Permit � q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
m COMMUNITY DEVELOPMENT Permit#: ELR2015-00050
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/23/2015
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12268 SW SCHOLLS FERRY RD
Project: Orange Theory Fitness Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: Data,CCTV,and audio systems.
Contractor: EMPOWER DIGITAL SOLUTIONS INC Owner: FW OR-GREENWAY TOWN CENTER LLC
1271 NE HWY 99W STE 415 PO BOX 790830
MCMINNVILLE,OR 97128 SAN ANTONIO,TX 78279
PHONE: 503-928-6018 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/23/2015 $225.00
12%State Surcharge-Electrical 02/23/2015 $27.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 3
Audio&Stereo: 1 Boiler Controls: 0
CCTV: 1 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: 0 Total $252.00
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 se es or direct questions to OUNC by calling 503. 32.1•:7 or 1.800.33 44.
Issued By: Permittee Signature: fit err
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.
Ai 'Ele'ctrical Permit Application GO FOR OFFICE I .l- ON I 1
City of Tigard v`i Receives
�, Plan Review
: ;.r '_.ter •L
13125 SW Hall Blvd.,Tigard.r Plan Review
11,„
a Phone: 503.7182439 Fax: 50 60 10`� Date/13y: Other Permit:
i'1 GA R Ll Inspection Line: 503.639.4175 Qe Date Ready/By: luris I ® See Page 2 for
Internet: www.tigard-or.gov ��P GPap NotifiedAl.cthod. : Supplemental Information
TYPE OF W*. Q��s v\f \O PLAN REVIEW
low
®New construction ❑Addition/alt 3'N!", ent . Please check all that apply(submit I,sets of plans w•/items checked below)
0u
❑Demolition 0 Other: ❑Service or feeder 400 amps or mom 0 Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating huildinp.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
1 0 I-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: j ❑Fire pump. ❑Installation 01 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system
❑Addition of new motor load of ❑"A'."E` '1-2 ^1_}'
Job no.:171814 Job site address:12268 SW Scholls Ferry Road 1001iP or more oec nation
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 0 Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations 600 volts nominal.
Suite!!bldg.iapt.no.: Project name:Orangetheroy Fitness 1 ❑Service UT feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 1 ore. i Taw 1 - '
New residential single-or multi-family dwelling unit
includes attached garage.
l 1,000 sq ft or less 168.54 4
Subdivision: 1 Lot no.: ,
Ea.add'I 500 sq.ft.or portion 33.92 1 i
Tax map.parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.(10 2
Voice,data,CCTV,audio Limited energy,multi-family -
residential(with above sq.ft.) 75.00
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ® TENANT 200 amps or less 1000.70 2
1 201 amps to 400 amps 133.56 2
Name:Orangetheroy Fitness 401 amps to 600 amps 200.34 2
I Address:12268 SW Scholls Ferry Road 1 601 amps to 1,000 amps . 301.04 i 2
Over 1.000 amps or volts I 552.26 12
City Stater7,IP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or
Phone:( ) Fdx:( ) relocation
- 200 amps or less 59.36 1 I
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps i 125.08 I 2
. intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps I .68 54 2
Owner signature: Date: - Branch circuits-new,alteration,or extension,per panel
® APPLICANT I ❑ CONTACT PERSON A.Fee for branch circuits with 1
above service or fix-der fee,
Business name:Emppower Digital Solutions,Inc each branch circuit 7.4
`'B.Fee for branch circuits without {
Contact name:Jerry L.Koch service or feeder fee.first
56.18
branch circuit
Address: 1271 NE Hwy 99w,Suite 415 Each add')branch circuit 7.42 f 2
Miscellaneous(service or feeder not included)
City/State/ZIP:McMinnville,OR 97128 1
Each manufactured or modular
67.84 2
Phone:(503)438-6629 Fax::(503)928-6018 dwelling.service and/or feeder
Reconnect only 67,84
E-mail:jerry@,empowerdigital.com Pump or irrigation circle 67.84 2
CONTRACTOR '
� Sign or outline lighting 67.84 2
Business name:Empower Digital Solutions,Inc. Signal circuit(s)or limited-energy 3 Sec 225 tx)
_panel.alteration.or extension. Page 2 - 2
Address: 1271 NE Hwy 99w,Suite 415 ; Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Cilv/State/ZIP:McMinnville,OR 97128 Investigation t t hr min) 66.25,'hr
Phone:(503)438-6629 Fax:(503)928-6018 industrial plant(1 hr min) 78.18/hr
1 — inspections for which no fee is
CCB Lie.: 195629 Electrical Lic.: CLE290 I Suprv.Lie.: 994LEA specifically listrd(h hr min) x)-001 hr
�)Jisl '7/t 117 ELECTRICAL_ PERMIT FEES
Suprv. f;lectrician signature,required: `-, 7 , tit I ,17 �-
1,. c.-F -..- - Subtotal: 225.00
Print name: Jerry L.Koch ..__) I Date: 2/23/15 Plan review(25%of permit fee): N/A
I State surcharge(12%of permit fee): 27.00
Authorized signature: I•
L l ty ., __ . TOTAL P£Rtif1T FEE: 252.00
This permit application expires if a permit is not obtained within(110
Print int name: Jerry L.Koch Date: 2/23/15 days after it has been accepted as complete.
' Number of inspections allowed per permit.
l\i ssnding'Permiti•LLC'_Permitdpp_ELI ORS.doe Rev osat2nt) 4404615T(I Ii5SS('OSt.'WER
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 Descepnan I Qty. : rK I lbw 1 •
Renewable electrical energy systems:
Check Type of Work Involved: 5 k-a or less 1 00.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* C 15.01 to 25 kva 200.34 2
❑ Burglar Alarm
Wind generation systems in excess or 25 kva:
25.01 to SO 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 91 8-309-0040)
Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 1 7.42 3
Vacuum Systems* >l00 kva-no additional charge 0 Q 3
Each additional inspection over allowable in any of the ahove:
E
Other: Each additional Inspection is 66.251 hr 1
charged at an hourly(I hr inn])
Inspections for which no fee is 90,001 hr
specifically listed(ii hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 I Subtotal I
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit tee):
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 after it has been accepted as complete.
• Number of inspection.allowed per permit.
❑ Boiler Controls
n Clock Systems
Z Data Telecommunication Installation
❑I Fire Alarm Installation
HVAC
U Instrumentation
U Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Z Other CCTV
Total number of commercial systems: 3
*No licenses are required. Licenses are required
for all other installations
I•'Building`Permits\E1.C_P.-mtitApp_ELR ERE doe Rev t5"21:20t3
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12268 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Commercial - Electrical Limited Energy
135 Low voltage rough-in
PASS
ELR2015-00050
Jeff Grove
Violation Summary:
Inspector Contractor