Permit .01 . CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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' COMMUNITY DEVELOPMENT Permit#: ELR2018-00029
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/21/2018
Parcel: 2S101AD03200
Site address: 12909 SW 68TH PKWY 350 Jurisdiction: Tigard
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Project: Williston Financial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Data telecommunications system.
Contractor: BRITTINGHAM ENTERPRISES INC Owner:
PACIFIC REALTY ASSOCIATES
857 SW THEATER DR ATTN: N PIVEN
BEND, OR 97702 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 541-382-5563 PHONE:
FAX: 541-323-3513
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 02/21/2018 $75.00
Type of Use: COM 12%State Surcharge-Electrical 02/21/2018 $9.00
Class of Work: ALT
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 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: 0
Other Desc: Total $84.00
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through•:j-•52-001-0090. You m- •• -in a copy.. -ru es•r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By:
:Alt, Permittee Signature:
OWNER INSTALLATION ONLY G,--
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE:
Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'
Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
um(orrlcl: I:sl:o\l.)
City of Tigard Et `'$d
13125 SW Hall Blvd.,Tigard,OR 97223 �j ' Date/By: Permit#: � r� .
' = Phone: 503.718.2439 Fax: 503.598.1960 Plan Review �C'
earlycpate/By: Related Permit#: /.>e P`-7 or
T 1 G A R D Inspection Line: 503.639.4175 Qeady Date By: Jaris: y dV 1 1
Internet: www.tigard-or.gov See Page 2 for
g N�tifedMethod: 9j Supplemental Information
TYPE OF WORK + OF 6 , PLAN REVIEW
❑New construction �`y�h �q p�'
Addition/alteration/rep TINGV iSi Please check all that apply(submit 2 sets of plans w/items checked):
0 Demolition 0 Other: li ❑Service or feeder 400 amps or more ❑Building over three stories.
CATEGORY OF CONSTRUCTION where the available fault current 0 Marinas and boatyards.
❑ 1-and 2-family dwelling ommercial/industrialexceeds 10,000 amps at 150 volts or ❑Floating buildings.
0 Accessorybuildingless to ground,or exceeds 14,000
0 Commercial-use agricultural
amps for all other installations. buildings.
El Multi-family El Master builder El Other:
0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: I Job site address: No
0 Addition of new motor load of system.
s‘,/,) (l T441 aitz.K tAjill,
i 100HP or more. ❑"A„ <E„ l_2„ l_3„
❑Six or more residential units. occupancy.
City/State/ZIP:
.71(./
1 P t.14i',K1 0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: "31.4i Furl, Project name: tij c 0 Hazardous locations. 0 Supply voltage for more than
(�� Z.
El or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job slle:7.5
FEE SCHEDULE
Description i Qty. I Each l Total
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 WORK Ea.add'l 500 sq.ft.or portion 33.92 1
� � Limited energy,residential
L.- 4,) tr (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
CO PROPERTY OWNER I 0 TENANT Renewable Energy ❑ See Page 2
(7 Services or feeders installation,alteration,and/or relocation
Name: r pp��
��t �� l ); ,, -i- 200 amps or less 100.70 2
Address: 3j S o c GTU o1 1 ap 201 amps to 400 amps 133.56 2
City/State/ZIP: ( „o-,..f
' a 401 amps to 600 amps 200.34 2
�i 7 0.2- (�Zz 1/ 601 amps to 1,000 amps 301.04
Phone:( ) 2
Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
Owner installation:This installation is beingmade onpropertyrelocation200amps
intended for sale,lease,rent,or exchange,according to ORS 7,449,670,and 701.not 1 pto 400 amps 59.3651
amps125.08 1 2
Owner signature: Date: 401 amps to 599 amps 168.54
2
0 APPLICANT I CZ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
Business name: .5�>' t l r�t/1 A.Fee for branch circuits with
N 'Ti17 e kis-65 Id ti above service or feeder fee,
Contact name: Cg2 ..r r 1,t??__ _ (J each branch circuit 7.42 2
��1 (�� { is 44Nn B.Fee for branch circuits without
Address: e - tS A) P/i4tle r12 service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: ..�� 0 77 ) -7-` Each add'l branch circuitj� 9 f fG' 7.42 2
Phone:(�7 1) 3 Miscellaneous(service or feeder not included)
, .s b J I Fax: :( 6-P-(,o/1• L Each manufactured or modular
Email: 131Z ;, .'- --1-7y� ('° dwelling,service and/or feeder 67.84 2
�� PN1'L ) 1 1 1 S N (9 0'V' Reconnect only
CONTRACTOR 67.84 2
Pump or irrigation circle 67.84 2
Business name: "Sp ,i-T-,,,i 1 b }—�; ,e it` { Sign or outline lighting 67.84
t , �I L/ Le_
2
Address: ..7 ) . „i (-11,16,-61-1-1,1-1,t"� Signall, circuit(s)or limited-energy
V" R► �,Jrj panel,alteration,or extension. ee Page 2 "ZS:� 2
City/State/ZIP: 'c � d fz -7,70� Each additional inspection over allowable in any of the above
Y ) 7 Sib I q . Additional inspection(1 hr min) 66.25/hr
Phone:9 Li /g c `j Fax:( )
J Investigation(1 hr min) 90.00/hr
Email: ' S�1 ,'S r-7 1)150,
)15 , J+ Industrial plant(1 hr min) 78.18/hr
l7 1 1 1 �f G Inspections for which no fee is
CCB1Lie.: 1(,j l j�' 5 I Electrical Lic.:0 Suprv.Lic.: c specifically listed(%z hr min) 90.00/hr
St �� ectncian signature,required9t2 lir i ELECTRICAL PERMIT FEES
,� l t Subtotal: 7
Print name: J _ 1 1/D r -__L. ` I Date: Z/24/Si 0 Plan Review Required(25%of permit fee):
�� c rel/ �'vv YdV7/7 ` State surcharge(12%of permit fee):
Authorized signature: Q 1Ge f 1 J 1b; TOTAL PERMIT FEE: ifili"V
Print nam= /5 �� � — This permit application expires if a permit is not obtained within 180
J"5 —_ � Date: 3 t days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015
440-461 T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK FEE SCHEDULE`'._,.,
RESIDENTIAL Description Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved: 5.01 to 15 kva 133.56 2
❑ 15.01 to 25 kva 200.34 2
Audio and Stereo Systems*
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
>100 kva-no additional charge 0.0 3
❑ Vacuum Systems* Each additional inspection over allowable in any of the above:
Each additional inspection is 66.25/hr 1
[11 Other: charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/hr min)
ELECTRICAL PERMIT,FEES,
COMMERCIAL;WORK ONLY: .. Subtotal(Enter on Page 1):
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
IZI\Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n 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