Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2015-00281
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/30/2015
Parcel: 2S102CB01804
Jurisdiction: Tigard
Site address: 13305 SW PACIFIC HWY
Project: Taco Bell Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 32
Project Description: Burglar alarm.
Contractor: TYCO INTEGRATED SECURITY LLC Owner: WEBER COASTAL BELLS LIMITED
6305 ROSEWOOD ST SUITE A WEBER, EDUARD
LAKE OSWEGO, OR 97035 840 CONGER ST
EUGENE, OR 97402
PHONE: 855-201-1482 PHONE:
FAX: 503-675-4412
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/30/2015 $75.00
12%State Surcharge-Electrical 11/30/2015 $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: 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: 1 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 Cent-r. Those ries are set forth in OAR
952-001-0010 through OAR 9 -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.- 2.1•
or 1.800./ 344.
I
Issued By: Permittee Signature: ( • i�
OWNER INSTALLATION ONLY
411
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 REC,®IVEE. •
:'14: 1,.-.*, i ,FOR OFFICE USE ONLY ':I: ''
-,c,,;:.:;,, +u`R•eceived ,+ `
' City of Tigard DateB :// Ye A• gig' y Permit Mg4,C. 2015"—et4.2j:),/
RI 13125 SW Hall Blvd.,Tigard,OR 97223
NOV 3 ® 2015 plan Review
Phone: 503.718.2439 Fax: 503.598.1960 J Date/B Related Permit#:
'' Inspection Line: 503.639.4175 Tei �1 c r} Ready Date/By: Juris. Ed See Page 2 for
fIGARD CITY a F IG 1±R...
. Internet: Line.www.tigard-or.gov j�t�l 1 Notified/Method: Supplemental Information
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TYPE OF WON)° ":'41'4" 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.
❑ 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.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
['Addition of new motor load of system.
Job#: 108325175 Job site address: 13305 SW Pacific Hwy 100HP or more. ❑"A","E","1-z","l-3^,
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:Taco Bell 15347 Job 02 ❑Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW Park St FEE SCHEDULE
Description I Qty. I Each I Total 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Install Full BA System. 1 panel,2 panic switch cold temp,4 hold ups additional
75.00 2
(with above sq.ft.)
Limited energy,multi-family 75.00 2
indoor/outdoor strobe and mount magnetic strip. 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
1=1 APPLICANT E1 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Tyco Integrated Security above service or feeder fee,
each branch circuit 7.42 2
Contact name:Autumn Jones B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:6305 SW branch circuit
City/State/ZIP:Tigard Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: (503)639-2922 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67 84 2
Business name:Tyco Integrated Security Sign or outline lighting 67.84 2
Address:6305 SW Rosewood St Signal, circuit(s)or limited-energyxens . (u_See Page 2 2
panel,alteration,or extension.
City/State/ZIP:Lake Oswego Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)451-2055 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: autumnjones@tyco.com
Inspections for which no fee is 90.00/hr
CCB Lic.: 197010 (///ApElectrical Lie.: CLE322 Suprv.Lie.: 1199LEAspecifically listed p/2 hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: `1`7_ 1-)
Print name: . ,,i Date: , :„7„,,..., ❑Plan Review Required(25%of permit fee): ,
State surcharge(12%of permit fee): G\ . r,L
Authorized0 TOTAL PERMIT FEE:
i
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.
1\Budding\Per.1s\ELI PermitAppELRERE.doe •ir/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
Description I Qty. I Each I Total I *
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
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 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(Yz hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * 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 Telecommunication Installation
n Fire Alarm Installation
HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
Nurse Calls
E Outdoor Landscape Lighting*
n Protective Signaling
Other: I�JC'U \ Gk,
Total number of commercial systems: 1_
*No licenses are required. Licenses are required for all
other installations
I-\Building\Permits\ELC_PermitApp_ELR_ERE doc Rev 06/17/2015