Permit (29) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'.
2 COMMUNITY DEVELOPMENT Permit#: ELR2016 00245
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued:
T[ a1.�.t� 9 10/20/2016
Parcel: 1 S 136DA00101
Jurisdiction: Tigard
Site address: 11410 SW 68TH PKWY
Project: Oregon PERS Subdivision: None Lot: None
Project Description: Fire alarm panel upgrade.
Contractor: SIEMENS INDUSTRY INC Owner: OREGON, STATE OF PUBLIC
15201 NW GREENBRIER PKWY EMPLOYEES' RETIREMENT FUND
SUITE A4 11410 SW 68TH PKWY
BEAVERTON, OR 97006 TIGARD, OR 97223
PHONE: 503-207-1839 PHONE:
FAX: 503-207-1901
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/20/2016 $75.00
Type of Use: COM 12%State Surcharge-Electrical 10/20/2016 $9.00
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: 1
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 Cep - Those rules are set forth 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 503.2 .1987:.11.800.332.2344.
Issued By: ( 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 A i I licati!.1 r role molt i l sl,oil.v
FIVF1)
City of Tigard � I Received
/IMEZEIR111 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : I ,, _fit ��
2 0 2016 Plan Review '
_
Phone: 503.718.2439 Fax: 503.598.19¢{d T b Date/B : Related Permit#: l 1 '
Inspection Line: 503.639.4175 1)1 i ` -
l 1 G A R p Ready Date/By: Jur s: ® See e Page 2 for
Internet: www.tigard-or.gov Notified/Method: 7--- . Supplemental Information
Cin♦ of IGARDn
TYPE OF �1�['�� lJN
PLAN REVIEW
❑New const action ddition/ • 1':ti 2tGefIICIIt 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.
El1-and 2-family dwelling =Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
{u1 amps for all other installations. buildings.
❑Multi-family Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
//9/e) 0 Se ' � P
4„7/
Addition of new motor load of system.
Job#: Job site address: G✓ 100HP or more. ❑`°A",°°E",°l-2",°l-3",
City/State/ZIP: 7= � � ,Q 0 Six or more residential units. occupancy.
��^^�LL �- j.�'` ?�� ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: "Project name: 0 Hazardous locations. 0 Supply voltage for more than
'� / 600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: ldp G FEE SCHEDULE
S Description I Qty. I Each I Total I *
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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK
Limited energy,residential
®� �, (with above sq.ft.) 75.00 2
ung �"6 - € ' _r e ,C21(4e/ Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
PROPERTY OWNER ❑;TENANT Renewable Energy 0 See Page 2
Services or feeders installation,alteration,and/or relocation
Name:
_St a f D/, O^ 200 amps or less 100.70 2
Address: ,I/t fiO Ste e- / 201 amps to 400 amps 133.56 2
[o 0 401 amps to 600 amps 200.34 2
City/State/ZIP: 7244rd se 97273 601 amps to 1,000 amps 301.04 2
Phone:(S05) G :, 7 f51 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
eirAPPLICANT" CONTACT PERSON Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:
V/e n e f. above service or feeder fee,
each branch circuit 7.42 2
Contact name: Ci iia y B.Fee for branch circuits without
Address: /S g�f � �/ service or feeder fee,first
iti �'�e e,. b/:4, �,[w y , /9 U branch circuit 56.18 2
City/State/ZIP: P.otG���„ 9�9240E040� Each add'l branch circuit 7.42 2
/ Miscellaneous(service or feeder not included)
Phone:(50 3) O/G .- ,387 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Cj - 1),o/,crA7 € 3I fp" Q/IS. C Pelt Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: b---i 6,0,e„.. , Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
AIL., bre 04 kr;'Q.. /ie, /f 4/ panel,alteration,or extension. ❑ See Page 2 2
Address: /3-20/
City/State/ZIP: 44,
l�n �n 900 Each additional inspection over allowable in any of the above
Ue/' / LLLPPP Additional inspection(1 hr min) 66.25/hr
Phone:(503) S/G -93 7 Fax:( ) Investigation(1 hr min) 90.00/hr
Email: qi �t7/ Q p e^ Industrial plant(I hr min) 78.18/hr
eo M Inspections for which no fee is 90.00/hr
CCB Lic.:/3 se)y/ Electrical Lic.: _ uprv.Lic.: �� 'G specifically listed(''/z hr min)
J / / ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: %C 1'j
Subtotal: 75,
Print name: CJ V/Jril_ . / Date:/tyle/j 4 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: •Vg j7
This permit application expires if a permit is not obtained within 180
Print name: Cs "eSi _ Date/X0 / 4 days after it has been accepted as complete.
Date/X01/
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 44 15T(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:
5 kva or less 100.70 2
Check Type of Work Involved:
5.O1 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
TI Garage 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:
❑ 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 O • ,,, 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:
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
❑ Dat Telecommunication Installation
Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
n Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015