Permit r� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
N a ° • COMMUNITY DEVELOPMENT Permit #: ELR2013 -00107
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/13/2013
Parcel: 2S 101 DD00800
Jurisdiction: Tigard
Site address: 14020 SW 72ND AVE
Project: United Rentals Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: (4) branch circuits for new desk circuits
Contractor: BRY -COM Owner: I S PROPERTIES LP
14244 SE BUSH ATTN: UNITED RENTALS LEASE ADMIN
PORTLAND, OR 97236 BY FISCHER & COMPANY URI
13455 NOEL RD, STE 1900
DALLAS, TX 75240
PHONE: 503 - 761 -5156 PHONE:
FAX: 503 - 760 -7501
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/13/2013 $75.00
12% State Surcharge - Electrical 05/13/2013 $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 ' work is suspended f• more the 80
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Ce• sr. Those • es are forth in /AR
952 - 001 -0010 • • g • - - 952 -00 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 -. 987 a 1.800,3 ' 44. -
Issued =y: I 111° , ' Permittee Signature: . / ' ��/ / _AM
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 Applicatl FOR OFFICE USE ONLY
' 71
City of Tigard Received ® �� permit No.: / /� /�G
13125 SW Hall Blvd., Tigard, OR B CE IVED
PlaneReview 1 +K dC�[ !CJ
Phone: 503.718.2439 Fax: 503.598.19{ Ay 1 3 ZOI3 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: Vl See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF DVtLTJtNG DIVISION PLAN REVIEW
El New construction a) Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 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 I3Commercial/industrial ❑ 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 derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l -3 ",
Job no.: Job site address: MO 10 SO f7Z.14 ,4 ? 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: --176AfEL ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: (AO i'f t6 I . PTA L ' ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
J Description I Qty. I Fee. I Total i •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
TTkt. I �,�// r�f� .S a�cVe 0C4 q ��� C ,( L energy, multi - family
1, �� L4(I4 �"` .. residential (with above sq. ft.) 75.00 2
Oft tal aT ^ , 4oL 2 Services o Energy ❑ See
io Page 2
`— wt K. PICA I / S L`i Svices or feeders installation, alteration, and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation
200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
B. Fee for branch circuits without
Contact name: service or feeder fee, first
branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder
Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: 8e Signal circuit(s) or limited -energy
panel, alteration, or extension. I' Page 2 2
Address: �(� Z��1 S L �� Each additional inspection over allowable in any of the above
City/State /ZIP: ( 4'1236 Investigation i ti (1 hr min) 66.25/ hr
Phone: ( l am ' 7 / 4 ! ' 7 5 Fax: ( ) 3 ) 1} -_933 9' Industrial plant (I hr min) 78.18/ hr
Inspections for which no fee is
CCB Lic.: f /0/ 3 Electrical Lic.• /ag/4 Su. . Lic.: /3?/‘£g specifically listed (%z hr min) 90.00 / hr
Suprv. Electrician signature, required: ^ ELECTRICAL PERMIT FEES
e Subtotal:
Print name: him, S J Date 5713 3 Plan review (25% of permit fee):
State surcharge (12% of permit fee):
CI
Authorized signature: TOTAL PERMIT FEE: 3.Sa
Print name: Date: This permit application expires if a permit is not obtained within I80
days after it has been accepted as complete.
• Number of inspections allowed per permit.
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Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE' 4..1
Fee for all residential systems combined .. $75.00 Description I Qty. I Fee F Total m l r •
y 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 301.04 2
•
❑ kva 552.26 2
Garage Door Opener* 50.01 to too
>100 kva (fee in accordance with
OAR 918- 309 -0040) 552.26 2
❑ 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 (%¢ hr min)
COMMERCIAL WORK'ONLY: ,1 I. ELECTRICAL PERMIT FEES , " °?`rsc,,0 1
Subtotal:
(SEE OAR 918- 309 -0000)
Fee for each commercial system $75.00 Plan review, if required (25% of permif • State surcharge (12% of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Systems days after it has been accepted as complete.
Audio and Stereo S
❑ y Number of inspections allowed per permit.
❑ 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
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