Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
lig I • COMMUNITY DEVELOPMENT Permit#: ELR2015-00119
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/04/2015
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 190
Project: Professional Eye Care Associates of America Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Low voltage for data and security.
Contractor: LELAND ENTERPRISES, INC. Owner: PACIFIC REALTY ASSOCIATES
11374 NE EVERETT ST ATTN: N PIVEN
PORTLAND, OR 97220 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-784-8838 PHONE: 503-624-6300
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/04/2015 $150.00
12%State Surcharge-Electrical 05/04/2015 $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 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 is- • - or if work is suspend-• for more the 180
days. AT • •N: • -•• law requires you to follow the rules adopted by the Oregon Utility Notific. ion ente. Th• r,I ar- -et forth in OAR
952-00 -0010 through OAR 95 0• ••••. ou may obtain a copy of the rules or direct questions to OUNC by calling 51 32 987• 1.8.• c 2..4••.
I sued By: ' 9�/ Permittee Signature: /t /s`L
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:
.' C•IT'ACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' , r / Date: $- Y/A(
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 Applicatio MR 111 1 I( 1 l ',1 1l\I 1
City of Tigard ECE�VET� ffia � Permit#: . s-,�,/
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 ] Date/B : Related Permit#:
Inspection Line: 503.639.4175 "' . 4 2015 Ready Date/By: Juris: ® See Page 2 for
'' \I'I' Internet: www.tigard-or.gov Notified/Method: Supplemental Information
❑New construction Addition/ ac 'et .r.I Please check all that apply(submit a sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition 0 Other:
where the available fault current ❑Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑Floating buildings.
l/industrial El Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling Commercia
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived
Job#: Job site address: 121 6/S W (o ❑Addition of new motor load of system.
fitieetiAl 100HP or more. ❑"A" "E" "l-2""1-3"
D Q ❑Six or more residential units. occupancy.
City/State/ZIP:
i /?/?/5' ❑Health-care facilities. ❑Recreational vehicle parks.
(S7.lte�bldg./apt.#: /9 0 I Project name: Q g,c,�-q. ❑Hazardous locations. ❑Supply voltage for more than
JJ ❑Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site:
Description Qty. Each Total •
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft or less 168.54 4
Tax map/parcel#: Ea.add'I 500 sq.ft.or portion 33.92 1
Limited energy,residential 75.00 2
I.' (with above sq.ft.)
/ s 4 e Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Gl'tXII Renewable Energy ❑ See Page 2
Q...,� ��11 Services or feeders installation,alteration,and/or relocation
Name: to eds,q,.t .. IG Q%g( a,., il. M...,;,e a 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:( ) I 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 signature: Date: 401 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension, ter panel
A.Fee for branch circuits with
Business name:14 D C N6 �KE. ' above service or feeder fee, 7.42 2
each branch circuit
Contact name: �nnL L L• a 1-4o' B.Fee for branch circuits without
Address: 43-J� e service or feeder fee,first 56.18 2
3 Ch re branch circuit
City/State/ZIP:Vos,rf/ 7II) at. ' 7z2.3 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(803) gif.i 31 I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: 1Ij G Cpl Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy g G`
Address: �/' ►'1"4 e- panel,alteration,or extension. See Pa e 2 /�. 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) 1 i'l Investigation(1 hr min) 66.25/hr
Email:
1 I I 1 1 Industrial plant(1 hr min) 78.18/hr
io�t Inspections for which no fee is 9000/hr
CCB Lic.:I(,'1 3 2.f Electrical Lic.: kft Ito j4`4 Suprv.Lic.:a._0 7 s ificall listed %hr min
Suprv.Electrician signature,required: c9 ibt, Subtotal:
Print name: 1p(s-aR,u� 1,. OL4°0 Date/L1 ?,th 7 ❑Plan Review Required(25%of permit fee):
rt ( State surcharge(12%of permit fee): /g'.x'
TOTAL PERMIT FEE: /eog rC{9
Authorized s' atllre: This permit application expires if a permit is not obtained within 180
Print name: - Date: &Ili 1,Q days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Pennits\EL _PermitApp_ELR_ERE.doc Rev 04/21/2014 15 (11/05/COM/wEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDUL
Description I Qty.for all residential systems combined: $75.00 Each Total
Renewable electrical energy systems:
s::
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* >100 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: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s.-cificall listed %hr min
COMMERCIAL WORK ONLY: �.n.
- .
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) ' Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
[1 Boiler Controls
❑ Clock Systems
';5 Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
; Protective Signaling
i;s
• Other:
Total number of commercial systems: 3-
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12909 SW 68TH PKWY 190, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2015-00119
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor