Permit (187) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
P '� 3 COMMUNITY DEVELOPMENT Permit#: ELR2018-00141
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/05/2018
1R.1 Parcel: 251060001400
Jurisdiction: Tigard
Site address: 17077 SW APPLEDALE RD
Project: River Terrace East Apartments,Building B Subdivision: RIVER TERRACE EAST Lot: None
Project Description: Building B: Fire alarm installation.
Contractor: FIRE PROTECTION SERVICES Owner: POLYGON WLH, LLC
5573 SW ARCTIC DRIVE 703 BROADWAY ST, SUITE 510
BEAVERTON, OR 97005 VANCOUVER,WA 98660
PHONE: 503-590-3732 PHONE: 360-695-7700
FAX: 503-628-6214
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/05/2018 $75.00
12%State Surcharge-Electrical 09/05/2018 $9.00
Type of Use: MF
Class of Work: NEW
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 1
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 0 52-001-0090. You may obtain a les or direct questions to OUNC by calling 503.2 2.1987 or 1.800.33 2344. r
t
Issued By: ermittee Signature: 1,7119&J /�
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 01-FIC I: I SE O\1.'
Cl of Tigard .,..:'°1I'' i •�'* r 1: "R-ceivedI.
g Dte7B : dc',77 /6F--- Permit No.6bej, - _DO/f/
13125 SW Hall Blvd.,Tigard,OR 97223
m Phone: 503.639.4171 Fax: 503.598.1960 A I;3 2 e L 0IRESIMIIMIE Other Per ': 0;1J/f'—4 9/'6
T I G A RD Inspection Line: 503.639.4175 s ate Ready/By: Allis: H See Page 2 for
Internet: www.tigard-or.gov -k 1 ; Notified/Method: Supplemental Information
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®New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
, a v exceeds 10,000 amps at 150 volts or
\ a 0 Floating buildings.
"'''`'` aaA `''`'w' "°" less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder ❑Other: 0 Fire pump. ❑Installation of 75 KVA or
`\\\` `\a\q\\)`` \"\w w v " \ `v\ a :\ `ti\\\\\ i axe p\. ❑Emergency system. larger separately derived system.
..ti�u..<a v` a,..s.. ��,��.u,v„ ,.,,�\e. . ,wi, , " \Ga u.a v ,,.. Say a`. .,.:., `vA\ i ❑Additionofnewmotorloadof ❑..A„ ..E„ ..1-2„ ..1-3"
Job no.:3001 Job site address: 17077 SW Appledale rd 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP om' r,t?. 4°1-5,0 ',•y 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: A Project name:River Terrace East Cend.& ❑Service or feeder 600 amps or more
Cross street/directions to job site: j'i'/i2T/-/e-2VIS Description Qty. Fee Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: 1,000ft.or less 145.15 4 1
Lot no.: sq. ;'
Tax map/parcel no Ea.add'1500 sq.ft.or portion 33.40 1 ii;
Wv\a \ Limited energy,residential, \ ,
75.00 2
\ " � A A (with above sq.ft)F awase, � „,eix� a � � aa
Limited energy,multi-family
install new Fire Alarm Panel residential(with above sq.ft.) 75.00 2
Services or feeders installation,alteration,and/or relocation
o\\ \\\ \` \ 200 amps or less 80.30 2
�'"`@\� �v N o\•�vA vry v� v ia` V�` a �v v� \V��'
� � �a,aam. �� �as.,•..A ., �,A A.u` �m.vw\ � v, ‘,4,,,,.aw„vV`��\+vA�v av •..• bei\\.4,.rc201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less 66.85 1. 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 133.75 2
s
Branch circuits—new,alteration,or extension,per panel
Owner signature: Date:
A.Fee for branch circuits with
a\p� ° VAAa \ a \VAa A', ``� h V 7 v v a \
\vr Y above Service or feeder fee,
Vvc a a,v� �v„ v �sa �ca�,e„a . �c o � v., ��o ova a aovve a ,u,,,.,�^ v. a,�„b3 sas..�s> 6.65 2
each branch circuit 1
Business name:Fire Protection Services Inc B.Fee for branch circuits
without service or feeder fee,
Contact name:David M Phipps first branch circuit 46.85 2
Address:9950 SW Arctic Dr Each add'l branch circuit 6.65 2
Miscellaneous(service or feeder not included)
City/State/ZIP:Beaverton Or 97005 Each manufactured or modular 90.90 2
dwelling,service and/or feeder
Phone:(503)590-3732
Fax: :(503)628-6214 Reconnect only 66.85 2
E-mail:phipps@fpsnw.com Pump or irrigation circle 53.40 2
�Z nrn\ a ...a,,,a c�\\boa\�..r1\\\\,.,'��..aaw�\\\�Sa�,,,�.a,.\. ,•vec.,,,.: :.,a,a\c1C \o\\\\u., ;���,y\\�\\`:`�\ :��\\�`. \x1u0a� `� \� \v\ Slgri Or Outline lighting 53.40 2
. a �.. ,...,
Business name:Fire Protection Services Inc Signal circuit(s)or limited-
energy panel,alteration,or
Address:9950 SW Arctic Dr extension.Describe: 1 Page 2 75.00 2 '
City/State/ZIP:Beaverton,OR 97005 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone:(503)590-3732 Fax:(503)628-6214 Investigation per hour(1 hr min) 62.50
CCB Lic.: 154333 Electrical Lie.: CLE3488 Suprv.Lie.: 4120LEA Industrial plant per hour 73.75
v„ � v. �� � .a v,� �. tia. a , ..
Suprv.Electrician signature,required: ynSubtotal: 75.00
Print name: David M Phipps ��j/%�:, ./�%fes Date: 8/23/18 Plan review(25%of permit fee):
,� �'' State surcharge(12%of permit fee): 9.00
Authorized signature: � i�i1l` J TOTAL PERMIT FEE: 84.00 1/
/� This permit application expires if a permit is not obtained within 180
Print name: David M Phipps Date: 8/23/18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC-PermitApp.doc 05/23/06 440-4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RE a
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
t m
Fee for each commercial $75.00
system
(SEE OAR 918-260-260)
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
I:\Building\Permits\ELC-PermitApp.doc 03/23/06
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17077 SW APPLEDALE RD, SHERWOOD,
OR, 97140
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2018-00141
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor