Permit (57) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Pri COMMUNITY DEVELOPMENT Permit#: ELR2019-00131
TiG ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/18/2019
Parcel: 2S 103DC01000
Jurisdiction: Tigard
Site address: 11265 SW GAARDE ST
Project: Gaarde Christian School Subdivision: None Lot: None
Project Description: Low voltage for HVAC.
Contractor: HUNTER DAVISSON INC Owner: TIGARD ASSEMBLY OF GOD
1800 SE PERSHING ST 11265 SW GAARDE ST
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503-542-3628 PHONE:
FAX: 503-542-3654
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/18/2019 $75.00
12%State Surcharge-Electrical 07/18/2019 $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: 1 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
Issued By: g --.. Permittee Signature: �/•t) C1---270/
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 rermit 1:41:::, FOR OFFICE USE ONLY
CityO Tigard ' i'3 Received �/' Pen' ` p' )
. f g JULU 1 PlanDmeR ✓�Iu i i.r' 13 J
't. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review , ��
Phone: 503.718.2439 Fax: 503.598.1960 ", D
Date/B : `e'4664. ,0
Juris: 0 See 'a
TIGARD Inspection Line: 503.639.4175 I,,,ul I .--'-- ' ReadyDate/By: gee for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORT( , . PLAN,REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF'CONSTRUCTION'"_' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1 and 2-family dwelling Iii Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION,AND.LOCATION 0Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: /9(73 I Job site address: //a 65 S\/ Gek tikrOk STtQ,¢,1 100HP or more. ❑"A","E "1-2 °t-3",
A ❑Six or more residential units. occupancy.
City/State/ZIP: TT'a -4 O f Rel y ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name:6o,ckrde cA t t.ffiarl sL hots l ❑Hazardous locations. ❑600v1olts norm al.for more than
❑Service or feeder 600 amps or more.
Cross street/directions to job site:E ,t'i � All :,`, , • :FEE"'SCHEDULE `
Description Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I 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 I
DESCRtPT'ION OF WORD ,,. . .. Limited energy,residential
d } (with above sq.ft.) 75.00 2
Cot �O j�q� N�/7 C Co rl 11"O�jr Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
DilRenewable Energy ❑ See Page 2
PROPERTY OWNER' - ", ••❑ TENANT'-. Services or feeders installation,alteration,and/or relocation
Name: v ct qre, ch /S fi 4N .514001
200 amps or less 100.70 2
Address://2? TO Gtr de../Q ..11112R4'1 201 amps to 400 amps 133.56 2
401 amps to 600 ams 200.34 2
City/State/ZIP: 7-0Aird 0/e ? y 601 amps to 1,000 amps 301.04 2
Phone:(503 ) '6J6-37-5'33 C 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: amps2
ttoor extension,perpanel
401 to 599amps
Branch circuits new,altera' n n a
,APpIACANT.,' .,,.• , j-T, ,.0,CONTACT,P0.,SO 1 A.Fee for branch circuits with
Business name: Nur,J+ ,r v (//sSa N SrJG+ above service or feeder fee, 742 2
each branch circuit
Contact name: JI N P e,et B.Fee for branch circuits without '
service or feeder fee,first
Address: /ApoQ h/ r 5-. ..- TS 1 q S!SQ,Q,�t" _ branch circuit 56.18 2
City/State/ZIP: ,qrtf ,�� D�J 7:7,24a Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:($3)5-€62 6 Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:C n6'f�Q UN er / j'cSe Al , C O AA Reconnect only 67.84 2
r CONTRAC'I'QR Pump or irrigation circle 67.84 2
__ Business minim. $atMt - otee, IigI' a
Signal circuit(s)or limited-energy See Page 2 2
Address: panel,alteration,or extension. I
City/State/ZIP:- Each additional inspection over allowable in any of the above _
Additional inspection(1 hr min) 66.25/hr
Phone:( ) I Fax:( ) Investigation(I hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic./e/, I Electrical Lit.:a .a��el Suprv.Lic.:w p LEE specifically listed(Y2 hr min)
a• „ELECTRICAL:PER1t�iTT FEES
Suprv.Electrician signature,required: ' h Subtotal:
Print name:T'M ak SSON Date: 7-04?-19 0 Plan Review Required(25%of permit fee):
/,a State surcharge(12%of permit fee):
"/-
Authorized signature: I �/
® This permit application expires if a permit is not obtained within 180
Print name: /eye,./j) jo fee Date:7-.8— /9 days after it has been accepted as complete.
* Number of inspections allowed per permit.
C\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I1/05/COM/WEB
Electripal•Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
combined: $75.00 DescriptionnewaI Qty. •
Fee for all residential systemsEach I Total I
Renewable electrical 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 30104 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)
n 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
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
Y " Number of inspections allowed 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
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other: dd
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
1:\.uilding\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015