Permit (100) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2017-00020
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 02/01/2017
TIGARD 9
Parcel: 1S126DC00900
Jurisdiction: Tigard
Site address: 9580 SW GREENBURG RD
Project: Greenburg Apartments Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: Building 5-Low voltage for fire alarm&data.
Contractor: INTEGRATED WEST TECHNOLOGIES LLC Owner: RES-OR TIGARD LLC
38751 DUBARKO RD 730 NW 107TH AVE STE 400
SANDY, OR 97055 MIAMI, FL 33172
PHONE: 503-476-2106 PHONE:
FAX: 503-826-0926
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 02/01/2017 $150.00
Type of Use: COM 12%State Surcharge-Electrical 02/01/2017 $18.00
Class of Work: NEW
Total Number of Systems: 2
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 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 $168.00
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 thr( 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. 344.
� ,
Issued By: �J CQ�f� i Permittee Signature:
_ z
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 N)►z 01 1 l( 1 1 ',1 0\1 l
Ci ofTi and Received n
`'fg Date/Date/f3 : ., A K�D/7 Permit#: ei- _
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: �l�s�/l0 67/53
Inspection Line: 503.639.4175 Ready Date/By: Jurist
Page 2 for
1 I(.,'\Is 1) Internet: www.tigard-or.gov Notified/Method: SSupplleemental Information
❑New construction 0 Addition/alteration/replacement 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.
❑Demolition Other:
§ t where the available fault current 0 Marinas and boatyards.
Sfil. �. -... l r . .; V 0. �. ? ,a . 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 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
C
21 ';';'4'.:�"'':''''''"'C'''.1':::;''.:.' r':41.'''''' a,,ty I?;(1 '': d n'§ i°3'I ''; 's� '- ❑Emergency system. lar er se aratel derived
.-75-- 1_,b SCJ 6 b ❑A 011Pn o of new motor load of system.
Job#: Job site address: r-e{�� a f� 100HP or more. ❑"A">"E","1-2","1-3",
City/State/ZIP: �r1 0 s q 7a(23 / ❑Six or more residential units. occupancy.
/< / ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:6,. 6CAi pd ❑Hazardous locations. 0 Supply voltage for more than
1� f ❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job sit , �e >= y -7714117$5r wsw..-.P„z
/7 Description Qty. Each Total
12-k��a 6 r- - - 6 t,t,f'G, New residential single-or multi-family dwelling unit.
Subdivision: / I Lot#: r Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
r Ea.add'l 500 sq.ft.or portion 33.92 1
rxf ,4:,�c '4 ,'tom Y ";. a / ,,s? ,t sv) t ria .,„' 'I`a Ham. t '17.4.P., Limited energy,residential
175.00 with above ft.) 75.00 2
”` — /f41-43A— �� t� Limited energy,
a
multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy See Page 2
'; ' £` tiLl'-ttti *- "t' Services or feeders installation,alt❑eratiion,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
4"' + ' ,- Branch circuits—new,alteration,or extension,per panel
`t',' ::� n`"` , ? ':, "` .. ` ` ' 1% ' 41.1 �. 14, `- a, A.Fee for branch circuits with
Business name:et t.....eh L.Nu✓ Lrs�®,,e0f r,..1,.c 43 L _c____ above service or feeder fee, 7.42 2
each branch circuit
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:( ) Fax::( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:
Reconnect only 67.84 2
�,, � Pump or irrigation circle 67.84 2
Business name:-17— /rQY /. /? ,---,---7----,- /n44 �r Sign or outline lighting 67.84 2
/ y 6,0,-
�(,Cl� ) (/► Signal circuit(s)or limited energy See Page 2 2
Address: yg Sj t>c ,0, ,- panel,alteration,or extension.
City/State/ZIP: /� /' Each additional inspection over allowable in any of the above
. t/1—'e- / O4 %7e Additional inspection(1 hr min) 66.25/hr
(5-0
Phone: 5 ) ,(74,, a-/06, I Fax:(fO3 ),5?(.- i t g Investigation(1 hr min) 90.00/hr
ppp Industrial plant(1 hr min) 78.18/hr
Email:
'e{ f_)71 ) � , 6.04...v
O - Inspections for which no fee is
CCB Lic.:/73--)/5— Electrical Lic.: L. Suprv.Lie.: / specifically listed(V2 hr min) 90.00/hr
C 7 p 7���� � ELECTRIAL PERMIT PEES
Suprv.Electrician signature,required: .
t Subtotal:
Print name:_��/ s �� Dater////7 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Description � � Qb Each � � Tohl
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
O 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
❑ Garage Door Opener* >100 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
❑ 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:
❑ Other: Each additional inspection is
6625/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s.:ificall listed '/z hr min
=z. Y [ FI:1;Y?"
F&vn '.S EL F,",,'.. �`ff.. -: E±-; °c 8...&. 'K z{ ,;xnY` ,",.. .d.
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:
❑ Audio and Stereo Systems
❑ Boiler Controls
O Clock Systems
aData Telecommunication Installation
aFire Alarm Installation
❑ HVAC
O 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