Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• ' COMMUNITY DEVELOPMENT Permit#: ELR2016-00089
T 1G ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/05/2016
Parcel: 2S112DD00400
Jurisdiction: Tigard
Site address: 15940 SW 72ND AVE B17
Project: SCS Engineers Subdivision: None Lot: None
Project Description: Low voltage for communication cables
Contractor: FREEDOM CUSTOM COMMUNICATIONS LLC Owner: PACIFIC REALTY ASSOCIATES L P
6526 SW WINTERS RD 15350 SW SEQUOIA PKWY#300-WMI
CORNELIUS, OR 97113 PORTLAND, OR 97224
PHONE: 503-544-1302 PHONE:
FAX: 503-359-5695
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/05/2016 $75.00
12%State Surcharge-Electrical 04/05/2016 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 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 otification Center. Those rules are set forth in OAR
952-001-00 through 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calli 503.232.19 . 32.2344.
Issued /\ Permittee 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 Application .. c,..,, . .. , i, ; , ;,
Received ___ / . ,f�,,-OOO
City5 Tigard g p er e I�/CL' P Perm t a:
•13125 SW Hall Blvd.,Tigard,OR 9 V G 1/CReviewRelated Permit#:
' ` " '
r. Phone: 503.718.2439 Fax: 503.598.1960 C Date/13 :
Inspection Line: 503.639.4175 APR 0 62 016 Ready Date/By: Reis: H See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
' . 1.11111111.1111111111111111.111111111111111111
❑New construction 0 Addition/.e4- i l•R",1'1”!,1! vt I , Please check of that apply(submit 2 sets of plans wlitems 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.
exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amp❑Multi-family 0 Master builder 0 Other: uall other installations. buildings.
ns0 Fire pump. 0 Installation of 150 KVA or
❑Emergency system. larger separately derived
No C 0 Addition of new motor load of system.
Job#: Job site address:
4 v 1"T b SCJ A•J 100HP or more. ❑ E„ t-2„ 1-3 ,
City/State/ZIP: --1' 1(."(:),(2() 1 --4:2_I ,t it ❑Six or more residential units. occupancy.
0❑Health-care facilities. Recreational vehicle parks.
Suite/bldg./apt.#: Project name: C ['Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
Description Qty. Each Total "
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel# 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Limited ne ,rfteresidential
75.00 2
(with above .)�W )to'
G=)c 6- .- � +.' )t,3\Cal-'1 :V. Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
�,ce.s ._ ,d: .�'� »...., ,,;� ny_.c'. • Services or feeders installation,alteration,and/or relocation
Name: ,, c_75-T-,___) .---7 200 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 l
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
= . c' °�_..� `�.•- ,,----,--•--•'-• __-_ _ ` Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: C_----1— above service or feeder fee,
each branch circuit 7.42 2
Contact name: J a).4.,�,S,..i r--4-1 . - B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: ,. Z G
4 3 N v t Zq t. C-
, __ i. branch circuit
City/State/ZIP: \ (....1, tt�a 20 Q t 9 ( Each aad'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(s-cy ) 5--ei d ', 9 Fax: :(rte). ) +-Z 4 ) L. I Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: ..Z V ul-1\NJs. CZ'M GAS , NST Reconnect lteco ect only 67.84 2
- '_ `...,: w._. r., ..-4.:_•_.-...e-, ' ._-..._-- , ._ _. ._ . Pump or irrigation circle 67.84 2
Business name: . Gla s7�K M K u 2.L.. I e, Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ❑ See Page 2 7s 2
Address: , Uv( y� ` ., . panel,alteration,or extension. g
City/Stat‘/ZIP: � � �"1 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(03) siii Lf . . 72.... Fax:(S-03) )641•Slog,s' Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
I% Irilli: " �f y-G� - Inspections for which no fee is 90.00/hr
CCB Lic.: I 3330 Electrical Lic.: zit Wep Suprv.Lic.: G Let,/ ificall listed /A hr min
Suprv.Electrician signature,required: w�f / y ....................
,_„�, Subtotal: 7S'p
Print name: Ate,ARre, le,e,%el Date: 0 Plan Review Required(25%of permit fee): -�
State surcharge(12%of pennit fee): .oc2
Autho d signature:
TOTAL PERMIT FEE: OG
� O D •
This permit application expires if a permit is not obtained within 180
Print name• t \)1_1,1\-..A Date: L . . 1 t'o days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_Pem itApp_ELR_ERE.docx Rev 04/21/2014 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 WORK ONLY: FEE,SCHEDULE
Description I Qty. F Each I Total I *
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
❑ G• arage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min) •
Inspections for which no fee is 90.00/hr
specifically listed(%z hr min)
ELECTRICAL PERMIT' FEES
COMMERCIAL WORK ONLY: 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:
❑ A• udio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ L• andscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ O• utdoor Landscape Lighting*
El Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.docx Rev 04/21/2014
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
15940 SW 72ND AVE B17, TIGARD, OR, 97224
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00089
Jeff Grove
Violation Summary:
Inspector Contractor