Permit „ CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2016-00009
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Datelssued: 01/19/2016Parcel: 2S102BA00304
Jurisdiction: Tigard
Site address: 9820 SW TIGARD ST
Project: Barrier Corporation Subdivision:RTH TIGARDVILLE ADDITION,AMENC Lot: 22
Project Description: CCN system.
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: 503-245-2996
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 8 Stereo: 0 Boiler Controls. 0
CCN: 1 Clock Systems. 0
Data 8 Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentations 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting'. 0 Medical: 0
Nurse Calls'. 0 Protective SignaI.. 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 copy 01 pervRS-OfVir t questions to OUNC by calling 503 232 WS r 1 800 332.2344.
Issued By: i Pernm 'ignature:
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 tho job site until completion of the project.
Approved plans are required on tha job site at the time of each inspection.
Electrical Permit Application vEQ
City of Tigard QECj�`V G r—Review
/G Permit q:
�z3 7
• 13125 SAV Hall Blvd.,Tigard,OR 97 A` 16 Phone: 503.7182439 Fax: 503.598.1960 `O RelatedPermit nInspection Line: 503.639.4175 �N�Qy: ® See Page 2 for
Internet: www.tigard-or.gov O� \� rr�st_`Qod: Supplemental lnformadon
TYPE OF WO •7 PLAN $RVDEW
❑New construction J2 ,Addition/alterat replacement Please check all that apply(submuj sets ofplams 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 a1 150 volts or ❑Floating buildings.
❑ 1-and 2-farril dwelling ommercial/industrial lea:to ground.or exceeds 14.000 ❑Commercial-use agricultural
y g ❑Accessory building
amps for all other inslelletiona. buildings.
❑ Multi-family ❑ Master builder ❑Other: 0ire pump_ ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency systemlarger scpamlely derived
i,. ( `l y ❑Addition of nem'motor load of "Stem.
Job#: lob site ad ss: �/
City/State/ZIP: ❑Si.ormore residential units. occupancy.
10Ilealth-care facilities_ 0 Rce,catuoul vehicle parks.
Suite/bldg./apt.p: ProjeC ❑time: t ❑Ilazardous locations. ❑Supply voltage for more than
M v/ e C ❑Ser,tee or feed,,600 amps ounom. 600,.11,n(......ul
Cross street/directions to job site: FEE SCHEDULE
Description 1 011. 1 Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1.000 sq.11.or Iess 16Ki4 4
I(a_add'I 500 sq.Itor pompon 33.92 I
DESCRIPTION OF WORK Limited energN,residential
(with above sr.Il.) 75.00 _
crryLimited energy,multi-family75.00 '
residential(with atx)\e sq.ft.)
Renewable Ener ❑ See Page 2
❑ PROPERTY OWNER ❑ TENANT Services or feeders installation alteration,and/or relocation
Natne: 200 amps or less 1 100.70
Address: 201 amps to 400 amps 133.56
401 amps to 600 amps '_00.34
City/State ZIP: 601 amps 10 1,000 mnps 301.04
Phone: ( ) Fax: ( ) Ovcr 1,000 amps or volls 552.26
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that 1 own which is not 200 amps or less 59.36 I
intended for sale,lease,rent,or exchange,according to ORS 447.449,670,and 701. 201 amps to 400 amps 11_5.08
Owner signature. Date: 401 amps to 599 amps 168.54 '_
[:1 APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension per panel
A.Pec for branch circuits myth
Business name: atatvc service or fceder tee, 7.42
each branch circuit -
Contact name: B.Fee for branch circuits nithow
service or feeder fee,first
Address: branch circuit 56.18 _
City/State/ZIP: Bach add-I branch circuit 7.42
Miscellaneousservice or feeder not included
Phone: ( ) Fax: :( ) tach manufactured or modular 67.94
Email: iiselling,serxicc and/or fader
Reconnect only 67.84
CONTRACTOR Pump or irrigation dude 67.84
Business pante: V14 Sign or outline lighting 67.84 _
Signal circuigs)or limited-energy w
Address ( � s �� panel,alteration,or extension. age 2 7S �- 2
City/State/ZIP: Q �' Each additional inspection over allowable in any of the above
6 T Additional inspection(I hr min) 66.25/hr
Phone:(S ) 7�- Z !.� Fax:( ) Investigation(I hr min) 90.00/hr
Email[ Industrial plant(I In min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.: 3 �, Suprv. Lic.: &it specifically listed p7:hr it i
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: Date:12 ❑Plan Review Required(25%of permit fee):
r State surcharge(12%of pennil TOTAL PERMIT FEE:
p
Authorized signature: 0
This permit application expires if a permit is not obtalned within 19a
Print name: Date: days atter it has been accepted as complete.
a Number of inspections allowed per permit.
1:Building Permits 151 C Pe uApp 1-1 R ERFdoc Res O6 17]015 440-4615T(I 1 0(OM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Dncnpfion I QIv. I E.,h ToW
FaRN-A
Fee for all residential systems combined; $75.00 Renewable electrical energy systems:
1
Check Type of Work Involved: 5 kv a or less 00.70 2
5.01 to 15 k%a 133,56 2
F-1 Audio and Stereo Systems* 1.5.01 to 25 k%a 200.34 2
Wind generation systems in excess of 25 kvs:
F-1 Burglar Alarm 25.01 to 50 k,a 301.04 2
50.01 to 100 k,a 552.26 2
❑ Garage Door Opener* I 100 kca(fee in accordance 552.26 1
,,ah OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* fachadditional k,a o,cr Is 742 3
F1 Vacuum Systems* >100 k,a—noadditional charge 3
Each additional inspection over allowable in an of the above:
F1 Other: Each additional inspection is 66.251 fir
charged at an hourK(I hr min) I
Inspections for sc hich no fee Is 90.00 fir
listed("_fir min) I I
COMMERCIAL WORK ONLY: ELECTIUCAL PERMIT FM
Subtotal(
Fee for each commercial system: $75.00 Nuinberof inspections alto
perpennit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
F-1 Audio and Stereo Systems
F] Boiler Controls
F-1 Clock Systems
F-1 Data Telecommunication Installation
F-1 Fire Alarm Installation
F-1 HVAC
F-1 Instrumentation
F-1 Intercom and Paging Systems
F] Landscape Irrigation Control*
F-1 Medical
F] Nurse Calls
F-1 Outdoor Landscape Lighting*
F] Protech"
c SignalingOther
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
11R FRF doe R,,O',1-2015