Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
9
COMMUNITY DEVELOPMENT Permit#: ELR2016-00011
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2016
Parcel: 2S102BA00302
Jurisdiction: Tigard
Site address: 9898 SW TIGARD ST
Project: Barrier Corporation Subdivision:RTH TIGARDVILLE ADDITION.AMENC Lot: 22
Project Description: CCN System for suites 9898,9900,9902,9904,9908, and 9910.
Contractor: SIMPLE SECURITY Owner: TIGARD INDUSTRIAL LLC
PO BOX 80577 5845 JEAN RD
PORTLAND, OR 97280 LAKE OSWEGO, OR 97035
PHONE: 503-574-2254 PHONE:
FAX 503-245-2998
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/19/2016 $75.00
Type of Use: COM 12%State Surcharge-Electrical 01/19/2016 $9.00
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCN: 1 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm. O
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 Dose 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 it 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 copy of the rules or direct questions to OUNC by calling 50323 8 o'r 332 234 1 /!
Issued By: -_Mill 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 dale.
This permit card shall be kept in a conspicuous place on tho job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
rY Received
City of Tigard w��T�r�1v V )ng B Permit H:
13125 SW Hall Blvd.,Tigard,OR 9{7(]; Plan Review P l
Phone: 503.718.2439 Fax: 503.59 Ing r��jj A\ ^Q1�Fy Date Related Penna a:
Inspection Line: 503.639.4175 11 A1v 1 9 L p Ready Date By: Juris. ® see Page 2 for
Internet: www.(igard-or.gov J i1D Nwified'Method: Supplemental Information
M2 ```rrr''ffnll ��.TYPE OF W i5tF`a PLAN REVIEW
❑ New construction ,ZAddition/altera���t.paya}�. ent Please check all that apply(submit 2 sets ofplans w/items checked):
V"- ❑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 lolls or ❑Floating buildings.
❑ I-and 2-family dwelling mmercial/industrial ❑Accessory building less to ground,or exceeds 14.000 ❑Commercial-use agricultural
amps for all other Installations- buildings-
❑ Multi-family E]Master builder ❑Other: Fire pump. ❑Installation of 150 KVA or
308 SITE INFORMATION AND LOCATION ❑Emergency systemlarger separately derived
❑Addition of new motor load of system.
Job#: Job site address: if W ( IOOHP or more. ❑"A','T "I-2 "1-3".
❑Six or inom residential units- occupancy.
City/State/ZIP: V 0Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Pro ect name: r ❑Ilazzrdous locations_ ❑Supply voltage for more than
❑Service or feeder 600 amps or more, 600 vuh,nominal
Cross street/directions to job site. r FEE SCHEDULE
Descri tionI 0o. I Each I total
Nein residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 16854 4
Tax map/parcel#:
Ea.add'I 500 s'qftor portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
5.00 2
CG jL6 k weabovesq.NJ
Limited d energy,multi-family
5.00
residential(with above s' .R-) ,,
-
❑ PROPERTY OWNER ❑ TENANT Renewable Ener ❑ See Pa e 2
Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 1 100.70 2
Address: 201 amps to 400 amps 133.56
401 maps to 600 amps 200.34
City/State/ZIP: 601 amps to 1,000 amps 301.04
Phone: ( ) Pax:( ) Over 1,000 amps or voles 55226
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
Owner signature: Date. 401 amps to 599 amps E41 168.54 -
❑ APPLICANT ❑ CONTACT PERSON Branch circuits—new alteration,or extensionper panel
A.Fee for branch circuits Indy
Business name:
above service or feeder Ice, 7.42
each branch circuit
Contact name: 13. Fee for branch circuits wahma
service or feeder fee,first
Address: branch circuit 56.18
City/State/ZIP: I Ach add'I branch circuit 7.42
Miscellaneous service or feeder not included
Phone:( ) Fax: : ( ) Tach manufactured or modular 67.84
dwelling,seniceand/or feeder -
Email:
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: 14A Pte S-L �t ti Sign oroutlinc lighting 67.84 2
Address: Signal cacuh(s)or limited-energy Sm Page 2
tone],alteration or extension.
City/State/ZIP: \ Each additional inspection over allowable in an of the above 4 5Z
li Additional inspection(I hr nin) 66.25/hr
Phone:I Z73 ) 5_�L Z,j Fax:( ) Im'estigation(1 hrnin) 90.00/hr
Email: Industrial plant(I h,man) 78.18/hr
Inspections for a-hich no Ice is 90.00'hr
CCB Lic.: `ZG7 C Electrical Lic.:3 60 , Suprc. Lic.: s xiticalb listedmint
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: 14 del" Dater Zo ❑Plan Review Require[(25%(if permit fee):
State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE: -$L
This permit application expires If a permit is not obtained within Iall
Print name: Date: days after it has been accepted as complete.
• Number of inspections allotted per permit.
I Bulldiny Permits ELC Petm,App ELR EREdoe Ro Ufi 1-'01v440-4RISnl1 OS COM WE 13
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
:fARaA 1 ' fy:..'�
I... R Y�Jr�n'«.� h � ur"
Desan rtoa F¢h Taml
Fee for all residential Systems combined: y$75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 '_
5.01 to 15 kva 133.56 '_
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind-generation systems in excess of 25 kva:
❑ Burglar Alarm 2S.111 to 50 ks-a 301.04 2
50.01 to 100 kca
❑ Garage Door Opener* 100 k%a(ree in accordant
with OAR 918-309-0050) 55_._6 _
❑ Heating, Ventilation and Air Conditioning solar generation systems in excess of 25 kya:
System" Fach additional kva over 25 7.42 ]H3 F-1VacuumSystems* >I00 kva-no additional charge OA
Each additional inspection over allowable in any of the above:
F-1 Other: hourly(I
additional inspection is 66.25/hr I
charged at an hou (I hr miu)
Inspections for which no fee is 90.00 hr
s pecifically listed(.,hr mint
COMMERCL1L WORK ONLY: ELECTRICAL PERMIT PEES
Fee for each commercials stem: $75.00 Showed r pen t.
�' " Number of inspections allowed per pemut.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
D16ther
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I.niriaing Pcrnws 11-( PeimLApv I I M I KA due ac%06 11'_01