Permit (38) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
INIa COMMUNITY DEVELOPMENT
Permit#: ELR2017-00011
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/24/2017
1"r :k ill D9 Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 610
Project: Guild Mortgage Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Low voltage for data
Contractor: BRY-COM Owner: LINCOLN CENTER LLC
14244 SE BUSH BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97236 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-761-5156 PHONE:
FAX: 503-760-7501
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/24/2017 $75.00
12%State Surcharge-Electrical 01/24/2017 $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 law. All work will
be done in ante 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. TENTION: Orego?N1aw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules ar set forth ' ' OAR
952- 1-0010 througheOAR 952-001-0090. 'o may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19; •r 1.800.33 .2344
I ued By: U v4 / •
Permittee Signature: L. `1 ., t---
l.
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 DIII( II FSI,0yI.A
City of Tigard «»r, Received/ ,1,/ / Permit#: E Lk-4:720/7—e.0O//
. . Fn
DatB e9"1-
7
lig13125 SW Hall Blvd.,Tigard,OR ' r .,.�.ry '„ Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 . Date/B Related Permit#: id(j/ noo?,
,36
Inspection Line: 503.639.4175 JAN 2 q 2017
01- Ready Date/By: Juris: RI See Page 2 for
I I G A R D Internet: www.tigard-or.gov `t Notified/Method: Supplemental Information
TYPE OIGI/NglOF f(GARD PLAN REVIEW
❑New construction Additio ac a 6 oi 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.
❑ 1-and 2-family dwelling 12]Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑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:/0 22_42 S(,d ,ej 0 Addition of new motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
�
0 Six or more residential units. occupancy.
City/State/ZIP: I letsRecreational vehicle parks.
� 0 Health-care facilities. 0
Suite/bldg./apt.#: io/6 Project name: G (/tL I'J' i /)6 g ❑Hazardous locations. ❑Supply voltage for more than
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: 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
DESCRIPTION OF WORK Limited energy,residential
-v) 7 // ,( ` i./ do_i //f i! 1)CT ,q_/� (with above sq.ft.) 75.00 2
CAAt, �`� �'' h/Ntivl(i(/��/ //!�/C/ Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER ❑ TENANT 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
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 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
0
APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
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'!branch circuit 7.42 2
- Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 6784 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: / �/ f! Sign or outline lighting 67.84 2
/ qL�' 5 ah 6(S/r Signal circuit(s)or limited-energy
panel,alteration,or extension. 0 See Page 2 75-..e6 2
Address:
City/State/ZIP: )),-1,6, g72.36 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 3) 76/-6-7 5_6 Fax:(0 3) 76O-7339' Investigation(1 hr min) 90.00/hr
Email: ,8/'cogL/1 7 tr .t Industrial plant(]hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: /22/2/113 Electrical Lic' -NIS" Strv.L'..: /3Q'f L IA specifically listed('Vs hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician
signature,required:y— fr../ ..„.(x..7, / ' Subtotal: --7€76C)
Print name: U1 A,... ,4„..,,- D. •: /ZS-/7 ❑Plan Revew Required(25%of permit fee): -
! State surcharge(12%of permit fee): 9.00
Authorized signature: TOTAL PERMIT FEE: g,0
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* 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:
n 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
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('/hr min)
COMMERCIAL WORK ONLY:
ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
21. Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: (
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR ERE.doc Rev 06/17/2015