Permit (165) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2018-00211
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/03/2018
T[C tl RD 9 Parcel: 1S 136DC03200
Jurisdiction: Tigard
Site address: 11740 SW 72ND AVE
Project: 72nd Avenue Apartments Subdivision: 72ND AVE APARTMENTS Lot: 8
Project Description: Fire alarm.
Contractor: DYNAMIC SERVICE FIRE SECURITY LLC Owner: 72ND AVENUE PROPERTY LLC
1041 FABRY RD SE BY CASSINELLI, RICHARD
SALEM, OR 97306 11720 SW 72ND AVE
TIGARD, OR 97223
PHONE: 503-302-7122 PHONE: 503-545-5217
FAX: 503-990-7222
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/03/2018 $75.00
12%State Surcharge-Electrical 12/03/2018 $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: 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 OAR 952-001-0090. You ma obtain a co• • the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
r;
Issued By: Permittee Signature:
OWNER INSTALLATION ONt'�(
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 ECM_OFF! F I. SE ONEN
City ofTigard - ('-' ' ES!iliMillifill., : fl!Infil
13125 SIN flail Blvd_,Tigard,OR 9 ,..,A,4 .,it,„„
Phone: 503.7182439 Fax: 501598.191W '''
III Dateth : Related Person ir:pe,„0„
Inspection Line: 501639.4175 Ready Datelfly. MIIIII lil See rage 2 for
T 1 A k 1) Internet: www.tigard-or„gov otified/Me
13EC 3 ' `I N •thod-
Supplemental information
TYPE OF WORK , . .,, , ,.,4 . ! PLAN REVIEW
.-.. ,
V New construction 0 Additioniallerazimptcma ' Please check all that apply{submit 2,sets of plans witom checked):
0 Service or feeder 400 amps or more 0 Building over three stones.
0 Demolition 0 Other: Ik'41' f.,:-,. ',' .H .:
where the available fault current 0 Martnas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings-
.
,
El 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to groundor exceeds 14,000 0 CommerCial-ese agricultural
amm far all other installations. buildings.
'4 Multi-family 0 Master builder 0 Other: QFire pump. 9 Installation of 150 KVA or
JOII SITE INFORMATION AMP LOCATION . 9 EmerIen°Y*Yllem largerseparately derived
0 Additiem
Job 4: Job site address: j/ 7 e-/e:7 -la c\.„ 1001IP on of riesie motor load of systor more.
Osix or,MOTe residential irons_ occimancy.
City/SutteiZIP:-VkcyAcC: Oftealti facilities. Oftecreauunal whack parks.
Suite/bldg./apt.4: Project natne:ir3Hazardous locations_ El-Supply voltage for more than
0 Service or feeder 600 amps or mom 600 was nenunal
Cross street/directions to job site: FEE SCREDULE
' Description 1 Qty. 1 Tata. I Total 1 .
New residential single-or multi-fatuity dwelling snit
Subdivision: ' Lots: bachadies attaebed garage.
1,000 sq.R.or less 168.54 4
Tax map/parcel ft:
En_cider/500 sq ft or porticos 3192 1
DESCRIPTION OF WORK . . Limited energy,residential
75.00 2
CC\\C‘
(.,Vith above sq.ft.)
Limited energy,multi-limits
- 75.00 2
residential(with above sq..h.)
Renewable&sem/ CI See Page 2
0 PROPERTY OWNER I 0 mr - - - - -
Services or feeders instaRanow„alteratiow andlor relocation
Name: 200 amps,or less 100.70 2
201 amps to 400'amps, 133.56 2
Address:
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 not200 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
.
NT 0 CONTACT PERSON -e: ‘'' C'jeclS) ..,....E_
Brawl/circuits-new,
alteration,or esteasioa„ , r pastel
/APPLICANT El Fee for brancIrcurans tr'itir
Business nam \C Scs-<... k C \--
above service or feeder foe,
each,brant.h,csieun 7A2 2
Contact B.Fseereviceerocbrainetcirrefenie:afirnstithour
Address:n(Jt\ c-1\ c"-\( Va"-5 .... 56:18 2
branch circuit
City/StateiZII . ( X-'s orizob Each addll branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone: 1\aa Fax:'( ) 'Each inanufactore4 or modular '
67.84
2
Rdw,ecccollinnecg,tseorvrtlyice and/or feeder
C.4_4\r) 67.84 2
CONTRACTOR Pump or itrignion circle 67.84 2
Business M
+C% k-
name_c. Kk\ •••••)Q...S-0\c.,e...., V/k \\......Q...... Sign or outHinclighting_ 67..84 2
i_
Address:W-.5-\ _,‘ •K's\k V._ . S gn,, -1,al mocurni)or limnedenergy MEr. 1
, tmelon or exiension. et Ar . __ - '
City/State/ZIP: (1._“-
'N\ Each additional inspection over allowable many of above
Additional inspecnon(I lir min) ' 66.25/hr .
Phone:en .3(. --1,3, Fax:( ) investigation(1 hrrnin) 9000/hr
todvatual$,,,,(t hr rn-no. 181 hr
Elna 4 \Ur: '`') kek Ute.-,, zpokkbolt, C..k) 73-
kc..._,
Inspections for which an fee is
CCB LAI:\ Elee r.f al Lie.:(247,_16,, Sultry.1..iez..C=...-.40 specifically listed(%Munn) 9°""hi
CI
ELECTRICAL, ?MUT FEES
fie ' .
= Suprv.Electrician swati ure,remn - Subtotal: —7;7'1'
- .
' Piint nallie:\-- \\c'QC V I_ e j..\C_./ Datc,i ii:Thfoc czs Review Required(25%of pourer fee):
t
State surcharge(12%of permit fee): 7 6,
TOTAL PERMIT FEE:
Authorized signature:
, J This permit application expires Ma permit is not 416taired within me
Print name: Date: days after it has been accepted as complete.
*- Number of inspections allowed per permit.
TABuildiregVerntitiELC PertnitApp ELR ERE doe Rev 06/1712015 440-4615T(Itr05tCOVYWEB
Electrical Permit Application-City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees
Dearaiptioa I Qty. I Eaeb 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 StereoSystems* 15.01 to 25 kva 200.34 2
Wind-generation systems in e‘scess of 25 kva:
Burglar Alarm 250t to 50 kva 301.04 2
50.01u1,00 kva 552.26 2
- Garage Door Opener*
>100 kva(fee in'accordance
552.26 2
-mists OAR 91g-3(19,6040)
H• eating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Pooh additional kva over 25 7.42 3
>100 kva-no additional charge 010, 3
- Vacuum Systems*
Each additional inspection over allowable in any of the above:,
fl Other: Each additional inspection ia
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is
93.001 hr
specifically listed(V2 hr min),
ELECTRICAL 1EMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: S75.00
Nuanber of inspectiors allowed par pennit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
n Boiler Controls
- C• lock Systems
fl Data Telecommunication Installation
f>rFire Alarm Installation
n H• VAC
Instrumentation
- Intercom and PagingSystems
fl Landscape Irrigation Control*
O Medical
• Nurse Calls
- Outdoor Landscape Lighting*
fl Protective Signaling
O Other.
Total number of,commercial systems: I
*No licenses are required. Licenses are required for all
other installations
'Ulliatiktin5kPearaits1ELC_PeratitApp_ELR_EXE doe Rev,06/17/2015