑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: Pie,' /✓e_ 11(_,7 (-Oak_( (,,t„- --S '- FEE SCHEDULE // Description I Qt). I Each 1 706,1 I ' 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'I 500 sq.ft.or portion 33.92 I DESCRIPTION OF WORK Limited energy,residential C, ^ Vi (with above sq.ft.) 75.00 C ( 7 f `"M w D r Limited energy,multi-family 75.00 residential(with above sq.ft.) Renewable Energy ❑ See Page 2 ❑ PROPERTY OWNER I pr TENANT Services or feeders installation,alteration,and/or relocation Name:1 14?-O CO Li-n 4-...6,C(,t.,61 C..1 >Fr—“,.,C (t..- C- 200 amps or less 100.70 2 Address: g U 2 2 S Lam) I f o_(f (gt.fr pl J S'1_,,_,' 201 amps to 400 amps _ 133.56 _ 2 401 amps to 600 amps 200.34 2 City/State/ZIP: 'a PR v elf 1-0 L4 0 2 4 70-0 a 601 amps to 1,000 amps 301.04 2 Phone:(„S-0,3) 7 _ 6 -(( I ( I Fax:( ) Over 1,000 amps or volts 552.26 2 1 t Temporary services or feeders installation,alteration,and/or Email: A NAT-0,.. , y e pt , „In i t w(t t o al , Go w. 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 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel 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 service or feeder fee,first 56.18 Address: branch circuit - City/State/ZIP: Each add'/branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) I 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: �1_y,1 t f Lt $'c r,'� /(.t (,'c(.�� [,L C Sign or outline lighting 67.84 2 Z 7 V _ Signal circuit(s)or limited-energy ee Page 2 ' 2 Address: B� p(it e J f panel,alteration,or extension. City/State/ZIP: OP, .� `�� 3 t{© � _Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(1\91) 7 '(G 7 Fax:( ) Investigation(1 hr min) 90.00/hr f Industrial plant(1 hr min) 78.18/hr Email: V r 1 C Z evf 1t 1 !d 0 f/4 •_ c.0 c,--A it- Inspections for which no fee is 90.00/hr CCB Lic.: / 97 ?(y / Electrical L. . x '�' uprv.Lic.: yG3�L�� uy listed(i hr min) ' ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: `/�• Subtotal: --25,.* Print name: (/f'../...0,'7 Ile? f re-- Date: (0/DJ.'(`.sue 13 Plan Review Required(25%of permit fee): ( State surcharge(12%of permit fee): 4..- Authorized signature: TOTAL PERMIT FEE: -- 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. I:,Buitding Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/l1S/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 Description Qt . End, 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: 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) 552.26 '_ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 n 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 charged at an hourly(1 hr min) Inspections for which no fee is 9(1,0(1%hr hcriliculh li,(ed l -hr min) COMMERCIAL WORK ONL :" ELECTRICAL PERMIT FEES � � Subtotal(Enter on Page I): Fee for each commercial system: $75.00 * Number of inspections allowed (SEE OAR 918-309-0000) per permit. Check Type of Work Involved: Audio and Stereo Systems Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation n HVAC Instrumentation Intercom and Paging Systems Landscape Irrigation Control* Medical f Nurse Calls Outdoor Landscape Lighting* Protective Signaling I I Other: Total number of commercial systems: *No licenses are required. Licenses are required for all other installations Ir Building'Perini ts,ELC_PermitApp_ELR_ERE.doc Rev 06117,2015