Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I . COMMUNITY DEVELOPMENT Permit#: ELR2013 00213
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/26/2013
Parcel: 2S112ACO2000
Jurisdiction: Tigard
Site address: 14915 SW 72ND AVE
Project: Portland Construction Solutions Subdivision: FANNO CREEK ACRE TRACTS Lot: 47
Project Description: Data Telecommunications and Access control systems.
Contractor: ANDERCOM Owner: GLASS HOUSE INVESTMENTS
8560 SW 151ST PL 1662 WORTHINGTON ST
BEAVERTON,OR 97005 LAKE OSWEGO,OR 97034
PHONE: 503-886-9045 PHONE: 503-329-2141
FAX: 503-644-5273
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/26/2013 $150.00
12%State Surcharge-Electrical 08/26/2013 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire Alarm: 0
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: 1 Total $168.00
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 co. = ules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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.
08/22/2013 10:29 T0:+1 (503) 5981960 FROM:50 `h, Page: 2
Electrical Permit ADDlicati rrt• VSC\ r I(,U 0.1 FR l._t,L'()\I., . _
- City of Tigard • y ti0� Received
13125 SW Hall Blvd.,Tigard,O'•• '` �� DatdD : '�' i�7 1. /
Phone: 503.718.2439 Fax: 503.-'8.1960A�� GHQ` Other Permit: �(^
Inspection Line: 503.639.4175 1r^ 'C\C? 5-' ' ��"
Q\\ski' S See Page l or
Internet: www.tigard-or.gov �\��� Supplemeotallaformatioo
TYPE OF WO PLAN REVIEW •
❑New construction [ Addition/alteratior ent Please check all that apply(submit j sets of plans w/items checked below):
❑Service or fader 400 amps or more ❑Building over throe 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 ,Commercial/industrial ❑Accessory building
amps for all other installations. buildings.
❑Multi-family Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KvA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1.3"
Job no.: I Job site address: a(` 5 5t(J T Z Ad AJe- 1 Six or or more residential Recreational 1 ❑Six or more residrntial units. ❑Rerxea[ianal vehicle parks.
City/State/ZIP: - 0 s2 41 Z-q ❑Health-care facilities. 0 Supply voltage for more than
l Hazardous locations. 600 volts nominal.
Suite/bldgJapt.no.: Project name: C S Pv L. ice or feeder 600 amps or more.
_ _ ,
FEE SCHEDULE -
Cross street/directions to job site: 7 2 fcl / 0‘t.)11-1- t.--,Q Dcserlorloa I Qrv. I Fee. I tow I •1/ New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 1 168.54 4
Fa.add'l 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
(� II \ 0431--'s Limited energy,multi-family 75.00 2
t 1 lC U T 5 1)c r residential(with above sq.ft.)
n/� Renewable Energy ) ❑See Page 2
J('G• 11 A-L fin - Services or feeders installatio alteration,and/or relocation
❑ PRowRTY OWNER I 0 TENarrr 200 amps or less 100.70 2
Name:
201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
^Temporary services or feeders installation,alteration,and/or
Phone:( ) f Fax:( ) relocation
200 amps or less 59.36 1 I
Owner installation:This installation is being made on property that 1 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,aer panel
APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with
ateve
Business name: each btartchcc circuit
fee,
(1�L yr 7.42 2
Contact name: t B.Fee for branch circuits without
1 C Lk T�/►n service or feeder fee,first
branch circuit 56.18 2
Address: 1(J 65 C t 5 \ s,_ pL/A ce Each add'I branch circuit 7.42 2
City/State/ZIP: gEnJV C�`Q� O� CA 70L7 Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 2
Phone:(5) ,) is,6_q C„(5 I Fax::(SG3) 7 6 G _ 5 od dwelling,service and/or feeder
E-mail: �( L Reconnect only 67.84_ 2
r ��-!;(D�`IC(•c iv t Pump or irrigation circle 67.84 2
CONTRACTOR Signor outline lighting 67.84 2
Business name: Signal circuit(s)or limited-energy See
panel.alteration,or extension. _ ?/ Page 2 1 U' 2
Address: S 5CO l S` CT pl J� r Each additional inspection over allowable in any of the above
B Additional inspection(1 hr min) 66.25/hr
D
City/State/ZIP: ,a Q R_ 170 0 7 Investigation(1 hr min) 66.251 hr
Phone:(5o3) . 1;(. _ ?c,Lt Fax:(505) p.c. _�5 Industrial plant(1 hr min) 78.18/hr
spections for which no fee is
CCB Lic.: iici 551 // Electrical Lic.: Lt.,E et\ Suprv.Lie.: 3;,}3 LL 0;/sapecifically listed(vi hr min) i �/hr
Suprv.Electrician sillAtu ,tt aired: /� A 7 ELECTRICAL T �
'^ E✓' Subtotal: (50 •o0
Print name: fl 1, Lu. -•��Z `� Date: 512,ti Plan review(25%of permit fee):
LUU�UUJ State surchazge(12%of permit fee): j le
Authorized signature: r �1 TOTAL PERMIT FEE: _iF'°`p0
Print name: Q1 O 1 3 This permit application expires if a permit is not obta ei �hin 180
l ( Date: V ?-ii days after it bas been accepted as complete.
• Number of inspections allowed per permit.
I\Building\Pmmsa\ELC_PermnApp EIR--ERE doe Rev 05/21201) 440.461ST(11/05/COM/WEB
08/22/2013 10:29 T0:+1 (503) 5981960 FROM:5037666508 Page: 3
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined $75.00 Dimon I rns. I Fee 1 Teal 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
❑ Burglar Alarm Wind generation systems in excess 61 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating,Ventilation and Air Conditioning OAR 918-3090040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 00 3
Each additional inspection over allowable In any of the above:
❑ Other: Each additional inspection is 66.25/hr I
charged at an hourly(l hr min) -
Inspections for which no fee is
90.00/hr
specifically listed(5 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMrr FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
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
❑ Audio and Stereo Systems days atter it has been accepted as complete.
• Number of inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems •
TA Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other kCS Kv 1 ��
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
MBuildingWm 5s\ELc pammApp_ELR_ERE.dot Rev 05/21/2013
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14915 SW 72ND AVE, TIGARD, OR, 97224
Commercial - Electricial Limited Energy
199 Electrical final
2013-10-28 (null)
ELR2013-00213
PASS - No C of O
Violation Summary:
Inspector Contractor