Permit (46) q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2016-00016
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/01/2016
Parcel: 2S 101 DC05000
Jurisdiction: Tigard
Site address: 13410 SW 76TH AVE
Project: ALBERTINA KERR CENTERS Subdivision: PACIFIC RIDGE Lot: 2
Project Description: Fire alarm and access control systems.
Contractor: METRO ACCESS CONTROL Owner: ALBERTINA KERR CENTERS
2525 NE COLUMBIA BLVD ATTN: JERALD A HOFFERT
PORTLAND, OR 97211 424 NE 22ND
PORTLAND, OR 97232
PHONE: 503-258-7568 PHONE:
FAX: 503-285-1793
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/01/2016 $150.00
Type of Use: COM 12%State Surcharge-Electrical 02/01/2016 $18.00
Class of Work: ALT
Total Number of Systems: 2
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 1
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 copy direct questions to OUNC by calling 503.232.1987 or 1.800.333/2.22344.
Issued By: Permit ee ' ature: iC
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.
I
10
Electrical Permit Applica
City of TigardO�U Received
Date/By� 7 Permit No.:
0 P
13125 SW Hall Blvd.,Tigard,OR 9722k C- Plan Review
r Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 #A 11 Date/By: t
11� V "1 1!ko"I N, - JuT. - mloo
Inspection Line: 503.639.4175 "S Date Ready/By: JUTIS: 0 see Page 2 for
X Notified/Method: Supplemental information
Internet: www.tigard-or.gov �Ak I I
MIA
a,
❑ New construction-. �ddition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps Or more ❑Building over three stories.
F-1 Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
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 cErCommercial/industrial ❑Accessory building amps for all other installations. buildings.
E] Multi-family Ej Master builder E]Other: 0 Fire pump. El Installation of 150 KVA or
_ ,"l-,, 11 , [I Emergency system. larger separately derived syste
4m.
4*9m, OWN j" , ,
'a,,,
❑Addition of new motor load of [1A",E,"I-2' "1-Y
I OOHP or more. occupancy.
Job no.: Job site address: 1311 0 5 W 7`7-4 A Vi?- C)Six or more residential units. 0 Recreational vehicle parks.
0 Health-care facilities. 0 Supply voltage for more than
City/State/ZIP: 7-j Y a-VX -0 �'7 2- 0 Hazardous locations. 600 volts nominal.
0 Service or feeder 600 amps or more.
Suite/bldg./apt.no.: Project name: 7-1. 7- h 4,&
Cross street/directions to job site: LYS 5f
,7Description I Qty. I Fee. I Total I
Piv FiV. ;7- New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential 75.00 2
(with above sq.fi.)
Limited energy,multi-family 75.00 2
.Z,*)5 7-4 1- /ZIx residential(with above sq.ft.) I I
Renewable Energy 0 See Page 2
U A- Services or feeders installation, Iteration,and/or relocation
-0 �MAW 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: be,,,,,r1 Ay 1(,fk,, Ce.-;,re-A� 401 amps to 600 amps 200.34 2
Address: '12 1/ /V E7 .22 4 Ve 601 amps to 1,000 amps 301.04 1
Over 1,000 amps or volts 552.26 2
City/State/ZIP: f--Y r Z-&A-4 A 2. Temporary services or feeders installation,alteration,and/or
Phone:(fo)) 2_ 3 Fax: relocation
Y/01 200 amps or less 59.36 1
Owner installation:This installation is being made on property that I 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,p r panel
AWLACANT A.Fee for branch circuits with
above service or feeder fee,
Business name: each branch circuit 7.42 2
/�57e.- 466--�5 6 B.Fee for branch circuits without
Contact name: ,T-oh hk n-c e-i es- service or feeder fee,first 56.18 2
1 branch circuit
Address: 2- 5 IVE (fo Each add']branch circuit 7.42 2
City/State/ZIP: P41r7l—ald Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone: (f03 ) 3"� 6171 Fax: 5b3 ) 2,91- 17 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: J /*
Pump or irrigation circle 67.84 2
CON"U"W Sign or outline lighting 67.84 2
Business name: Signal circuit(s)or limited-energy See
/�5 1-VO panel,alteration,or extension. 47, Page 2 1 2
Address: Z S .2- 5- Each additional inspection over allowable in any f the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: Investigation(I hr min) 66.25/hr
Fax:(fo3 2 Y5- 17 f,? Industrial plant(I hr min) 78.18/hr
Phone:(503) .5 V 71e I - Inspections for which no fee is 90.00/hr
CCB Lic.: L/6 0 Electrical -
Lic.:4 /F7 specifically listed(
_%_ ?44Suprv. Lic.: IL F,4 '/2 hr min)
Suprv. Electrician signature,required: I"
KCAL-PROM WS
F
K Subtotal:
Print name: Plan review(25%of permit fee):
, 11 Y _[Date: State surcharge(12%of permit fee):
V1Authorized signature: TOTAL PERMIT FEF-
application expires if a permit is not obtained within 180
Print me: —FDat,. j� This permit- .2 3 days after it has been accepted as complete.
Number of inspections allowed per permit,
1:Building Permits GLC_PermnApp_ELR_ERE.doc lkec 05 21 2013 4404615T(I 1,05%COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RFSI UXUAL WOWONLY.-
Fee for all residential systems combined........ $75.00 Description Qtv. I Fee I Total
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
❑ Burglar Alarm Wind generation systems in excess of 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 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
❑ � /7 /L yam% ����f ���I TVOtr Each additional inspection over allowable in an of the above:
Other: l � Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed('/:hr min)
CUAIIIW WL** . (lRKI'NLY. EUCTRWAL PERMIT FEES
Fee for each commercial system....................... $75.00 12- Subtotal:
(SEE OAR 918-309-0000) 3 1, 15 Plan review,if required(25%of permit fee):
J C State surcharge(12%of permit fee):
Check Type of Work Involved: 2 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 inspections allowed per permit.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
NFire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other /a 6C e SS
Total number of commercial systems: 2
*No licenses are required. Licenses are required
for all other installations
L Building Pn snits ELC Pe itApp ELR ERE.doc Rn05.212013