Permit (9) q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
''1 11 COMMUNITY DEVELOPMENT Permit#: ELR2014-00154
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/08/2014
Parcel: 2S 113AC00101
Jurisdiction: Tigard
Site address: 16655 SW 72ND AVE 800
Project: Microlnterconnects Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 37
Project Description: (2)low voltage sustems,security and access controls.
Contractor: VIKING SECURITY Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 3503 ATTN: N PIVEN
SALEM, OR 97302 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-910-9803 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/08/2014 $150.00
12%State Surcharge-Electrical 07/08/2014 $18.00
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: 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 $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 =nd all • er applicable I. work will
be done in a .. • • - .'th approved plans. This permit will expire if work is not started within 180 days of issuan -, •r if w• k is susp nde• •r o'- the 180
days. A TION: Oregon .w requi - you to follow the rules adopted by the Oregon Utility Notification ' - .r. T o-e rule ar> --t, o in OAR
952-00 -0010 through OAR 952-06 -0r r. Y.u ma obtain a copy of the rules or direct questions to OUNC by calling 503 • : or 1 :0,.332. .44.
4111 0
Iss ed By: � ( ((may(//� . - _.&. Permittee Signature: k AL. .iL . A .ass
V
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 ApplicatiOp FOR OFFICE USE ONLY
City of Tigard r,As ) Date/B : 0� Ei4siv /1V/S
Permit#: �f/t�
.111 • 13125 SW Hall Blvd.,Tigard,OR 9 dur,mvfr Plan Review
11
II Phone: 503.718.2439 Fax: 503.598.196 L S l,1 1 Date/B : - '
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
1 I t' \1.1) Internet: www.tigard-or.gov �f f Notified/Method: Supplemental Information
TYPE OF `i V Ur,I PLAN REVIEW
❑New construction Addition/alter tl la en ." 1 Please check all that apply(submit 2 sets of plans w/items checked):
p ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CA(EGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ I-and 2-family dwelling IS Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
E l Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
'l ❑Addition of new motor load of system.
Job#: Job site address: //4 Lad 7Z TA Ar• ii e do 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: ❑Six or more residential units. occupancy.
pow--04A.,4) ( 972. ❑Recreational vehicle parks.
❑Health-care facilities. P
Suite/bldg./apt.#:��r, X00 Project name:no, £ ,L('v n P(h 44 G ❑Hazardous locations. ❑600 pply voltage for more than
❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: 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 1
DESCRIPTION OF WORK Limited energy,residential
A-0 a f.5 S °t- y 1 u I Ty (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I CI TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less _ 100.70 2
Address: 201 amps to 400 amps 133.56 2
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 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 signa re: Date: 401 amps to 599 amps 168.54 2
to le
APPLICANT Jr ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
, / �� T / A.Fee for branch circuits with
Business name: V r�,! ! above service or feeder fee,
7.42 2
je each branch circuit
Contact name: l-4o B.Fee for branch circuits without
Address: l /1 /y service or feeder fee,first 56.18 2
a• ix 3c branch circuit
City/State/ZIP: (11/41, k g 7S°Z Each add'I branch circuit 7.42 2
�� �� l Miscellaneous(service or feeder not included)Phone: (1' ) a- LLL Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Emai :d LA.L4k- C� 0 /f ` n/
Reconnect only 67.84 2
COWERACTOR Pump or irrigation circle 67.84 2
Business name: U(K(/' u e�t'—,(./,`I Sign or outline lighting 67.84 2
Address: �(�, �/Qax a� Signal circuit(s)or limited energy See Page 2 /69. 2
n nn�� F� panel,alteration,or extension.
City/State/ZIP: 'J'j9./P / �� 9 Each additional inspection over allowable in any of the above
+t Additional inspection(1 hr min) 66.25/hr
Phone: �'(93) bS /1 ( Fax: Investigation(1 hr min) 66.25/hr
Email: 3� ® ���� eQ� Inspectiol s for w is hr no) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB ic.: get z Electrical Ltc.. (1 2 Z3 Suprv.Lic.:2(9/ 4 E, - specifically listed(Y2 hr mm)
Sup �/ /� la�i��y ELECTRICAL PERMIT FEES
:Electrician signature,required: t J Subtotal: l�Q.
Print name: /MOD /�(/. 4� 7/le Date: 7/C f�'/ ❑Plan Review Required(25%of permit fee): —
4"Jf State surcharge(12%of permit fee): `8,�
g /� TOTAL PERMIT FEE: /t ,00
Authorized signature: q�
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.
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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
Dncription I Qty. I Each I Total f *
Fee for all residential systems combined: $75.00 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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >I00 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ 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: kers-4' 64i4.) Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(%:hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00
Subtotal(Enter Page 1):
y " Number of inspections alllowed owed 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
❑ 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:\Building\Permits\ELC_PermitApp_ELR_ERE-docx Rev 04/21/2014