Permit (250) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELR2017-00001
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/03/2017
T r t.AlI Dg Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 100 -
Project: Healthy Living Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Data telecommunications system.
Contractor: HATFIELD COMMUNICATIONS LLC Owner: G&S FC LLC
PO BOX 83825 16083 SW UPPER BOONES FERRY RD,
PORTLAND, OR 97283 STE
TIGARD, OR 97224
PHONE: 503-978-8888 PHONE:
FAX: 503-978-8899
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/03/2017 $75.00
12%State Surcharge-Electrical 01/03/2017 $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: 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 la . A ork 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 su -nd-- or -r he 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification e er.' hose ,..1 set '•���{{{{{{-, ' OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules 9r direct questions to OUNC by calling 50 . 32.1 r 1 :�*1'x.344
i.
Issued By: �.�,. _ ._ —� Permi-ee Signature: !' 1 -�
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 ,..,„
, , :8
Y
Received
City of Tigard ' Date/By: ! .3 i 7 /�-- Permit#: ,��,/,p 74)i 7 c s,y.t i
, - • 13125 SW Hall Blvd.,Tigard,OR 97223- ''41t'- x �P''� i.t t
1 Plan Review Related Permit#:,84/;20/4,.....063.3)
Phone: 503.718.2439 Fax: 503.598.19..= ' Date/By:
T I G A K D Inspection Line: 503.639.4175 �\ ,1 ,�,Rt,ady Date/By: Juris: e Page 2 for
Internet: www.tigard-or.gov P r Iititified/Method: 7, Supplemental Information
TYPE OF WORK. 1 h 1•., 11: -i PLAN REVIEW
Please check all that apply(submit 2 sets ofplans w/items
0 New construction ❑Addition/alteration/repl��el'nent pp y checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition 0 Other: �+, where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUC WIN exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling J Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address: /, r. ❑Addition of w motor load of system.
G, 3 3 S Cluj ,),"..A0/1,6) 001IQr re. ❑ A> E„ 'l_2» l_3„
City/State/ZIP: dY 2 2-V
`r ASix or more residential units. occupancy.
/ ' �� / - ❑Health-care facilities. ❑Recreational vehicle parks.
o Hazardous locations. 0 Supply voltage for more than
Suite/bldg./apt.#: �� I Project name: fv4 /'f/ Z ljt
0 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.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WO Limited energy,residential 75.00 2
D
hi/19
ih /G�� 9Q/ (with above sq. t)
1/ /Y �— (� `� Limited energy,multi-family 75.00 2
/ residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 6 is f L L 200 amps or less 100.70 2
� 201 amps to 400 amps 133.56 2
Address: /0‘, E 3 S� ?,p .„� b'pC x,k)„f 71-tne�,y jZ C 401 amps to 600 amps 200.34 2
City/State/ZIP: 7';1, ,_il 7 Z� ( / l 601 amps to 1,000 amps 301.04 2
Phone:( ) ` I 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 1 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
APPLICANTBranch circuits-new,alteration,or extension,per panel
0 0 CONTACT PERSON A.Fee for branch circuits with
Business name: /- 614 L 1 i t above service or feeder fee,
L 1 each branch circuit 7.42 2
Contact name: / B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
n CONTRACTOR ' Pump or irrigation circle 67.84 2
Business name: i)V-7I”, ( ,, lin t C A.1`U,J S �-C Sign or outline lighting /67.84 2
a Signal circuit(s)or limited-energy
Address: , Qt !� Z S panel,alteration,or extension. ��Page 2 / 2
City/State/ZIP: /� �/� ? 3 Each additional inspection over allowable in any of the above
/ Y ,`^ Additional inspection(1 hr min) 66.25/hr
Phone:( ) el ,p 0 gg g I Fax:(�v3 ) `.7e✓— g )9 Investigation(1 hr min) 90.00/hr
Email: 4---„-_,,,,,1 Industrial plant(1 hr min) 78.18/hr
n A S Inspections for which no fee is 90.00/hr
CCB Lic.:/ 7 I Electrical Lic.: 7 �,,Supry c.:54�0 L�f3 specifically listed('4 hr min)
l / ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: r G . Subtotal: CO
Print name: x-:e J 4) y . I y,_e/( Date: V249 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): -1,
Autho ' :I s':n to e:
/ TOTAL PERMIT FEE:
/ilk
This permit application expires if a permit is not obtained within 180
Prin n :r-• ��' Date:0/726r� � days after it has been accepted as complete.
Cs Number of inspections allowed per permit.I:iBuildint rermits\ELCPermitApp_EL'_ RE.doc R'06/17/2015 4615T(I1/05/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
DescrFee for all residential systems combined: $75.00 0" Qty• Each 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
n Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
n 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(V2 hr min)
COMMERCIAL WORKONLY: ELECTRICAL PERMIT FEES
SubtotalEnteron 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:
❑ 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
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PeanitApp_ELRERE.doc Rev 06/17/2015