Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' �! • COMMUNITY DEVELOPMENT Permit#: ELR2015-00146
T(GARD 13125 SW Hall Blvd.,Tigard OR 97223 503318.2439 Date Issued: 05/28/2015
Parcel: 1S134AB03300
Jurisdiction: Tigard
Site address: 10330 SW SCHOLLS FERRY RD
Project: Muslim Educational Trust Subdivision: ENGLEWOOD Lot: 88
Project Description: Low voltage for audio/stereo
Contractor: COMPVIEW Owner: MUSLIM EDUCATIONAL TRUST INC
10035 SW ARCTIC DRIVE PO BOX 283
BEAVERTON, OR 97009 PORTLAND, OR 97223
PHONE: 800-448-8439 PHONE:
FAX: 503-601-5575
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/28/2015 $75.00
12%State Surcharge-Electrical 05/28/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 1 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 $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 i •-•••- - approv=• •ans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ' TENTION: Oregon - requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-,s1-0010 through OAR 952 •01-0090. Yo =y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
sued By: e/iL �� 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.
Electrical Permit Application I (1 IL (/I I I( 1 I ■I ()NI
City of Tigard RECEIVED Received ,*, Ea 5 X19,I
,� Ci o Ti and : Pemtit#:
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503. �j Date/B : Related Permit 8:
Inspection Line: 503.639.4175 H 1 �+ 8 2015 Ready Date/By: Juri': 0 See Page 2 for
I I'' '''I 1 Internet: www.tigard-or.gov Notified/Method: Supplemental Information
New construction ❑Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived
f ❑Addition of new motor load of system.
Job#: Job site address: X0'330 5 l.,S diaUs ,`,ir�d 100HP or more. ❑"A","E","t-z","t-a",
City/State/ZIP: Q f ❑Six or more residential units. occupancy.
�4/� r R �"1 7.2 5 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: Ai ET- ❑Hazardous locations. ❑Supply voltage for more than
❑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'l 500 sq.ft.or portion 33.92 1
[/ Limited energy,residential 75.00 2
I-old o I- -A t E.//cTr;G4l — A-UV/0 5�-I,(? (withabovesq.ft.)
Limited energy,multi-family 75.00
F
residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
/ � Services or feeders installation,alteration,and/or relocation
Name: Uz,t M ii • I (VS J 200 amps or less 100.70 2
dat.4—lddt,t/
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 l
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,per panel
A.Fee for branch circuits with
Business name: S/e 3 0/s 1 above service or feeder fee, 7.42 2
J each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email: Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
Business name: C •�9 r' Uc ,1d Sign or outline lighting 67.84 2
Address: 5 5 W A T C_ `0r
Signal circuit(s)a an or limited-energy
14 See Page 2 7S-14V 2
�6Q 3 PC panel,alteration,or extension.
q Each additional inspection over allowable in any of the above
City/State/ZIP:
�e,V I�D t1 t 0 l 70 7 5 Additional inspection(I hr min) 66.25/hr
Phone:(4 0O) l q g/— r'f'S f( ,/ Fax:( ) Investigation(I hr min) 66.25/hr
Email: wi r,/S 5 t i( Fi C 1 V( Q h) • C 0 N1 Industrial plant(1 hr min) 78.18/hr
17 Inspections for which no fee is 90.00/hr
CCB Lic.: Electrical Lic.:Y8'57L Supry specifically listed Vs hr min
Suprv.Electrician signature,required: f Subtotal: 75"."54'
Print name: tf r K . ` o G s 5' + it Date: 5/a l !S ❑Plan Review Required(25%of permit fee):
1 State surcharge(12%of permit fee): 7.c. O
Authorized signature:
TOTAL PERMIT FEE: 8 y,Oci
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.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 04/21/2014 440-46151(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 gMiln
Desrriptiinn 1 Qty. Each Total •
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Chec ype of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
k! 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*
g p >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 over25 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 I
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/z hr min)
COMMENNITMIRIM ELECTRICAL PERMIT FEES
Subtotal(Enter on Page I):
Fee for each commercial system: $75.00 , Number of inspections allov.ed per permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
Ep Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El 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.doe Rev 04/21/2014
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
10330 SW SCHOLLS FERRY RD, TIGARD, OR,
97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00146
Jeff Grove
Violation Summary:
Inspector Contractor