Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
* COMMUNITY DEVELOPMENT Permit#: ELR2016-00133
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/02/2016
Parcel: 23101 BD00100
Jurisdiction: Tigard
Site address: 7650 SW BEVELAND RD 170
Project: OMEP Subdivision: None Lot: None
Project Description: Low voltage for Access
Contractor: A& E SECURITY& ELECTRONICS SOLUTIONS Owner: PNWP LLC#2
PO BOX 179 PO BOX 2206
MCMINNVILLE, OR 97128-0179 BEAVERTON, OR 97075
PHONE: 503-883-4139 PHONE:
FAX: 503-883-7664
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/02/2016 $75.00
12%State Surcharge-Electrical 06/02/2016 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
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: 1 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. ATTENTI•.• • egon law requires you to follow the rules adopted by the Oregon Utility Notification enter. Those rules are set forth in OAR
952-001-00 hrough OAR•, -.: -00.4. .0 may obtain a copy of the rules or direct questions to OUNC • a ing i• . .1987 or 1.800.332.2344.
Issu=• By: k. .� ./L ! — i Permittee 1 ilre Pr
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 FoR orFicE USE oyl.l
Received
Tigard ►
City of /_
g Date/B s . •
III I II 13125 SW Hall Blvd.,Tigard,O' 28� Plan Review r
Phone: 503.718.2439 Fa 1 'S0 Date/B : Related Permit#:
I i t, ,�;1) Inspection Line: 503.639.41` _ �0� yy`yy Ready Date/By: Ions: Ei See Page 2 for
Internet: www.tigard-or.gov t � l``7 Notified/Method: Supplemental Information
tt
,. . TYPE_OF` iC �w�� `O PLAN'REVIEW'
❑New construction ®Addition/alterat 4RC Please check all that apply(submit 2 sets of plans w/items checked):
} 0 Service or feeder 400 amps or more 0 Buildingover three stories.
1/4..
1P
❑Demolition ❑Other:
V� �� where the available fault current 0 Marinas and boatyards.
CATEGORY OF Co.,� strial ['Accessory building' . . ON exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ®Commercial/i
less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB 0TE1100RMATION AND.=LOCATION: { 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address:7650 SW BEVELAND STREET100HP or more. ❑"A "E "1-2 "1-3
Ci /State/ZIP:PORTLAND OR 97223 ❑Six or more residential units. occupancy.
ty ' ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 170 Project name: O M t..." 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: r'r,, ' REF - D
Description I Qtv. I Each I Total 1 *
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'1500 sq.ft.or portion 33.92 1
' t i-,.. w.. u ;: e t. : :r ._.'...t -i ?r. .iew - _.a Limited energy,residential
LOW VOLTAGE-ACCESS
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
{ ,.,- ROPF ,'i'3t s1 .. .rr i.st".R'r.* ,, -N ::- 4. _ ...., r Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
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 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 I
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 Ps 168.54 2
BA.ranchfor. circuits-ccircuitnew,alteration,with or extension,Per panel
At� �.>c� • CONYACT PER�DN
Fee s
Business name:A&E Security above service or feeder fee,
7.42 2
each branch circuit
Contact name:Doug Elsberry B.Fee for branch circuits without
Address:PO Box 179 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:McMinnville,OR 97128 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)883-4135 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:delsberry@4security.org Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:A&E Security Sign or outline lighting 67.84 2
Address:PO Box 179 Signal circuit(s)or limited-energy
panel,alteration,or extension. ® See Page 2 75.00 2
City/State/ZIP:McMinnville,OR 97128 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)883-4135 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:delsberry@4security.org Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 65198 Electrical Lie 181495 Suprv.Lic.: specifically listed('/A hr min)
� ]�• ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ,{l\w,,1 Subtotal: 75.00
Print name: Michael Elsberry Date: 5/24/16 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of pennit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signature:
'*t This permit application expires if a permit is not obtained within 180
Print name: Michael Elsberry !1 Lk Date: days after it has been accepted as complete.
C 111 * Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
•
Electrical Permit Application—City of Tigard
t
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTLALVVORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description Qty. Eeen Total
3' 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/z hr mm) SES
�O*.tIViE4C .VOCOMs
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: Access
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
1:\BuildingWennits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015