Permit Support Document (29) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMEfEYJIE
Permit#: ELR2017 00135
F[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/23/2017
Parcel: 2S 113AA00500
Jurisdiction: Tigard
Site address: 16100 SW 72ND AVE B18
Project: Food&Beverage Innovations Subdivision: ROSEWOOD ACRE TRACTS Lot: PT A&f
Project Description: Security System cabling.6/28/17 REPRINTED to change of scope to fire alarm.
Contractor: ADVANCED COMMUNICATIONS SERVICES INC Owner: PACIFIC REALTY ASSOCIATES
PO BOX 231196 ATTN: N PIVEN
PORTLAND, OR 97281-1196 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-598-7082 PHONE:
FAX: 503-598-7320
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/23/2017 $75.00
Type of Use: COM 12%State Surcharge-Electrical 06/23/2017 $9.00
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock S ste 0
Data&Telecommunications: 0 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 $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: • -.•a law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 t •ugh OAR 95 101 .-i. Y.0 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By. - ' Permittee Signature: �ffrt:f/s.1-21
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 603.639.4176 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 01:I: t sl: 0\1.1
City of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : i x�'�� Permit#: �'L2aQ!7—OD/3Sr
c Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Inspection Line: 503.639.4175 Date/B : Related Permit#:
ReadyDate/By:
I G A IZ D
Internet: www.tigard-or.gov kris:
H See Page 2 for
Notified/Method: Supplemental Information
TYPE OF WORK
❑New construction 0 Addition/alteration/replacement Please check all that apply PLAN REVIEW
0 Demolition pp y(submit 2 sets of plans w/items checked):
❑Other:
0 Service or feeder 400 amps or more 0 Building over three stories.
CATEGORY OF CONSTRUCTION where the available fault current
exceeds 10,000 amps at 150 volts or 0 Marinasg and boatyards.
❑ 1-and 2-family dwelling ❑Commercial/industrialless to 0 Floating buildings.
a
0 Accessory building ground,or exceeds 14,000 ❑Commercial-use agricultural
ID Multi-family ❑Master builder amps for all other installations. buildings.
❑Other: 0 Fire pump.
0 largInstallationer
eof150KVA or
JOB SITE INFORMATION AND LOCATION
El Emergency system. larger separately derived
Job#: I Job site address: /4/OD `'� K 0
Addition of new motor load of system.
100HP or more. ❑"A" "E" "1-2" "1-3"
City/State/ZIP: ❑Six or more residential units. occupancy.
Suite/bldg./apt.#:
0 Health-care facilities. 0 Recreational vehicle parks.
Project name:
0 Hazardous locations.
0 Supply voltage for more than
Cross street/directions to job site: ❑Service or feeder 600 amps or more. 600 volts nominal.
FEE SCHEDULE
Description I Qty. I Each I Total I *
Subdivision: New residential single-or multi-family dwelling unit.
I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less
168.54 4
DESCRIPTION OF WORK Ea.add'1500 sqft.or portion 33.92 1
C� Q„ Limited energy,residential
q,-Q_ �— l" 4-06161 't O _ (with above sq. lti 75.00 2
� '-'4" Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
PROPER 0 R 0 TENANT Renewable Energy
El See Page 2
0Name: Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70
Address: 2
201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
Phone:( ) 601 amps to 1,000 amps 301.04 2
I Fax:( ) Over 1,000 amps or volts
Email: 552.26 2
Temporary services or feeders installation,alteration,and/or
Owner installation:This installation is being made onpropertyrelocation
intended for sale,lease,rent,or exchange,according to ORS 7,449,670,and 701.s 201
2001 amps toro l00 59.365
1
Owner signature:
201 amps to 400 amps 125.08 2
Date: 401 amps to 599 amps 168.54 2
0 APPLICANT 1 0 CONTACT PERSON Branch circuits—new,alteration,or extension, •er panel
Business name: A.Fee for branch circuits with
above service or feeder fee,
Contact name: each branch circuit 7.42 2
B.Fee for branch circuits without
Address: service or feeder fee,first
City/State/ZIP: branch circuit 56.18 2
Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax::( )
Each manufactured or modular
Email: dwelling,service and/or feeder 67.84 2
CONTRACTOR Reconnect only 67.84 2
Business name: n i Pump or irrigation circle 67.84 2
D d �0..e0 -Wv � ` Sign or outline lighting 67.84
Address: Signal circuit(s)or limited-energy 2
panel,alteration,or extension. 0 See Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Phone:( ) Additional inspection(1 hr min) 66.25/hr
Fax:( ) Investigation(1 hr min) 90.00/hr
Email:
Industrial plant(1 hr min) 78.18/hr
CCB Lie.: Inspections for which no fee is
Electrical Lic.: I Suprv.Lic.: specifically listed(%hr min) 90.00/hr
Suprv.Electrician signature,required: ELECTRICAL PERMIT FEES
Print name: Subtotal:
I Date: ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:
TOTAL PERMIT FEE:
I Print name: This permit application expires if a permit is not obtained within 180
I Date: days after it has been accepted as complete.
I:\Building\Permits\ELC_Permitppp ELR_ERE.doc Rev 06/17/2015 k Number of inspections allowed per permit.
440-4615T(11/05/COM/WEB
Electrical Permit Application–City of Tigard
Page 2–Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
.�. '1'1:4'
§t Each
.: ,�
•
Total
Rey+ . o j `§ x x �;tF - Description QtY
Fee for all residential systems combined: $75.00 Renewable electrical energy systems: 100.70 2
5 kva or less
Check Type of Work Involved: 133.56 2
5.01 to 15 kva
0
15.01 to 25 kva
200.34 2
Audio and Stereo Systems*
Wind generation systems in excess of 25 kva:
ID 25.01 to 50 kva
301.04 2
Burglar Alarm 552.26 2
50.01 to 100 kva
0 Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Solar generation systems in excess of 25 kva:
Heating,Ventilation and Air Conditioning
System* 3
Each additional kva over 25 7.42>100 kva—no additional charge 0.0
3
O Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
• Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(1 hr min
ar :s rf CAL P T
)
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
O Boiler Controls
O Clock Systems
O Data Telecommunication Installation
O Fire Alarm Installation
• HVAC
O Instrumentation
O Intercom and Paging Systems
O Landscape Irrigation Control*
O Medical
O Nurse Calls
O Outdoor Landscape Lighting*
O Protective Signaling
O Other:
Total number of commercial systems: —
*No licenses are required. Licenses are required for all
other installations
1\Budding\Permits\ELC_PennitAPP_ELR_ERE.doe Rev 06/17/2015