Permit (174) IN
s
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
! COMMUNITY DEVELOPMENT Permit#: ELR2016-00263
T f ..GA 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/17/2016
Parcel: 2S102AD02900
Jurisdiction: Tigard
Site address: 12790 SW ASH AVE
Project: Burnham&Ash Apartments Subdivision: BURNHAM TRACT Lot: 5
Project Description: Building 2-Low voltage for irrigation controller
Contractor: TEUFEL NURSERY INC Owner: PREMIUM PROPERTY-TIGARD LLC
7431 NW EVERGREEN PARKWAY STE 200 1015 NW 11TH AVE, STE 243
HILLSBORO, OR 97124 PORTLAND, OR 97209
PHONE: 503-646-1111 PHONE: 503-226-1972
FAX: 503-646-1112
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 11/17/2016 $75.00
Type of Use: COM 12%State Surcharge-Electrical 11/17/2016 $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: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 1
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 Center. Those rules are set forth in OAR
952-001-0010 ugh 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: Y� P.). (Q. ,ate Permittee Signature: ( _A. if mari./
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 Applicat' - FOR OFFICE USE ONLY
City of Tigard GtZi‘i °°i Received
DateB filrit>� Permit#' �jl iw�J/-�?
r 4 13125 SW Hall Blvd.,Tigard,OR 972 �} Plan Review -tJ""a�
■ Phone: 503.718.2439 Fax: 503.598.1 av 1 7 2016 Date/B : Related Permit#: Aet.Pac/4. `g
%CTc)Alt[) Inspection Line: 503.639.4175 ReadyDateBy: Juris:
Internet: www.ti and-or, ov (�fl y' i`• +- GAR€ SuJ plePent 2 lInr
g g � Notified/Method: Supplemental Information
_. :-", TYPE ' '!nfrV 1 -. T; i ,:: ii 41, : PLO"REVIEW '-'i'4, '
E New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition 0 Other: ❑Service or feeder 400 amps or wort ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
a CATEGORY OF'CONSTRUCTION ,.'i.,, 'i,' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑Multi-familyamps for all other installations. buildings.
0 Master builder ®Other:Mixed Use ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#:81608 Job site address: 12790 SW Ash Ave O Addition of new motor load of system.
I
City/State/ZIP:Tigard,OR 97223 ix or or more. ❑oA`,ancy. -2","I-3",
❑Six or more residential units.. pane
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:2 Project name:Burnham&Ash Apartments ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps ar more. 600 volts nominate
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: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORK Ea. sq.ft.or portion 33.92 I
Limitedited energy,residential
Landsca e&irri ation 75.00 2
p g (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft) 75.00 2
PROPERTY, 1VNI R TENANT Renewable Energy
0 ❑ See Page 2
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
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) 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 trirh
Business name:Teufel Nursery,Inc. above service or feeder fee,
each branch circuit 7.42 2
Contact name:Kelly Dalpoggetto B.Fee for branch circuits mithom
Address:7431 NW Evergreen Parkway,Ste 200 service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP:Hillsboro,OR 97124 Each add'I branch circuit 7.42 2
Phone:(503)646.1111Miscellaneous(service or feeder not included)
Fax: :(503)646.1112 Each manufactured or modular
Email:I{ellyD@Teufel.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Teufel Nursery,Inc. Sign or outline lighting 67.84 2
Address:7431 NW Ever ren Parkwa Ste 200 Signal circuit(s)or limited-energy A
g y' panel,alteration,or extension. See Page 2 150.00 2
City/State/ZIP:Hillsboro,OR 97124 Each additional inspection over allowable in any of the above •
.. Additional inspection(1 hr min) 66.25/hr
Phone:(503)646.1111 Fax:(503)646.1112 Investigation(1 hr min) 90.00/hr
Email:KellyD@Teufel.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 41669 Electrical Lic.: LCB 5133 Suprv.Lic•: specifically listed(%s hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMII FE)S
Subtotal: 75.00
Print name: Date: 0 Plan Review Required(25%of permit fee):
}
State surcharge(12%of permit fee): 9.00
Authorized signature:g / TOTAL PERMIT FEE: 84.00
t This permit application expires if a permit is not obtained within 180
Print name: /.,1 "(` , C ctt 2�-, ate: { I days after it has been accepted as complete.
( i" i J 11 Number of inspections allowed per permit.
1:\Building\Pennits\ELC_PermitApp_EI.K_ RE.doc Rev 06/171 O 440-4615T01/OS/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY. -FEE scHLll,ULE
Fee for all residential systems combined: $75.00 Description Qty. I c ch I Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
H Audio and Stereo Systems* 15.01 toes kva 200.34 2
Wind generation systems in excess of 25 kva:
Burglar Alarm 25.01 to 50 kva
301.04 2
I
Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
[] H• eating,Ventilation and Air Conditioning
Solar generation systems in excess of 25 kva:
System*
r'''� Each additional kva over 25 7.42 3
P I V• acuum Systems* >100 kva-no additional charge 0.0 3
r7Other:
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
specifically listed('A hr min) 90.00/hr
COlVIIVIERCIAL WORK ONLY . <;ELECTRICAL P Rli�rr t yrs ,•
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
1 I Instrumentation
Intercom and Paging Systems
® Landscape Irrigation Control*
❑ Medical
n Nurse Calls
I I Outdoor Landscape Lighting*
I 1 Protective Signaling
Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC PermitApp_ELR_ERE.doc Rev 06/17/2015