Permit (26) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'ri 11 COMMUNITY DEVELOPMENT Permit#: ELR2018-00085
TITfc;ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/05/2018
Parcel: 2S110AA01200
Jurisdiction: Tigard
Site address: 14300 SW PACIFIC HWY
Project: Spec Space Subdivision: CANTERBURY PLACE,AMENDED Lot: 8
Project Description: Data telecommunications system.
Contractor: PHOENIX ELECTRIC CO Owner: JAW INVESTMENT LLC
PO BOX 14037 14300 SW PACIFIC HWY
PORTLAND, OR 97293 TIGARD, OR 97224
PHONE: 503-231-8006 PHONE:
FAX: 503-235-4300
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 06/05/2018 $75.00
Type of Use: COM 12%State Surcharge-Electrical 06/05/2018 $9.00
Class of Work: ALT
Total Number of Systems: 1
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 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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to 0U NC by calling 503.232.1987_or 1.800.3 (//y
32.2 4.
__,,,Issued By nature: ,/'n!7 ��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.
Electrical Permit Applicatio gECEI.VEI)
roR mu ICE CSI: ()NI.)
City of Tigard JUN 5 2018
018 Received
Ill 111111 13125 SW Hall Blvd.,Tigard,OR 97223 Date/B : (✓ S j ���� '
_ Phone: 503.718.2439 Fax: 503.59 hti Plan Review
OFTIGDate/B : Related Permit#: _.i ,- _ 7
7.1 G A]z Inspection Line: 503.639.4175 Ready Date/By: Fa See Page 2 for
Internet: www.tigard-or.govY ILDING DIVISIONNotified/Method: EMI Supplemental Information
E OF WORT{ PLAN REVIEW
❑New constructionAddition/alteration/r lacement Please check all that apply ep pp y(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEG9RY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
El .-1-and 2-family dwelling Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
0 amps for all other installations. buildings.
Multi-family 0 Master builder 0 Other: 0 Fireum
P P. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
Job#: 0,69_0) �Job site address: `„ ' /. fl,r 0 Addition of new motor load of system.
Jv[/ lC� T!G{/ 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: 4 l L/zJ ❑Six or more residential units. occupancy.
�� ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:. _ - _ ❑Hazardous locations. 0 Supply voltage for more than
Cross street/directions to job site: ❑Service or feeder 600 amps or more.
600 volts nominal.
FEE SCHEDULE
Description I Qty. I Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
y�� rr t;� (with above sq.ft.) 75.00 2
/ /C � �f/1�'(‘
tl r_,i/�/1 `r< 'r,, Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
0
PROPERTY OWNER 0 TENANT Renewable Energy 0 See Page 2
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
City/State/ZIP:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) 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
Branch circuits–new,alteration,or extension,per panel
0 APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name: C___ _ �,,,/r J above service or feeder fee,
,Serle
.�•Y t(� r� ' 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, 67.84 2
Email: service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:n1✓/ u • 11� l j� T�ZI Sign or outline lighting 67.84 2
Address: ! �j 7/y�� •V /j/�/ 7 Signal circuit(s)or limited-energy
t V6)>< /` 63 [ panel,alteration,or extension. alfee Page 2 75-±5- 2
City/State/ZIP: 4),"—AA r �y Each additional inspection over allowable in any of the above
O 7 99,! Additional inspection(1 hr min) 66.25/hr
Phone:(5,x"3)0 / , G4 /� Fax:( ) Investigation(1 hr min) 90.00/hr
Emaii �� .1 D !� Industrial plant(1 hr min) 78.18/hr
r �� � ' Q moi( / Inspections for which no fee is
CCB L1C.: 90.00/hr
`0-'7 3 Electrical Lic.: dgu Suprv.Lic.:5l�Q5 specifically listed(IA hr min)
Suprv.Electrician signature,required: / / ELECTRICAL PERMIT FEES
�_ x Subtotal: .75";CV
Print name: �� Dater e / 0 Plan Review Required(25%of permit fee):
LL ���/// State surcharge(12%of permit fee):
Authorized signature: �` `1 •W TOTAL PERMIT FEE: , pig/
/
� This permit application expires if a permit is not otaained within 180
Print name: �j � 14)e-11 Date: ___5--......_1 / days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PemtitApp_ELR_ERE. oc 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:
n r mr
RESIDENTIAL� , �� ;„�FEE 5CII)El?ULE ;ri
i1.1�SIDE1� IAL WORK ONLY: ,.. �` Description Qty. I Each I Total I *
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
❑ 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 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
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above.
nOther. 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('/z hr min)
�L,TcTRICA�. P�R11%TtT FEES �<
C Ml1%IERCIAL '( 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
El Clock Systems
ata Telecommunication Installation
n Fire Alarm Installation
n H• VAC
n Instrumentation
❑ Intercom and Paging Systems
I-1 L• andscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
n P• rotective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015