Permit (16) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
"IN . COMMUNITY DEVELOPMENT Permit#: ELR2016-00240
13125 SW Hat Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 10/10/2016
g Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16154 SW UPPER BOONES FERRY RD
Project: Allstructure Engineering Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Data telecommunications system.
Contractor: ALLPHIN COMMUNICATIONS INC Owner: PACIFIC REALTY ASSOCIATES LP
23220 SW BOSKY DELL LANE ATTN: N PIVEN
WEST LINN, OR 97068 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-638-9000 PHONE: 503-624-6300
FAX: 503-638-9100
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/10/2016 $75.00
12%State Surcharge-Electrical 10/10/2016 $9.00
Type of Use:
Class of Work:
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 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 iss - ce, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notificati.n i enter. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a c. of tb rules or direct questions to OUNC by calling 5'(3.23.1987 or 1.800 2.2344.
i
Issued By: _ egimittee 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 FOR OFFICE i.sr 0y1.1
City ' Received f
f g 1F M X,',..A<,-
• o Ti and ) Date/B : (S 1 ,�,'���
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
= Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: AIL S
Inspection Line: 503.639.4175 $ i l ReadyDate/By: runs:
1 I G A R D ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
i.iklh ikb
TYPE OF WORM` i ,. PLAN REVIEW
❑
New const action Addition/alteratlori/ t ';'=; t Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: c 0 Service or feeder 400 amps or more 0 Building over three stories.
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:
❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
f�.�µ ❑Addition of new motor load of system.
Job#: �10 Job site address: /to/$4 3') Ur O f Al)eS 100HP or more. ❑"A","E",°`1-z",`°t-3",
�4 c7-7"2-2
—' 4 ❑ •Six or more residential units. occupancy.
City/State/ZIP: O/-(��u/ // 22 0 Recreational vehicle parks.
0 Health-care facilities.
Suite/bldg./apt.#: (31d/c I Project name: 0 Hazardous locations. 0 Supply voltage for more than
J ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: I 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
DESCRIPTION OF WORK Limited energy,residential
^et` V/ � (with above sq.ft.) 75.00 2
/ S/14,0---- Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
0 Renewable Energy 0 See Page 2
PROPERTYWNER ' is5 TENANT, Services or feeders installation,alteration,and/or relocation
Name: S >Jcz)
vty ) �r✓yv / O 200 amps or less 100.70 2
Address: L•(, 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:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Email:
Temporary services or feeders installation,alteration,and/or
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
APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: /,/Ih 1;4'
r� 1"/"''"1‘167M..
��" I r( , above service or feeder fee, 7 42 2
Contact name: v
"�'F' y" each branch circuit
r�%. it't B.Fee for branch circuits without
��2 �� �j „kit ) service or feeder fee,first 56.18 2
Address: 3 9 I i J"' branch circuit
City/State/ZIP: VA.Jes,t t -1.,,,'� 04 6%7apoEach add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(4-43* )&13'5,_36;00e> I Fax: :(5p,)6$9> `Woo Each manufactured or modular
Email: lCa, dwelling,service and/or feeder 67.84 2
�/ (""' • Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy page 2 / 2
Address: panel,alteration,or extension.
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: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: /07 -1i€) I Electrical ic.:3-29r Y Suprv.Lic.: , -- specifically listed(V2 hr min)
J a 7iG ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: < ����
t/"I Subtotal:
Print name: 4 Date: 0 Plan Review Required(25%of permit fee): -�
State surcharge(12%of permit fee):
Authorized signature f t‘,/ TOTAL PERMIT FEE:
t, � This permit application expires if a permit is not obtainl�within 180
Print name:9�y°(-p a ?;_/,�r,t� Date: /04b koo* days after it has been accepted as complete.
f �r " ( lll * Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 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 WORK ONLY: FEE SCHEDULE
Description I Qty. I 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:
El Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
El 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:
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('h hr min)
ELECTRICAL PERMIT'FEES
COMMERCIAL WORK ONLY:
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
in A• udio and Stereo Systems
n B• oiler Controls
El Clock Systems
AlData Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015