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Permit (62) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT '- , Permit#: ELR2017-00069 �. . .. COMMUNITY DEVELOPMENT 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/03/2017 TWA ° Parcel: 2S112AA00900 Jurisdiction: Tigard Site address: 14160 SW 72ND AVE 150 Project: CED Greentech Subdivision: 1992-007 PARTITION PLAT Lot: 1 Project Description: Installation of low voltage for data. Contractor: BRY-COM Owner: ICON OWNER POOL 1 WEST LLC 14244 SE BUSH BY RYAN PORTLAND, OR 97236 PO BOX 460169 HOUSTON, TX 77056 PHONE: 503-761-5156 PHONE: FAX: 503-760-7501 FEES Description Date Amount Specifics: Restricted Energy Permit 04/03/2017 $75.00 12%State Surcharge-Electrical 04/03/2017 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 0 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 $84.00 Other Desc: Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in acc. •-. e with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspend. % or more the 180 days. AT TION: Oreg..' law requires you to follow the rules adopted by the Oregon Utility Notification Cent- Those rules .et forth in OAR 952-001 '010 through OAR 95 r0 .490. YY-- may obtain a copy of the rules or direct questions to OUNC by calling 503.232. '• 111..8�00.33�34 Iss d By: , °—AL Permittee Signature: G/G/ 4 / OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale,lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR.ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Electrical Permit Applicati. n. 1 olz 011.R. I, I. sl:Oil.l i City of Tigardr t., ; Recei Date/B d fQ,7 Permit#: .,/L 9421 7.0006, j 1111 II 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review C Phone: 503.718.2439 Fax: 503.59§.1960 e, Date/B : Related Permit#: bga017--00453 Inspection Line: 503.639.4175 't i 'i I/ Ready Date/By: Jure gi See Page 2 for I I G A R D Internet: www.tigard-or.gov Notified/Method: Supplemental Information TYPE &lit WeltIti I1(3 it PLAN REVIEW ' ^ 0 New construction Additi$il/atelaollhefl#=s= ; Please check all that apply(submit 2 sets of plans w/items checked): fiYaeme ', ❑Service or feeder 400 amps or more 0 Building over three stories. 0 Demolition ❑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 5 Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural amps for all other installations. buildings. ❑Multi-family ❑Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived 41(6,0 -(6,0 c w 72/ 0 Addition of new motor load of system. Pty J 100HP or more. ❑"A">"E","1-2","1-3", Job#: Job site address: occupancy. ..f 6,4k Ai �,h-7 0 Six or more residential units. p y City/State/ZIP: (/] ! ❑Recreational vehicle parks. ❑Health-care facilities. Suite/bldg./apt.#: /5 0 Project name: .E 46, 0 Hazardous locations. 0 Supply voltage for more than ❑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#: i n 33.92 1 Ea.add'I 500 sq.ft.or portion DESCRIPTION OF WORK Limited energy,residential S/�'/ '�)� /J �j�/e ,�yy (with above sq.ft.) 75.00 2 iJ�— �/ (� V(11)1 Limited energy,multi-family 75.00 2 j �h� residential(with above sq.ft.) PROPERTY OWNER 0 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 2 401 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 ' ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,Per panel A.Fee for branch circuits with Business name: above service or feeder fee, 7.42 2 each branch circuit Contact name: B.Fee for branch circuits without service or feeder fee,first 56.18 2 Address: branch circuit City/State/ZIP: Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:( ) Fax: :( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email: Reconnect only 67.84 2 CONTRACTOR Pump or irrigation circle 67.84 2 • Business name: , r�C,0744 Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address: / lySG �/,S)4 anel,alteration,or extension. ❑ See Page 2 7720 2 Each additional inspection over allowable in any of the above City/State/ZIP: j z.46th q7�-36 `7 Additional inspection(1 hr min) 66.25/hr / Phone:( )7‘,/--- S f Fax:(3)3) 7 )_73 3/[�. Investigation(1 hr min) 90.00/hr Email: � �tlD f 7 L(/� i4 e[/ , , Industrial plant(1 hr min) 78.18/hr _ ! LInspections for which no fee is 90.00/hr CCB Lic.: /LYyy 3 Electrical Lic.: 46Sa Suprv. Sc.:/39 i,¢ specifically listed(%hr ) �� / ELECTRICAL PERMIT FEES 11 Suprv.Electrician signature,required: L G //' minSubtotal: T__GQ Print name: ,S1.140/SJ, ,&, ate: L( 5.-/7 ❑Plan Review Required(25%of permit fee): / State surcharge(12%of permit fee): 5f.00 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. 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 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: ❑ 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 ❑ 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 charged at an hourly(1 hr min) 66.25/hr 1 Inspections for which no fee is 90.00/hr specifically listed('/z hr min) ,�rELECTRICAL PERMIT FEES COMMERCIAL,WORK©at Y 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 ❑ Clock Systems Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls T 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_ELRERE.doc Rev 06/17/2015