Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I COMMUNITY DEVELOPMENT Permit#: ELR2017-00169
T iiGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/01/2017
Parcel: 1 S135DC09000
Jurisdiction: Tigard
Site address: 11625 SW 91ST AVE
Project: Pacific Evergreen Homes Subdivision: CHARBEN Lot: 8
Project Description: Burglar alarm system.
Contractor: GUARDIAN SYSTEMS NW INC Owner: PACIFIC EVERGREEN HOMES
13500 SW PACIFIC HWY 7410 SW OLESON RD STE 133
STE 245 PORTLAND, OR 97223
PORTLAND, OR 97223
PHONE: 503-639-3723 PHONE: 503-664-6423
FAX: 503-624-8258
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/01/2017 $75.00
12%State Surcharge-Electrical 08/01/2017 $9.00
Type of Use: SF
Class of Work: ALT
Total Number of Systems:
Audio&Stereo: N
Security Alarm: y
Garage Door Opener: N
HVAC: N
Vacuum System: N
Other: N
Other Desc: Total $84.00
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 C ter. Those rules are sr forth in OAR
952-001-0010 throughugOAR 952-001-0090. You may obtain .py of -rules or direct questions to OUNC by calling 503.232. 987 or 1.800.3 344. //I
,d,j
Issued By /� ,� Permittee Signature: ��
VVV /�
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 FOR OFFICE USE ONLY
IICity of Tigard Received
13125 SW Hall Blvd.,Tigard,OR 972 DateB : 1 �� „ �-
Phone: 503.718.2439 Fax: 503.59MIIIIIIIMIMPlan Review
Date/B :
Inspection Line: 503.639.4175 ��� /
TIGARD Ready Date/By: furls: See Page 2 for
Internet: www.tigard-or.gov \\\\G 1 - Notified/Method:
�U �� /,J--C' Supplemental Information
TYPE OF WORK 44,„„%.k5,DIN‘ PLAN REVIEW
f New construction 0 Addition/alteratiobAU Please check all that apply(submit 2 sets of plans w/items checked).
0 Demolition 0 Other: .3‘ ❑Service or feeder 400 amps or more ❑Building over three stories.
CATEGORY OF CONSTRUCTION where he 00able at urrent ❑ lnnag bd boatyards
exceedss10,0000ampss at 150 volts or ❑Floating buildings.
Igr 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑commercial-use agricultural
❑Multi-familyamps for all other installations. buildings.
0 Master builder 0 Other: ❑Fire pump. 0 installation of 150 KVA or
'OB SITE INFORMATION AND;LOCATION 0 Emergency system. larger separately derived
Job#: 1 Job site address: 1 Z,,c 5vti `i` ❑Addition of new motor load of system
1 I OOHP or more. ❑"A"."E" "1-2" "1 3"
City/State/ZIP: 440 Uc ✓ pL-7 ❑Six or more residential units. occupancy.
❑Health care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: ,1�� 0 Hazardous locations. ❑Supply voltage for more than
--• 600 volts nominal
�� ":/-'i�'�� ^) 0 Service or feeder 600 amps or more.
Cross street/directions to job site: N-E.c.J A-Do S
� S", ),( Sr FEE SCHEDULE
>�r (�.�;t�y,J' j�/(t,.. I P I Qty. 1 .. Each � Total � s
S Descri tion
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 CRIPTION OF WORK Limited
add'l 500 sq.ft.or portion 33.92 1
Limited energy.residential
2 6,-(. 2- 75.00 2
t tQ,Q/►1 (with above sq.ft.)
Limited energy,multi-faintly
residential(with above sq.ft.) 75.00 2
0 PROPERTY OWNER 1 0 TENANT
Renewable E ❑ See 2
Services abor feedersnergy installation,alteration,aPagend/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
601 amps to 1,000 amps 301.04 2
Phone:( ) I 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
0 APPLICANT ! 1 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: vl t-g S 1/41Sihv)"1 j4 above service or feeder fee,
each branch circuit 7.42 2
Contact name: (i/1.4.4/Lie L. p t 2..E.Z2_
B.Fee for branch circuits without
Address: I'22S-Z..)0 s Rae—A-Pic— 14-0-1/41 j LI service or feeder fee.ti�st
�^ branch circuit 56.18 2
City/State/ZIP: --p, , ,Eb^C„i L).7j 3 Each add'!branch circuit 7.42 2
�j l l ,p Miscellaneous(service or feeder not included)
Phone:
(5 >) Ce 5 q, 3-7 2, I Fax: : (�3) �'�, - �C�
1.. p Each manufactured or modular
Email: r dwelling,service and/or feeder 67.84 2
`(✓l+z� q.f412-D tp•V S Fre-n'l. l t.J
' �� Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 7
Address: T Signal circuit(s)or limited-energyc1�
panel,alteration,or extension. ee Page 2 ?� 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax: ( ) I hr min investigation
Email: ,� t ]v g ( ) 90.00/hr
Industrial plant(I hr min) 78.18/hr
1�1 i'd �,/� tZI 141'1,1 Inspections for which no fee is
CCB Lic.: 3 Electrical Lic.: — Suprv. l,ic.: 4'Z( "'I,4.. specifically listed(1z hr min) 90.00/hr
Suprv.Electrician signature,required: 3 ELECTRICAL PERMIT FEES
Subtotal: 7,)
Print name: NAjwac..1 we L ?t
"2-C•r-Z... Date: '7.3( 17 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): "0.,'
(i)
Authorized signature:
�
6a � �j'/3�� I TOTAL PERMIT FEE: bit
i 1 Thispermit application expires if a permit is not obtained within 180
Print name: i,��/4� J I PP P
!� T L 3 I Date: 1 1 - 1 days after it has been accepted as complete.
ei [ Number of inspections allowed per permit.
1:AnuilUingAPerinitsU?LC_PermitApp_1;LR_ERE.doc Rev 06/17/2015 44U-4615T(II/05/COM/WE13
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCIIEI ULE
Fee for all residential systems combined: $75.00 Description I Qty. I Each I Total
Renewable electrical energy systems:
Check Type of Work Involved:
5 kva or less 100.70 2
❑ Audio and Stereo Systems* 5.01 to 15 kva 133.56 2
15.01 to 25 kva 200.34 2
X
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 552.26 2
❑ Heating, Ventilation and Air Conditioning with OAR 918-309-0040)
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
ElOther: Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
COMMERCIAL WORK ONLY: specifically listed(1/2hr min)
ELECTRICAL PERMIT FEES
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:
*No licenses are required. Licenses are required for all
other installations
L\Building\Permits\El.C_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11625 SW 91ST AVE, TIGARD, OR, 97223 October 16, 2017 at 7:32:59
AM
Record Type: Record ID:
Residential - Electrical Limited Energy ELR2017-00169
Inspection Type: Inspector:
198 Low voltage final David Young
Result:
PASS - NoCofO
Comments:
No devises installed at this time.
Violation Summary:
Inspector Contractor