Permit (71) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' °f
'. COMMUNITY DEVELOPMENT Permit#: ELR2017-00157
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/18/2017
T f " Parcel: 2S 101 DA01900
Jurisdiction: Tigard
Site address: 6996 SW VARNS ST
Project: Madrona Recovery Subdivision: VARNS ACRES Lot: 3
Project Description: Low voltage for fire alarm
Contractor: OMLID AND SWINNEY FIRE PROTECTION Owner: NELSON VIAL LLC
157 S 47TH ST 7155 SW VARNES ST#120
SPRINGFIELD, OR 97478 TIGARD, OR 97223
PHONE: 541-741-1775 PHONE:
FAX: 541-741-0347
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/18/2017 $75.00
12%State Surcharge-Electrical 07/18/2017 $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: 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: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001 0 throu OAR 95 01-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Is ued By: Permittee Signature:
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�yJ roli orri(i l si.0y1.1
City of Tigard E'\i�D Date/Bea 7/ /4‘. d� Permit#: tip_go,7-60/6�f
III • 13125 SW Hall Blvd.,Tigard,O EIVED Plan Review n �t, r�
Phone: 503.718.2439 Fax: 503.598.1960 Date/B Related Permit#:f�(_✓��7 -t/
Inspection Line: 503.639.4175 JUL 1 8 2017 Ready Date/By: Juris: H See Page 2 for
1 I lrA R I) Internet: www.tigard-or.gov ��--��//((�� �+p p Notified/Method: Supplemental Information
TYPE OCgazQF TIGA�RC� PLAN REVIEW
❑New construction ❑Additio dtel l �rYl�tlt 1°N Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: 0 Service or feeder 400 amps or more ElBuilding over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
dwelling ❑Commercial/industrial 0Accessory building
❑ 1-and 2-familyless to ground,or exceeds 14,000 0 Commercial-use agricultural
ampbu
ngs.
0 Multi-family 0 Master builder ❑Other: Fire for all other installations. Installation
atio
0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATIONAND LOCATIO 0 Emergency system. larger separately derived
99/ ,i A 0 Addition of new motor load of system.
Job#: Job site address: `y 7(p a 100HP or more. ❑"A","E","1 2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: �� 0 2 Recreational vehicle parks.
0 Health-care facilities. 0
Suite/bldg./apt.#: Project name: HAI/At/30- ❑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: FEE SCHEDULE
Description I Qty. I Each I Total
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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
! l �'
J J �j (with above sq.ft.)
4i9 1 it' V O/J9'' � v.0A lti ,t/( Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 BIZOPERTY OWNERServices or feeders installation,alteration,and/or relocation
Name: E.,s0,J V1 0 TENANT L �� 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-c 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'l branch circuit 7.42 2
Phone: Miscellaneous(service or feeder not included)
( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR J Pump or irrigation circle 67.84 2
Business name: ' / fe -�,, (cfrtiel 2g /3 b -�j,. Sign or outline lighting 67.84 2
`7(�/`�� 6 1 n / r ll, "` Pana,circuit(s)or limited-energy
Address: See Page 2 2
panel,alteration,or extension.
�7 ,•�� , Each additional inspection over 4110;1/able in any of the above
City/State/ZIP:
ke ??1.)._-..)_''5.s Additional inspection(1 hr min) 66.25/hr
Phone:( 3) >' 57 ,S/S_S Fax:( ) Investigation(1 hr min) 90.00/hr
Email: j kA.kujeoL `L. t `],,Gjj� et,S Industrial plant(1 hr min) 78.18/hr
vv t/L Inspections for which no fee is 90.00/hr
CCB Lic.: aa�,� Electrical Lic.: Suprv.Lic.: specifically listed('V5 hr min)
1�LS7 �l0$ p �E'xk4<e,4
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,require �� -C Subtotal:
Print name: Jere z 4?.e."t j,-A t-- Date: -71I-Vi 7 ❑Plan Review Required(25%of permit fee):
l 4�-Y State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE: OU
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:
REStinNTIA .WORK O» Y:
FEC* DUCE
Description I Qty. I Each wYV Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems: I
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 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('h hr min)
COMMERCIAL WORK OILY: r i LE,CTRI4P:S
Fee for each commercial system: $75.00 per
l SubtotaEnteron Page 1).
3' * Number of inspections allowed pepermit.
(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
❑ 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