Permit (95) U
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 COMMUNITY DEVELOPMENT7,4
Permit#: ELR2017-00265
'TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/14/2017
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9321 SW WASHINGTON SQUARE RD T05
Project: Tesla Subdivision: None Lot: None
Project Description: Security system.
Contractor: VISION SECURITY SERVICE Owner: PPR WASHINGTON SQUARE LLC
10874 SW ROLAND CT PO BOX 847
WILSONVILLE, OR 97070 CARLSBAD, CA 92018
PHONE: 503-502-3909 PHONE:
FAX: 503-200-2907
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/14/2017 $75.00
12%State Surcharge-Electrical 12/14/2017 $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: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 1 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 .us.- d:• for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C-' -r. es are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain or direct questions to OUNC by calling 503.2 '.1987• :c r f 344
Issued By: --tridir -- e�'rr�i tttee Signature: r_
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.
,a -.
Electrical Permit Application r Folz of i icI: l,SE OyLv
City of Tigard `` Received )
ill 13125 SW Hall Blvd.,Tigard,OR 972 ° �Q�i Date/B : /��j -
Phone: 503.718.2439 Fax: 503.598.1960 C t"' s, . Related Permit#: ` _ I , ) 1
T I G A R D Inspection Line: 503.639.4175 \),°' q { .eady Date/By: ® See Page 2 for
Internet: www.tigard-or.gov ,, .--%'',t Notified/Method: At Supplemental Information
�� �) '� PLAN REVIEW
TYPE OF WORK '��,
� ' Please check all that apply(submit 2 sets ofplans w/items
0 New construction ddition/alterationtw cement PP y checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition ❑Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El1-and 2-family dwelling .pmmercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION To 5 0 Emergency system. larger separately derived
.o___
/A
--y• f q^f,j�1, ! (--
0 Addition of new motor load of system.
Job#: Job site address: (�Y�Tr w�_n� 100HP or more. ❑"A","E","1-2","1-3",
-jg o Six or more residential units. occupancy.
City/State/ZIP: -�l�-�' 0 Recreational vehicle parks.
0 Health-care facilities.
0 Hazardous locations. 0
Suite/bldg./apt.#: Project name: Supply voltage for more than
❑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 I *
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'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK
Limited energy,residential
\ J \ 75.00 2
01u nlnteC nN\ (with above sq.ft.)
Limited
energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER 0 TENANT 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
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
iii
APPLICANT 0 CONTACT PERSON Branch circuits-new,alteration,or extension,per panel
V
A.Fee for branch circuits with
Business name: �J- t c t q/,I:t-i (zE above service or feeder fee, 7 42 2
# (7 VFX
each h ncirci c
Contact name: � ]' � G �,11,�\) B.Fee for branch circuits without
ser\c*, ,` (' branchce it feederitfee,first
Address: J D UlN ` branch circuit 56.18 2
City/State/ZIP: VVl\%1. V VK (7\ (3-j.' -) Each add'l branch circuit 7.42 2
( ',qQ� Echman Miscellaneous(service doru feeder not included)
Phone: Fax: : ) ��. Each manufactured or modular
dwelling,service and/or feeder
Email: 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting
67.84 2
Signal circuit(s)or limited-energy •
Address: panel,alteration,or extension. - See Page 2 -6-34 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email: 0-11q 1q))7 'ii i I r7U -t t Industrial plant(I hr min) 78.18/hr
tL Inspections for which no fee is
CCB Lic.: \' ) `\ )' Electrical Lic.: CLE, Suprv.Lic.:3%200:A specifically listed(%hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ,' cP
�, r� r� Subtotal: ,
Print name: 1���-- v+Jcv l ate: i a')4'° r'T ❑Plan Review Required(25%of permit fee):
t State surcharge(12%of permit fee): 9-
Authorized signature: TOTAL PERMIT FEE: If---/
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:
+,rS+i.IDENTIAL WORK ONLY: FEE SCI3►ULE
Description
I Qty. I Each I Tara)
Fee for all residential systems combined: $75.00 Renewable l
3' Renwable electrical energy systems:
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:
:urglar 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
n 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(''/hr min)
ELECCA.L PERMIT FEES =,
COMMERCIAL WORK ONLY:
Subtotal Enteron Page 1):
Fee for each commercial system: $75.00 *
y 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
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
Protective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PennitApp_ELR_ERE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
9321 SW WASHINGTON SQUARE RD T05,
TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2017-00265
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor