Permit (53) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2016-00069
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/21/2016
Parcel: 1 S 1260000300
Jurisdiction: Tigard
Site address: 9516 SW WASHINGTON SQUARE RD H05
Project: Ben Bridge Jeweler Subdivision: None Lot: None
Project Description: Install CCTV equipment in existing space being remodeled.
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 03/21/2016 $75.00
12%State Surcharge-Electrical 03/21/2016 $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 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 se orth 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 503.23. •87 or111111e(
00.332.2344.
Issued By: 47 _ Permittee Signatu
OWNER INSTALLATION ONL
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 Applicatio E Et 1'E 1 oR Ol FI( I I SI. O\I 1
Received
City of Tigard q C Date/13 : 3 2/ 16 04irl Permit tlE�_ if/ DOO6 •
13125 SW Hall Blvd.,Tigard,OR 97223Mp`R 21 ZO�6
1'- Plan Review
I • Phone: 503.718.2439 Fax: 503.598.1960 /yL y Date/B :11114
Related Permit a:
Inspection Line: 503.639.4175 CII V VC d!CARD Ready Date/By: orris: ® See Page 2 for
H.. 11:I)
Internet: www.tigard-or.gov `i[JJ�,� �T p� `ric n Notified/Method: Supplemental Information
TYPE OFliI�UlliP Li�tl1�7�U�
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.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
` CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1 and 2-family dwelling ..Commercial/industrial 0 Accessory building less to ground-or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family ❑Master builder 0 Other: ❑Fireum
p p. 0 Installation of 150 KVA or
JOB SITE INFORMA N AND ..,
LOCATION 93 f ❑Emergency system. larger separately derived
Job#: Job site address: • C I c ❑Addition of new motor load of system.
� J � (Ai!.t Sh, Ytl.?� I OOHP or more. ❑`A..-..E..,..I_�...,.1_�..,
Cl /State/ZIP: ((���� �j U Six or more residential units. occupancy.
ty ?cr.,
V�i K / �),- hie 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: IA 0 G- Project name: " r�cre 0 Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
��% r r
❑Service or feeder 600 amps or more.
Cross street/directions to job site: kArwSh °�� cq9,-K, An.A l FEE SCHEDULE
Description I Qtr. I Each I Total I *
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'I 500 sq.ft.or portion 33.92 1
--+ DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
r //`` C w-�
J t( C l/ - �.(,I�_,, -F Limited energy,multi-family 75.00 2
�ix (./"lti( i I C Y IS � P4- residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2 I
Address:
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 5.52.26 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
0 APPLICANT I 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
-- — Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Ercall: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ��.\._Qy. L _c �/`^ Sign or outline lighting 67.84 2
Address: Signal circuit(s)or limited-energy
panel,alteration,or extension. ?tfSee Page 2 i 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( O.) 20k_ q 7 Fax ( ) Investigation(I hr min) 90.00/hr
Email: ` 1 j� -� `- Industrial plant(I hr min) 78.18/hr
t 1 �rl�`0�`� L./A"til. a,.., i S L O�� Inspections for which no fee is
[� CA
specifically listed('/hr min) 90.00/hr
CCB Lie,: 6f 4 �Z Electrics Lic.: �q�7� upry Lic.: 3io 3
ELECTRICAL PERMIT FEES
Suprv. Ele '-jut signature,require Subtotal: ./7S, CJ
Print name �q J1 O \0 Date: � 'z I 0 Plan Review Required(25%ofpermit fee):
State surcharge(12%of permit fee): 9,
TOTAL PERMIT FEE: `J
Authorized signature-• til / r 0—r)
This permit application expires if a permit is not obtained within 180
Print name: JI �G `J�t� Date: Z ( days after it has been accepted as complete.
a ' 1 * Number of inspections allowed per permit.
I Building Permits EEC PermitApp FLR_ERE.doc Res 06 I 44415 440-4615T111 05 COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
--110$1001114VtL'll M FEE atEDULE
' Description I Qty. 1 Each 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 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
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(1 hr min)
Inspections for which no fee is 90,00/hr
specifically listed(Y�hr min)
COMMERCIAL WORK ONLY: : _ ELECTRICAL'twin' FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(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 OtSignaling
her: C T�
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I Building Permits I-I CPermitApp ELR_ERE.doc Rec 00 17201 5
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
9516 SW WASHINGTON SQUARE RD H05,
TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00069
Jeff Grove
Violation Summary:
Inspector Contractor