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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 91 COMMUNITY DEVELOPMENT Permit#: ELR2017-00164 T t.GA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/31/2017 Parcel: 2S 101 CB00500 Jurisdiction: Tigard Site address: 12670 SW HALL BLVD, BLDG#3 Project: Canteen Vending Subdivision: None Lot: None Project Description: Fire alarm installation. Contractor: FIRE SYSTEMS WEST INC Owner: MCLELLAN ESTATE CO 600 SE MARITIME AVE#300 BY CHRISTOPHER M CAVE ESQ VANCOUVER, WA 98661 707 OLD COUNTY ROAD BELMONT, CA 94002 PHONE: 360-693-9906 PHONE: FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 07/27/2017 $75.00 Type of Use: COM 12%State Surcharge-Electrical 07/27/2017 $9.00 Class of Work: ALT Total Number of Systems: 0 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 952-001-0010 through OA 52-001-0090. 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: Permittee Signature: -( 7 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 RECEIVEI: FOR OFFICE USE ONLY _ Phone: 50 .7 . ZA ,7etti 7G9G11/7Cy5f3HTa1igrd,TiFgard,5O59978212360'J(J - G5 ?01- PReanRe v:die? �! Related Permit Z -(?-0I �© / /—C Inspection Line: 503.639.4175 CITY Igj F TITARI Ready Date/B y .� J°ns' See Page 2 forT1cAKD Internet www.ti ard-or. ov Nottfied/Methoc7 7 `Sylli Supplemental Information VSMN 0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked): 0 Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories. �`D u where the available fault current ❑Marinas and boatyards. ©+ 7t _ exceeds 10,000 amps at 150 volts or 0 Floating buildings. El1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-ase agricultural ❑Multi-familyamps for all other installations. buildings. ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or OB``sn*i.i `ott1►�tA,flOJ A li,. c * ❑Emergency system. larger separately derived Job 4: Job site address. 12670 SW Hall Blvd ❑Addition of new motor load of system. 100I1P or more. ❑"A","E","1-2","1-3", City/State/ZIP:Tigard,OR 97223 ❑Six or more residential traits. occupancy. �'1" � _ ❑Health-care facilities. ❑Recreational vehicle parks. Suite/bldg./apt.4: Project name:Canteen ram ❑Hazardous locations. ❑Supply voltage for more than ❑Service or feeder 600 amps or more 600 volts nominal Cross street/directions to job site:SW Hall Blvd&SW Commercial ST -SGIxIjL) Description Total New residential single-or multi-family dwelling unit. Subdivision: Lot 4: Includes attached garage. Tax map/parcel 4: 1,000 sq.ft.or less 168.54 4 Ea.add'l 500 sq.ft.or portion 33.92 DES RIPIIION.0? : . - :. 1 Limited energy,residential ,l„yl f (with above sq.ft.) 75.00 2 (� el eic +e �` 4[ 4 Y colt i� Limited energy,multi-family I��(' c�I o residential with above sq. ft. 75.00 2 Ti e- 1 e 'i,5 1'1 c e VI,C es ( q ) NIS', AfttAZ -' ' 2 : }�� " Renewable Energy see Page 2 t �� w . Services or feeders installation,alteration,and/or relocation Name:Canteen Vending Services 200 amps or less 100.70 2 Address: 12670 SW Hall Blvd 201 amps to 400 amps 133.56 2 City/State/ZIP:Tigard,OR 97223 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Phone:(503)285-9166 Fax:( ) Over 1,000 amps or volts 552.26 2 Email: Temporary services or feeders installation,alteration,and/or 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 P AI � - 'i_ ; � Branch circuits—new alteration or extension er anel A.Fee for branch circuits with Business name:Fire Systems West Inc. above service or feeder fee, Contact name:David Aswani each branch circuit 7.42 2 B.Fee for branch circuits without Address:600 SE Maritime Ave#300 service or feeder fee,first branch circuit 56.18 2 City/State/ZIP:Vancouver,WA 98661 Each add'l branch circuit 7.42 2 Phone:(360)693-9906Miscellaneous(service or feeder not included) Fax: :(503)289-2208 Each manufactured or modular Email:DavidA@FireSystemsWest.com dwelling,service and/or feeder 67.84 2 Reconnect only 67.84 2 . � ��, t, - 0*: , - * Pump or irrigation circle 67.84 2 Business name:Fire Systems West Inc. Sign or outline lighting 67.84 2 Address:600 SE Maritime Ave#300 Signal circuit(s)or limited-energy panel,alteration,or extension. ® See Page 2 1 2 City/State/ZIP:Vancouver,WA 98661 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(360)693-9906 Fax:(503)289-2208 Investigation(1 hr min) 90.00/hr Email:DavidA@FireSystemsWest.com Industrial plant(i hr min) 78.18/hr , Inspections for which no fee is CCB Lic.: 49732 Electrical Lic.: ,73655CLE Suprv.Lic.: 4935LEA specifically_listed(%2 hr min) 90.00/hr _- JI �_ Suprv.Electrician signature,required: '6ZNILISII, _ __ � � ' P4 ._ -, � �'F�'C.Q/f'1 Subtotal: -75,0 0 Print name: Jason Babien Date: 7/25/2017 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): ,0 0 Authorized signature: TOTAL PERMIT FEE: '"1 60 tit"' 'G[ This permit application expires if a permit is not obtained within 180 Print name: David Aswani Date: 7/25/2017 days after it has been accepted as complete. * Number of inspections allowed per permit. I:\Building\PermitsDLC_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: Fee for all residential systems combined: $75.00 Description Qty. Each Total f 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 Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 ❑ Garage Door Opener* 50.01 to 100 kva 552.26 2 >100 kva(fee in accordance Eiwith OAR 918-309-0040) 552.26 2 Heating, Ventilation and Air Conditioning System* Solar generation systems in excess of 25 kva: 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 specifically listed(14 hr mm) 90.00/hr Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): (SEE OAR 918-309-0000) * Number of inspections allowed per permit. 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: 1 *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitAppELR_ERE.doc Rev 06/17/2015