Permit (31) ,t
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t COMMUNITY DEVELOPMENT Permit#: ELR2016-00017
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/01/2016
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10104 WASHINGTON SQUARE RD
Project: Spec Space Subdivision: OAKBURG Lot: 9
Project Description: Security and CCN systems for future tenant.
Contractor: SIMPLE SECURITY Owner: PPR SQUARE TOO LLC
PO BOX 80577 PO BOX 847
PORTLAND, OR 97280 CARLSBAD, CA 92018
PHONE: 503-574-2254 PHONE:
FAX: 503-245-2998
FEES
Description Date Amount
Specifics: 12%State Surcharge-Electrical 02/01/2016 $9.00
Restricted Energy Permit 02/01/2016 $150.00
Type of Use: COM 12%State Surcharge-Electrical 02/01/2016 $9.00
Class of Work: ALT
Total Number of Systems: 2
Audio&Stereo: 0 Boiler Controls: 0
CCN: 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: 1 Other: 0 Total $168.00
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 OA
952-001-0010 through OAR 952-001-0090. You may obtain a copy of th 7=Permiftee
C by calling 503.2a7or00.332.2344.
Issued By: ature:
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 I OR OFFICE USE ONLN
City of Tigard e;vet ' .1 /r Permit 0:
ME
13125 SW Hall Blvd.,Tigard,OR 97223 Ian Review 1 %Phone: 503.718.2439 Fax: 503.598.1960 WTDate R : Related PermitInspection Line: 503.639.4175 I�ady Date/By: luris: ® See Page 2 for
Intemet: www.tigard-or.gov Ilfied/Method: 77�0Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ddition/alteration/replacement ..s i►' ' a Please check all that apply(submit I 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'' ijv 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 O Emergency system. larger separately derived
.( ❑Addition of new motor load of system.
Job#: Job site address: 17 p 5,�J: uJq c, i Ivs" IOOHP or more. ❑"A","E","1-2","1-3",
Ci /State/ZIP: ` O� S Q J K ❑Six or more residential units. occupancy.
City/State/ZIP: �1 aV t/ye- ZZ 3 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name: ❑Hazardous locations. ❑Supply voltage for more than
154 Q0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: Y FEE SCHEDULE
Description I Qty. Each I 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/parcel#: Ea.add'l 500 sq.ft.or portion33.92 1
DESCRIPTION OF WORK Limited energy,residential
with above .ft.) 75.00 2
Limited energy,multi-family 75.00 2 �
residential(with above .ft.
Renewable Ener ❑ See Pa e 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
❑ APPLICANT ❑ CONTACT PERSON Branch circuits-new,alteration or extension per panel
A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 1 7.42 1 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: 5 w, cJ C , ? Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: -Q, f7 �— panel,alteration or extension. Page 2 7� 2
City/State/ZIP: 2 �J Each additional inspection over allowable in an of the above
o rY 5 Additional inspection(1 hr min) 66.25/hr
Phone:(5o 3 tj Z Z 5 q Fax:(yea, ) � � f j - 2 (/ Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: f
5,219 Electrical Lic.:3y-(o�'��,G Suprv. Lic.: (q specifically listed 'h hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Date:01 b ;Wl(a ❑Plan Review Required(25%of permit fee):
e State surcharge(12%of permit fee): / �-
Authorized signature: TOTAL PERMIT FEE:
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.
(:,Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/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 Qtv. Each "rural
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* >100kva—noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/:hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter
Fee for each commercials stem:• $75.00
Y • Number of inspections allowed per permit. Page 1):
(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
6�-65then. C tl Vj
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10104 WASHINGTON SQUARE RD, TIGARD,
OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00017
Jeff Grove
Violation Summary:
Inspector Contractor