Permit CITY OF TIGARDlig ELECTRICAL RESTRICTED ENERGY PERMIT
)r . t Permit#: ELR2016-00039
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/01/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9546 SW WASHINGTON SQUARE RD H16
Project: Ben Bridge-Temporary Location Subdivision: None Lot: None
Project Description: Installation of low voltage for CCTV
Contractor: INTERFACE SECURITY SYSTEMS LLC Owner: PPR WASHINGTON SQUARE LLC
3773 CORPORATE CENTER DR EARTH PO BOX 847
EARTH CITY, MO 63045 CARLSBAD, CA 92018
PHONE: 314-595-0100 PHONE:
FAX: 314-595-0376
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/01/2016 $75.00
12%State Surcharge-Electrical 03/01/2016 $9.00
Type of Use: COM
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 ac ance withroved 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. ATT TION: Oregon law requir• •u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through OAR 952-001-01:*. You may obtain a copy/off therulesor direct questions to OUNC by calling 503.232.1987 or :00.332.23• .
Issu d By: k_____.)/01 / A��i7/� Perm ittee 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 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 ApplicatiREj C IVE FOR It c)r l I c I. I SI. c) I.
City of Tigard Received Permit#: Ea.,.0lfo_060- -
,�`Q,�� /� Date/B
.114 • 13125 SW Hall Blvd.,Tigard,OR 972 3t!J' Plan Review Related Permit#:
Phone: 503.718.2439 Fax: 503.598. Date/B
Inspection Line: 503.639.4175 Ready Date/By: Juris: H See Page 2 for
I I :I> Internet: www.tigard-or.gov (.411(Of i1(AKU Notified/Method: Supplemental information
TYPE ci MING DWISM1% PLAN REVIEW
.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.
❑Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
- CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Mu ti-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
5-5/0 JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: J J 0 Addition of new motor load of system.
y ��„. 100HP or more. ❑"A , E . 1.2 , 1.3 ,
Cit /State/ZIP: + Six or more residential units. occupancy.
y 1 l 4 O. 4'i 2 Z 3 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project Cf.
0 Hazardous locations. 0 Supply voltage for more than
�•N�r � 600 volts nominal.
Jut. ❑Service or feeder 600 amps or more.
Cross street/directions to job site: t s q t Ju� \�cr,�l FEE SCHEDULE
Description I Qt . I Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sqftor portion 33.92 I
DESCRIPTION OF WORK Limited energy,residential
75.00 2
N a f( �11 I r C C 4-v (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 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 1 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 CONTACT PERSON Branch circuits new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: tr- LE- / 4 '-€. above service or feeder fee, 7 42 2
�l each branch circuit
Contact name: ‘"----- t�V, B.Fee for branch circuits without
V,,. service or feeder fee,first 56.18
Address: t` l branch circuit
r /'�� -� �l
City/State/ZIP: \l,.yk `� LJA 77 2-t/ Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(Sti ) 7,0\ G(73 ' I Fax: :( ) Each manufactured or modular
67.84 2
�JV� C cy r /lJ
dwelling,service and/or feeder
Email:
.404 �lv��J I� L 1 � l. Reconnect only 67.84 2
CONT OR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: panel,alteration,or extension. 0 See Page 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(I hr min) 90.00/hr
Email: I I,(1 Industrial plant(I hr min) 78.18/hr
(0 inspections for which no tee is
I(C If-7, I Li C(2?j c A I pLie.:CLE ts specifically listed /hr mm 90.00/hr
CCB Lic.: 1 Electrical Lie.: _i L Py Su rv. 1. 1� y (�
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal: I6'1'7°
Print name: 1 t- Date: 1 Zi 0 Plan Review Required(25%of permit fee): �—
I\ �w � M��/ d �` State surcharge(12%ofpennittee): --_O�
Authorized signatu TOTAL PERMIT FEE: vi .Ov
:____Ic
This permit application expires if a permit is not obtained within ISO
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:Building Permits,ELC Permit App ELR ERE.doc Rev 06 172015 440-4615T(I 105 COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RENTIAL WORK ONLY: • ;'. . FEE SCHEDULE
DFee for all residential systems combined: $75.00 Renewable
Qty. Each r Total II
�' 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:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system:. $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
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: �TV
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:Building Permits ELC PermitApp_ELR_ERF.doc Re%06 I7 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
9546 SW WASHINGTON SQUARE RD H16,
TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00039
Herb Stabenow
Violation Summary:
Inspector Contractor