Permit (57) 114 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1E COMMUNITY DEVELOPMENT Permit#: ELR2018-00116
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/31/2018
€c_°'� ' g Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 460
Project: Staples Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Security system.
Contractor: SIMPLE SECURITY Owner: PACIFIC REALTY ASSOCIATES
PO BOX 80577 ATTN: N PIVEN
PORTLAND, OR 97280 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-574-2254 PHONE:
FAX: 503-245-2998
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/31/2018 $75.00
12%State Surcharge-Electrical 07/31/2018 $9.00
Type of Use: COM
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: 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 is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification -•er. Those rules are set forth in OAR
952-001-0010 through OAR,052-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.2- .19;7 or 1.800.332.2344.
Issued By: ! .__. Permittee Signature:
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.
ItECEIVED
Electrical Permit Applicatio Fo iz()Hi( i Ise oy 1.)
City of TigardJUL Received eg
Date/B : _7/ I Permit# 0,� _ /0fd,
ICS
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie
Phone: 503.718.2439 Fax: 503.591111
�i j OF TIGARD Date/B : Related Permit#:
Inspection Line: 503.639.4175 44 jx�t Ready Date/By: Juris: ® See Page 2 for
I I(,A R 1) Internet: www.tigard-or.gov BUILDING G DIVISION] Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction 51 Addition/alteration/replacement Please check all that apply(submit 2 sets of plansw/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling 10-Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
Multi-familyMaster builderOther: amps for all other installations. buildings.
0 0 0 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 1 20f cs' 4 tN w�j p4yk(,�r ,4r 100HP or more. ❑"A","E",
City/State/ZIP: resY1141 / F 'z. RI ❑Six or more residential units. occupancy.
ty t,,�P ZZ
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: y(p) Project name: ` 0 Hazardous locations. 0 Supply voltage for more than
�uGsob site:
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to
J 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'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
t, (with above sq.ft.)
sJeC V"a.,y SY 1 . _� Limited energy,multi-family
/ ` 75.00 2
residential(with above sq.ft.)
0 PROPERTY OWNER ❑ 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
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
0
APPLICANT 0 CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
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'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: ( N G Sign or outline lighting 67.84 2
c3 .L 46 ,V h Signal Meru t(s)or limited-energy ...AAddress: F,0, 0 r 5 panel,alteration,or extension. l�'ee Page 2 75 et 2
Each additional inspection over allowable in any of the above
City/State/ZIP: (�� '" / 0")(2- Z
1 Additional inspection(1 hr min) 66.25/hr
Phone:(5612) 5 3 t - .. 2..yq Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:
Inspections for which no fee is
CCB Lic.: i 52.0(ai Electrical Lie.: 40 3e-49 Suprv.Lie.: 7 iq i.. specifically listed(%z hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 75-4,--i)
Print name: D a 14 ,t" G v,/ Date:. 1 J,1 Z018 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9, 4rt
TOTAL PERMIT FEE: 0-5
Authorized signature: e�'�/�
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:
�®®i dTIAL WORK ONLY Q{�(�
*
Fee for all residential systems combined: $75.00 .systems Decelectrical 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:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
(� 50.01 to 100 kva 552.26 2
I I 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:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(Y2 hr min)
CO " l ; WORKONLY` . _ : .. ,��T :, . .
Fee for each commercial system: $75.00 Subtotalp per* Number of inspections alloweddEnteron Page 1).
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
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other: 5e cyr,1/ S r5 '`^•
Total number of commercial systems: /
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015