Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit# ELR2012 -00217
Date Issued 09/17/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S113AB00500
Jurisdiction Tigard
Site address 16083 SW UPPER BOONES FERRY RD 300
Project Therapeutic Associates Subdivision FANNO CREEK ACRE TRACTS Lot PT 37
Project Description TI
Contractor OHM SYSTEMS LLC Owner G&S FC LLC
PO BOX 86833 16083 SW UPPER BOONES FERRY RD,
PORTLAND, OR 97286 STE
TIGARD, OR 97224
PHONE 503- 484 -5700 PHONE
FAX 503 - 258 -0382
FEES
Description Date Amount
Specifics. Restricted Energy Permit 09/17/2012 $75 00
12% State Surcharge - Electrical 09/17/2012 $9 00
Type of Use COM
Class of Work ALT
Total Number of Systems 1
Audio & Stereo N Boiler Controls N
CCTV N Clock Systems N
Data & Telecommunications Y Fire Alarm N
HVAC N Instrumentation N
Intercom /Paging N Landscape /Irrigation N
Landscape Lighting N Medical N
Nurse Calls N Protective Signal N
Security Alarm N Other N 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 OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By../&d Permittee Signature E�--
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 CI' (7 Z
LICENSE NO 11 1 C7 U C
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 Applicatioi El FOR OFFICE USE ONLY
R eceived
City of Tigard Date/By
/7 //a 4ib., Permit No ��, «-O&2/7
13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
Phone 503 718 2439 Fax 503 598 1960C 1 7 2012 Date/By Other PermefQ / _Q0
T I G A R D Inspection Line 503 639 4175 Date Ready/By Juns ® See Page 2 for
Internet www tigard -or gov CITY OF TIGARD Notified/Method T7 6,- Supplemental Information
TYPE °FBIW*h1 ING DIVISION PLAN REVIEW
❑ New construction (®. Additton/alteration/replacement Please check all that apply (submit 2 sets of plans whtems checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2 - family dwelling aCommercial/mdustrlal ❑ Accessory building amps for all other installations buildings
❑ Multi - family ❑ Master builder ❑ Other ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately denved system
❑ Addition of new motor load of ❑ "A ", "E ", "l - ", "1 - ",
Job no Job site address I Q g 3 5 (..,/ k G or more occupancy
�� ❑ Six ix o or r more residential units ❑ Recreational eational vehicle parks
Cit /ZIP T , 3 e r J / c", \ f'<M�/ ❑ Health -care facilities ❑ Supply voltage for more than
,/ r ❑ Hazardous locations 600 volts nominal
Sulte/bldg /apt no 3 Q Project name ` V �, e r . /),,, I' L A ,, sac. ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site Description 1 ptv I Fee 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision Lot no 1,000 sq ft or less 168 54 4
Tax map /parcel no Ea add'l 500 sq ft or portion 33 92 1
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
f , w Limited energy, multi -family
LU"N/ V d l i - �� 1-.v (-.1„\- L, residential (with above sq ft ) 75 00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
401 amps to 600 amps 200 34 2
Name
601 amps to 1,000 amps 301 04 2
Address Over 1,000 amps or volts 552 26 2
City/State/ZIP Temporary services or feeders installation, alteration, and /or
ty relocation
Phone ( ) Fax ( ) 200 amps or less 59 36 1
201 amps to 400 amps 125 08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701
Branch circuits- new, alteration, or extension, per panel
Owner signature Date A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name B Fee for branch circuits without
service or feeder fee, first 56 18 2
Contact name branch circuit
Each add'l branch circuit 7 42 2
Address Miscellaneous (service or feeder not included)
City/State /ZIP Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone ( ) Fax ( ) Reconnect only 67 84 2
Pump or irrigation circle 67 84 2
E - mail
Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name panel, alteration, or extension Pa • e 2 2
"" l S �' S ! � � Each additional inspection over allowable in any of the above
Address -- K. , ," t - - Additional inspection (1 hr min) 66 25/ hr
City/State /ZIP T J d 4 l --72 Investigation (1 hr min) 66 25/ hr
<� v ^ Industrial plant (1 hr mm) 78 18/ hr
Phone (5 L/Sr.,1 5 d U Fax (5 ) -2,5 03 g z Inspections for which no fee r5,
specifically listed (/2 hr mm) 90 00/ hr
CCB Lic ir ` $ i ei Electrical Lic C LC 6 Supry Lie 10 0 /_EA ELECTRICAL PERMIT FEES
-
Supry Electrician signature, required / o Subtotal '7 5 , � -
Plan review (25% of permit fee)
Print name C L.1) , 1 J,-.,r c Date c73 47/ / 17- State surcharge (12% of permit fee) 9i Cre
Authorized signature TOTAL PERMIT FEE may, C�
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
1 \Building\Permits\ELC- PermitApp doe 07/01/10 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
,RESIDENTIAL WORK ONLY:
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.
2 COMMERCIAL WORK ONLY: — 1
Fee for each commercial $75.00
system
(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
Total number of commercial systems- /
*No licenses are required. Licenses are required
for all other installations
I \Butldmg\Permits\ELC- PermilApp doc 07/01/10