Permit (38) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 a COMMUNITY DEVELOPMENT Permit#: ELR2016-00105
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/21/2016
T t c; �I<'.D9 Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9779 SW WASHINGTON SQUARE RD D11
Project: Champs Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: Security system.
Contractor: SIMPLE SECURITY Owner: PPR WASHINGTON SQUARE LLC
PO BOX 80577 PO BOX 847
PORTLAND, OR 97280 CARLSBAD, CA 92018
PHONE: 503-574-2254 PHONE:
FAX: 503-245-2998
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/21/2016 $75.00
12%State Surcharge-Electrical 04/21/2016 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
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: 1 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 throu���AR/952-00� may obtain a sppy�ef� or direct questions to OUNC by calling 503f� 987 or 1.800.332.2344.
Issued By: % ` -" 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 503.639.4176 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 OR Ott 1( ► t SI t 1v 1 ,
City of Tigard Date/By:Received 1 a 1 / , Permit#: -61-49-010/(0"—a310
13125 SW Hall Blvd.,Tigard,OR 972 . Plan Review
'� . ' Phone: 503.718.2439 Fax: 503.598.1 ;) Date/By: Related Permit#: flr' b620/(1)—.01(1.)31/
(1)3
Inspection Line: 503.639.4175 Q16 Ready Date/By: loris: See Page 2 for
I(' l Internet: www.tigard-or.gov
Notified/Method: ., Supplemental Information
TYPE OP WORK r,cA‘Cit► Ire» vv - - .
❑New construction la Addition/alteration/retVi NS Please check all that apply(submit 2 sets of plans w/items checked):
'�/' SA)1 0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: 4where the available fault current 0 Marinas and boatyards.
r0400itt + CQ .VMexceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 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.
0 Multi-family ❑Master builder ❑Other: ['Fire pump. 0 Installation of 150 KVA or
l OCATION 0 Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address.:
w 45i,,t CJ g-2 100HP or more. ❑"A,,,..E,,•.l_2",..l_3..,
City/State/ZIP: '('` 0Z p (r ['Six or more residential units. occupancy.
0
'ay.,/ 0Health-care facilities. Recreational vehicle parks.
r Z
Suite/bldg./apt.#: 'A 11 Project name: C ,AM 0 Hazardous locations. ❑Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 1 k 1/"`p Nta C by cC��s FEE SCHEDULE
- Description I Q(v. I Each I Total 1
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.add'l 500 sq.ft.or portion 33.92 1
,__ SCR O4 OE WORK Limited energy,residential
75.00 2
/ !y (with above sq.ft.)
C(-)P. i(ficJ am/ r 1-& �� Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
- P1tOPER7"3 • , 1 Q'TENANT. Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
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
401 to 599 amps signature: Date: amps 168.54 2
Q APPT ito ',, 0 CONTACT PERSON
Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name: above service or feeder fee,
each branch circuit 7.42 2
Contact o tact name:
B.Fee for branch circuits k ithout
service or feeder fee,first 56.18 2
AAddress: branch circuit
City/State/ZIP:
Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included) j
Phone:( ) Fax: :( ) Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: s1 N^ _) / Ec. �1Ty 1/Vv
r Sign or outline lighting 67.84 2
Tic)x��x � / Signal circuit(s)or limited-energy g_See Page 2 -75-�
2
Address: J panel,alteration,or extension.
City/State/ZIP: c Each additional inspection over allowable in any of the above
Y ra'Y -CQit.� t:►7� 7 Ze 0 Additional inspection(1 hr min) 66.25/hr
Phone:(5(J'2) ) 15 7.Li- ZZ 5 Ei Fax:( ) Investigation(1 hr min) 90.00/hr
Email: Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: I c 70 / I Electrical Lic.:311-602) CLE Suprv. Lic.: '7-14' L'A' specifically listed('G hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: '" Subtotal: 75/
Print name: Lf N EN!1/i)V Date: I Arey, Zo i(!J 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): q
J
Authorized si nature: TOTAL PERMIT FEE: #e�_
g
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 06 172015 440-4615T(11'05 COM WEB
1
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
f r,,�... �:u?,*vr ..0 � �,t'?TI'� .Ciix P .,..d..ter.i r. YSte,w•._.irti�r .',.x�.'u.L1 xr..r. �jx
Fee for all residential systems combined: $75.00 Description Qty. �" Each Total I
3' 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 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
specifically listed(1/2 hr min)
c01'1 t etAx- ONLY: C R CAL, RMIT t�EE
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per pennit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ N• urse Calls
❑ O• utdoor Landscape Lighting*
❑ Protective Signaling
Other: j "r C C.
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
L Building Permits ELC PermitAppELR_FRF doc Rer(le 17 2015
I
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
9779 SW WASHINGTON SQUARE RD D11,
TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00105
Jeff Grove
Violation Summary:
Inspector Contractor