Permit (72) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
A
COMMUNITY DEVELOPMENT Permit#: ELR2016-00010
13125 SW Hall Blvtl.,Tigard OR 97223 503.718.2439 Date Issued: 01/19/2016
2S102BA00303
Jurisdiction: Tigard
Site address: 9806 SW TIGARD ST
Project: Barrier Corporation Subdivision:RTH TIGARDVILLE ADDITION,AMENS Lot: 21
Project Description: CCN system for suites 9806.9814,and 9816.
Contractor: SIMPLE SECURITY Owner: ANDREWS MANAGEMENT LTD
PO BOX 80577 TIGARD INDUSTRIAL LLC
PORTLAND, OR 97280 5845 JEAN RD
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%Stale Surcharge-Electrical 01/19/2016 $9.00
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 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 co the rules act questions to OUNC by calling 503.232.1 or 1 800 332.2344.
r
Issued By: Itee Signature: E ��
y�-
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 ins conspicuous place on the job site until completion of the project.
Approved plans are required on the job site attire time of each inspection.
Electrical Permit Application
Received
77
City W Tigard ¢."�� Dale/B 1 �� nnila:
13125 SW Hall Blvd.,Tigard.OR 97223 ``fi�tt Lril V Plan Review
Phone. 5(13.7182439 Fax: 5113.598.19 `. Date : Related Permit a.
Inspection Line: 503.639AI75 p p O,Fj Read)Dale By. orris: ® Se¢Paae 2 for
Internet: wwwfigard-or.gov �hN O L Notified Method: Supplemental Information
TYPE OF WORK PP PLAN REVIEW
❑New constructionddltltln/alteration/ D1 Pleasecheckall that apply(submit E sets ofplans wi items checked):
❑Service or feeder 400 amps or more [I Building over three stories.
El Demolition ❑Other. ���' where the available fault current
❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
❑ I-and 2-family dwelling commercial/industrial []Accessory building lass to ground,or exceeds 14,000 EI
Commercial-ase agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑fin,pmnp. ❑Installation off50 KVA or
JOB SITE _INFORMATION AND LOCATION ❑e:nnrgene)systemlarger separately derived
..� ❑Addition of new motor Toad of system.
Job#: lob site address: 5, e- j { q,a 4 r 10011P mm(ire. ❑-A',-E'.-I?-_-1-3-.
�.j� ❑Six or more residential units. occupancy.
City/State/ZIP: e/ {�-t y-. C]Health-care facilities_ ❑Recreational vehicle parks.
Suite/bldg./apt. #: Projec(name: LL Yy,1 e\C- C- ) v ❑Ilazardous loealiutu. ❑Supply Voltage for more than
❑Service or feeder 600 amps or more WO volts nunanal
Cross street,directions to job site: FEE SCHEDULE
Down Zinn I of,. I F.uM1 1 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/pared#:
Fa.add(500 sq_it or pomon 33.92 I
DESCRIPTION OF WORK Limited energy,residential
�V l5 � � 7S(10 2
5 t —`�`-� 'It (with above sq.11.) -
Lii esid energy,ith a1 %c 5q. 75 00
residential(with ab(ixc .h.) -
Renewable Energy ❑ See Pa e 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70
Address: 2201 amps to 400 amps 133.56 2
401 amps to 600 amps _^0094
City/State'ZIP: 601 amps to(,000 amps 30,
Phone: ( ) Fax:( ) Occr 1,000 amps or%(ills 552.26 -
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 Tess 59.36 1
intended for sale,(ease,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 168.54 -
❑ APPLICANT CONTACT PERSON Branch circuits-new alteration or extension per panel
A.Fee for branch circuits kith
Business name: above se,ice or feeder fee. 7.42
each branch circuit -
Contact name: B,I cc fin branch circuits o ithow
Address: service or feeder fee,first 56.18 2
branch circuit -
Clty./Stato/ZIP: Each add I branch circuit 7 42_ _
Miscellaneous serviceorfeeder notineluded
Phone: ( ) Fax: :( ) I ach manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Rceonnccl only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84
Business name: lM '� - 7�/C - Sign oroutline lighting 67.84 2
Address: ( t F! �- Signal c aerationns)or IimiLLd-energy paee Page 2 �C 2
unci,alteration,or extension. Y' " g -
City/State/ZIP: O"u j� (�L Z O Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(5 of ZZ "q Fax:(Sa 3 ) 2q Ct Investigation 0 hr min) 90.00/hr
Email: Industrial plant(I hr Ban) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: ( � Electrical Lic.:zjy-(pp CLF Sultry. Lic.: ( Q L.0 specificallylistedC2 htrain
ELECTRICAL PERMIT FEES
Supra. Electrician signature,required: /t Subtotal:
Print name: �, Dater Gf �k ZO( ❑Plan Review Rtxryired(25%of pm
ctit fee):
Stale surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: ib kill4�_
This permit application expires n a permit is not obtained within IAO
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit,
1'.Ituild'mg Permi¢19(' P¢mitApp P:IA FAEdoc Rec 06 1-'OU JJn-IEISTII IaS('IIM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
?z. ,..�7t't'1s,K.:�:ax;_' M+''•r Unori tion Ir. Eoch 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 I 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 2S.01 to 50 kva 301.04 -
511.01 to 100 kva 552.26 -
❑ Garage Door Opener* >I 00 kva(fee in accordance
55^_.26
with OAR 918-309-0040) _
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System
h:ach additional kca over'_i 742 3
❑ Vacuum Systems* 1100kvu-no additional charge O.o 3
Each additional inspection over allowable in any of the above:
F] Other: Each additional inspection is 66.25/In I
charged at an hourh'(1 hr min)
Inspections for which no fee is 90.00/hr
scificalllisted(9:hr min)
COMMERCIAL WORk ONLY: st eCtrxicw. FERMII ge I
Subtotal(Enter on Page ):
Fee for each commercial system: $75.00 Numb rof inspersions allowed per pcnnil
(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
Other: I'— LT V
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
C nulldlny Ponniu I'I C Permi1App FIR FRI&a Re%un I-2019