Permit u CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
! £ ° COMMUNITY DEVELOPMENT Permit#: ELR2016-00042
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2016
Parcel: 25101 DD00701
Jurisdiction: Tigard
Site address: 6960 SW SANDBURG ST
Project: Tigard Tualatin School District Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: CCTV system.
Contractor: A& E SECURITY&ELECTRONICS SOLUTIONS Owner: TIGARD-TUALATIN SCHOOL
PO BOX 179 DISTRICT 23J
MCMINNVILLE, OR 97128-0179 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-883-4139 PHONE:
FAX: 503-883-7664
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/03/2016 $75.00
12%State Surcharge-Electrical 03/03/2016 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 1 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 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 of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ � Permittee Signature:LIP
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 °'s1 ® Received FOR OFFl( I. [SF OyI.v
City of Tigard Date%B : LIM Permit#: g420t , ,
"hi' 13125 SW Hall Blvd.,Tigard,OR % Plan Revie
Phone: 503.718.2439 Fax: 50 s' �� DateiB Related Pennit#:
Inspection Line: 503.639.4175 `�n. ��Gl3 Ready Date%By: ® See Page 2 for
T It., \P I Internet: www.tigard-or.gov Wo V �� �,.NON Notified Method: Supplemental Information
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❑New construction ®Addition/alteratio 'a,1 -meat Please check all that apply(submit 2 sets of plans w/items checked):
❑ Demolition ❑Other:
0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current ❑Marinas and boatyards.
,',ATE N 4.`' ! exceeds 10.000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14.000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
S ttii'; .. ❑Emergency system. larger separately derived
❑Addition
Job#: Job site address:6960 SW Sandburg 100HP St Hof new motor load of system.
or more. ❑"A" "E" "I-2"-"I-�"
Ci /State/ZiP: Tualatin OR 97223 0 Six or more residential units. occupancy.
tY
❑Health-care facilities. ❑Recreational vehicle parks.
❑Supply voltage for
more thanSuite/bldg./apt.#: Project name: T!UJ0JTiAtii((-k,v (.01jt ❑Hazardous locations. 600 volts nominal.
0 Service or feeder 600 amps or more.
Cross street/directions to job site:
Description I Qty. I Each 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.addl
ena0 sq ft or gy,residents portion2 1
75.00
(with above sq.ft.)
Low Voltage-Camera
Limited energy,multi-family 75.00 2
residential(with above sq.fl.)
�, {� Renewable Energy ❑ See Page 2
...., %!d ii.., m,,,,, ,..:, ;.3'.Y ,..- Al' � �:-, C
a � ` ' t -'; Services or feeders installation,alteration,and/or relocation
Name:Tualatin School District 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 signature: Date: 401 amps to 599 amps 168.54 2
1
t .Al ' cl l , P. CONTACT.">f 1PEN Branch circuits—new,alteration,or extension,per panel
�'` A.Fee for branch circuits with
Business name: A&E Security above service or feeder fee,
7.42 2
each branch circuit
Contact name: Doug Elsberry B.Fee for branch circuits without
Address:PO Box 179 service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: McMinnville,OR 97128 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)883-4135 Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:delsberry@4security.org Reconnect only 67.84 2
CONTRACTOR = Pump or irrigation circle 67.84 2
Business name: A&E Security Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ® See Page 2 75.00 2
Address: PO Box 179 panel,alteration,or extension.
City/State/ZIP: McMinnville,OR 97128 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)883-4135 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: delsberry@4security.Org inspections for which no fee is 90.00/hr
CCB Lic.: 65198 Electrical Lic.: Suprv. Lic.: specifically listed( 'G hr min)
- IME CA PERNI f it FEE.,
Suprv. Electrician signature,required: Subtotal: 75.00
C
Print name: Michael Elsber1 I Date: 2/24/2016 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9.00
Authorized signature: ""'1 TOTAL PERMIT FEE: 84.00
C / This permit application expires if a permit is not obtained within 180
Print name: Michael Elsberry Date: 2/24/2016 days after it has been accepted as complete.
* Number of inspections allowed per permit.
Building Permits ELC PermitAppELR_ERE.doc Rev 0617 2015 440-4615TO 1 05 COM WEB
Electrical Permit Application—City of Tigard
Page 2-'Supplemental Information
4•r
Limited Energy Permit Fees: Renewable Energy Permit Fees:
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Description Qty. Each I Total +
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
ElAudio 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)
El Heating, Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El 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
specifically listed('h hr min)
�
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Co R RK I' :. r,. t,l� , (Enter
a ambit*PIIS
Fee for each commercial system: $75.00 Subtotal(Enteron Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
El Clock Systems
El Data Telecommunication Installation
n Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
® Other: Cameras / (C J
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
I:Building Permits ELC_PermitAppELR_ERE.doe Res 06 17 2015