Permit (84) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
N., COMMUNITY DEVELOPMENT Permit#: ELR201600083
T LG ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/30/2016
Parcel: 1S136DD00801
Jurisdiction: Tigard
Site address: 11565 SW 67TH AVE
Project: Green Office Subdivision: WEST PORTLAND HEIGHTS Lot: 6
Project Description: Low voltage for(2)systems:audio and camera
Contractor: TRI STAR ELECTIC INC Owner: GREEN OFFICE LLC
PO BOX 231175 ATTN: JOESPH E GREEN
TIGARD, OR 97281 11560 SW 67TH AVE
TIGARD, OR 97223
PHONE: 503-860-3838 PHONE: 503-806-3004
FAX: 503-590-2302
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/30/2016 $150.00
12%State Surcharge-Electrical 03/30/2016 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio&Stereo: 1 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 $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 i ccordanc- 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. TENTION: Oreg,•n I. • re. ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 -0010 through OAR• -001-009•. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss d By: • - Permittee Signature: L�.�� 41,Lw‘_1
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 ApplicaCF I.OR t 1 F I.I t l: I 1. a ►.
City of Ti and Received Permit#: EI.,/e.,;.0/(-�ag3
./g Dateiv +♦
u 13125 SW Hall Blvd.,Tigard,OR
�r3 Plan Review
II Phone: 503.718.2439 Fax: 503. s 1 r �eB _ Related Permit#: 6.44711v0-• QOg63
Inspection Line: 503.639.4175 Ready Date/By: Juris: 0 See Page 2 for
l I c'.\k D Internet: www.tigard-or.gov (.,I i ' u, A d. R.I) Notified/Method: Supplemental Information
TYPBNIMISC DIVISION PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other.
0
Service wheretea available ffaulfeeder 400 tccu ormore
t 0 Building over thrests,;es.
0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 ❑commercial-use agricultural
El1-and 2-family dwelling ®CommerciaVindustrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: 0 Fire pump- 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: 16015 Job site address: 11565 SW 67th Ave ❑Addition of new motor load of 'K',"system_
IOOHP or more. ❑"A',"E",`I-2","1-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. icy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:Connoisseur Concentrates 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description l Qty. I Each I Total l
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
Install LV y- aUc t GarYt.exa Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 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: relaxation
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 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
Address: service or feeder fee,first 56.18 2
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
67.84 2
Email: dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Tri-Star Electric,Inc. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:PO Box 231175 panel,alteration,or extension. tai See
Page 2 /jQ'()L 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Tigard,OR 97281
Additional inspection(I hr min) 66.25/hr
Phone:(503)860-3838 Fax:(53)590-2302 Investigation(I hr min) 90.001 hr
Email:debbiem@tri-starelectric.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 153559 Electrical Lic.: 34-620C Suprv.Lic.: 3832S specifically listed(V2 hr mm) 90hr
_ ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 1'�i isn""`"'� Subtotal: 15 0.00
Print name: Rich Metzler Date: 03/30/2016 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): /8,06
TOTAL PERMIT FEE: 1(08.0 0
Authorized signature:
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 06117/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL,AL WOR>C NL ': " FEE ScHE1 :
DescrFee for all residential systems combined: $75.00 Renewable
on 1 Qty. I Each I Total I
R
3' Renelectrical 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:
❑ B• urglar 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) 1 ,
❑ 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 1
charged at an hourly(1 hr mm)
Inspections for which no fee is 90.00/hr
specifically listed('/Y hr mm)
COMMERCIAL WORK ONIN: ELEtTRICtL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ C• lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ O• utdoor Landscape Lighting*
❑ Protective Signaling
• Other: Camera
Total number of commercial systems: 2
*No licenses are required. Licenses are required for all
other installations
I\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015