Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. 41
7111
' COMMUNITY DEVELOPMENT Permit#: ELR2017-00148
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/11/2017
Parcel: 2S101BB01400
Site address: 12072 SW GARDEN PL Jurisdiction: Tigard
Project: 3 Point Brand Management Subdivision: CROW PARK 217
Project Description: (2)low voltage systems for access/intrusion. Lot: 2
Contractor: A&E SECURITY&ELECTRONICS SOLUTIONS Owner: ICON OWNER POOL 1 WEST LLC
PO BOX 179 BY RYAN
MCMINNVILLE, OR 97128-0179 PO BOX 460169
HOUSTON, TX 77056
PHONE: 503-883-4135 PHONE:
FAX: 503-472-3570
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 07/11/2017 $150.00
Type of Use: COM 12%State Surcharge-Electrical 07/11/2017 $18.00
Class of Work: ALT
Total Number of Systems: 2
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 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: 2
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 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:� ,�. CPermittee Signature:--'Tt. f--G4)6194-,.ers'
2
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 A plicatio SECLIVE!)p It)!2 O1 i It ; *l ,a,l v
< City of Tigard Received:
civv 7ffir L-3,,e7--e ,,,n
i' n 13125 SW Hall Blvd.,Tigard,OR 97223 art
0 Phone: 503.718.2439 Fax: 503.598.19Plan Review
Inspection Line: 503.639.4175 N 2 9 2017 °atm Related Permit a:
TIC;A1Rh I
Internet: www.tt and-or, v Ready Date/By: B See Page 2 for
g IOF TIGARD
[i it Notified/Method: Supplemental Information
TYPE OF "1 .j 1 .V _
❑New construction t Addition/a ► : ,, `-r , erpgnt"' � Please check all that apply(submit(sh sets ofYREVIEW
w/items checked):
0Service or feeder 400 amps or more 0 Building over three stories.
Q Demolition C7 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessorybuildingless to ground,or exceeds 14,000
0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other:
a Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address:12072 SW Garden PL ❑Addition of new motor load of system.
10011P or more. ❑ A^,"E","1-2","I-3>
dl[�}
City/State/ZIP:Tigard,OR 97223
C3 Six or more residential units. occupancy.
�
/{� ❑Health-care facilities. 0 Recreational vehicle paries.
Suite/bldg./apt.#: Project name: 3 pe,r ti i i ry 0 Hazardous locations. 0 Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: /`i.4-Ni b'tffti='i
FEE SCHEDULE
Description I Qty. I Earl I.. .Total 1 =
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
DESCRIPTION OF WORKEa.add'I 500 sq.ft.or portion 33.92 ' 1
Limited energy,residential
Low Voltage-Access (with above sq.ft.) 75.00 2
Limited energy,multi-family
Low Voltage-Intrusion residential(with above sq.ft.) 75.00 2
I:] PROPERTY OWNER I El TENANT
Renewable Energy ❑ 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
City/State/ZIP: 401 amps to 600 amps 200.34 2
I 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
rektcation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400s
P 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
` APPLICANT -� CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:A&E Security above service or feeder fee,
each branch circuit 7A2 2
Contact name:Doug Elsberry B.Fee for branch circuits without
Address:PO Box 179 service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP:McMinnville,OR 97128 Each add'l branch circuit 7.42 2
Phone:(503)883-4135 Fax::(503)472-3570 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Email:delsberry(�4seeurlty.org dwelling,service and/or feeder
CONTRACTOR Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name:A&E Security el�z_e• -,,t ,3Lr4- a Sign or outline lighting 67.84 2
Address:PO Box 179 Signal cirtarit(s)or limited-energy
panel,alteration,or extension. 0 Page 2 150.00 2
City/State/ZIP:McMinnville,OR 97128 Each additional inspection over allowable in any of the above
• Additional inspection(1 hr mut) 66.25/hr
Phone:(503) ;:3.4135 ( Fax:(503)472-3570 Investigation(1 hr min) 90.00/hr
Email:delsberry@4security.org Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
90.00/
CCB Lic.: 65198 „ley Iii Electrical Lic 36-3 uprv.Lie.: 18149) specifically listed(/s hr min)
Suprv.Electrician signature,ll1$ ELECTRICAL PERMIT FEES
P required: lt(i
Subtotal: 150.00
Print name: Michael Elsberry // I Date: 6/23/2017 , 0 Plan Review Required(25%of permit fee):
/
State surcharge(12%of permit fee): 18,00
Authorized signature: �'�' TOTAL PERMIT FEE: 168.00
1 i This permit application expires if a permit is not obtained within 180
El: trical Permit Application—City of Tigard
. Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description [ Qty. f Each I Total I
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s 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 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:
❑ O• ther: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.001 hr
specifically listed(Y2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
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
El F• ire Alarm Installation
O HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ P• rotective Signaling
2 Other: Access/Intrusion
Total number of commercial systems: 2
*No licenses are required. Licenses are required for all