Permit 111I }' iiCITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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F. `1 ;j„ COMMUNITY DEVELOPMENT Permit#: ELR2015-00290
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/07/2015
t •,,, Parcel: 2S101BD00200
Jurisdiction: Tigard
Site address: 8005 SW HUNZIKER RD
Project: Medline Subdivision: 1994-025 PARTITION PLAT Lot: 2
Project Description: Low voltage for access control.
Contractor: VISION SECURITY SERVICE Owner: TIGARD DISTRIBUTION CENTER LLC
10874 SW ROLAND CT 4800 SW MACADAM, STE 120
WILSONVILLE, OR 97070 PORTLAND, OR 97239
PHONE: 503-502-3909 PHONE:
FAX: 503-200-2907
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/07/2015 $75.00
12%State Surcharge-Electrical 12/07/2015 $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: 0 Other: 1 Total $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is • ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other ap•.icabl- -w. All work will
be done ' accordance wi approved plans This permit will expire if work is not started within 180 days of issuance, or 'f - k is - ,,.- dad or more the 180
days TTENTION: Oregon I- -!uires you to follow the rules adopted by the Oregon Utility Notification Ce •r. .s= s ar: set forth in OAR
952- 1-0010 through OAR 95 .k1-009. •• may obtain a copy of the rules or direct questions to OUNC by calling 503 232. •87 or, r• •'34
Is ed By: / /_ � ;, - Permittee Signature:
k
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
Received
City of Tigard bate/a : / al scjth Penni(n: 90/5%-te A10
q 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
I. • Phone: 503.718.2439 Fax: 503.598.19t1IN
Q-f` 7 2015 Date/B Related Permit#:Inspection Line: 503.639.4175 U C 1, Ready Date/13y: Juris: ® See Page 2 for
TIGARDInternet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE Eig }WoNG DIVISION PLAN REVIEW
0 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
0 I-and 2-family dwelling Commercial/industrial 0 Accessory building less to ground.or exceeds 14.000 ❑Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: J Job site address:( � H/AE:062-PQ- 0 Addition of new motor load of system.
10011P or store. ❑"A E 1_� "I-4'
City/State/ZIP: I 1 C�� 0 Six or more residential units. occupancy.
1111 I cf\ _,D(../t
❑hlcallh-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: FEE SCHEDULE
Description I Qiv. I Each J 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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
` `�' 75.00 2
\1� (�'`Jk� Cai rete (with above sq.ft.)
l�/U Limited energy,multi-family 75.00
residential(with above sq.It.)
Renewable Energy _
❑ See Page 2
0 PROPERTY OWNER 0 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
0 APPLICANT El CONTACT 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: 13.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
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
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 1.5\01,, 51�l)ex\--- Sj� � Sign or outline lighting 67.84 - 2
l� v Po�i Signal circuit(s)or limited-energy Address: b /- panel,alteration,or extension. See Page 2 '14.0° Z
❑
`\City/State /ZIP: l-CR. U Each additional inspection over allowable in any of the above
w� 1 �� Additional inspection(I hr min) 66.25/hr
Phone:(503) 50?. J`9dCI1 Fax:603) ,,c9:904 Investigation(I hr min) 90.00/hr
Email: Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: V.A.\ 2r—Electrical Lic. I t4 Suprv. Lie.: p specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: 7,5"...C9°
/ 'Subtotal:
Print name: 16 1 13/2. Date: ' g—:-/-A5 ❑Plan Review Required(25%of permit fee): .....------
State surcharge(12%of permit fee): O4
0
Authorized signature: TOTAL PERMIT FEE: tT*'00
'I-his 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
Description I Qiy. 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:
n 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:
n Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(A 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 permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
Other: - ` 3 •
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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