Permit (58) CITY OF TIGARD7
ELECTRICAL RESTRICTED ENERGY PERMIT
' 1 . ' COMMUNITY DEVELOPMENT Permit#: ELR2019-00124
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/02/2019
T t G;1 R t3 g Parcel: 1 S136DC03200
Jurisdiction: Tigard
Site address: 11740 SW 72ND AVE
Project: 72nd Avenue Apartments Subdivision: 72ND AVE APARTMENTS Lot: 8
Project Description: Limited energy for data telecommunications,fire alarm installation,and protective signaling.
Contractor: DYNAMIC SERVICE FIRE SECURITY LLC Owner: 72ND AVENUE PROPERTY LLC
1041 FABRY RD SE BY CASSINELLI, RICHARD
SALEM, OR 97306 11720 SW 72ND AVE
TIGARD, OR 97223
PHONE: 503-302-7122 PHONE: 503-545-5217
FAX: 503-990-7222
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/02/2019 $225.00
12%State Surcharge-Electrical 07/02/2019 $27.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio&Stereo: Boiler Controls:
CCTV: Clock Systems:
Data&Telecommunications: Fire Alarm:
HVAC: Instrumentation:
Intercom/Paging: Landscape/Irrigation:
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: Other: Total $252.00
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 C nter. Those rules are set forth in OAR
952-001-0010 through OAR 9 001-0090. You =y obtain a copy of the rules or direct questions to OUNC by calling 50 .1987 or 1.800. .2
Issued By: �e%��16� / Permittee Signature: --.".../ ' !ia_... "Nigeo.
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 1 o►z oi i R i. I ,i o y►.l
City of Tigard Received
_ora�/�
i 13125 SW Hall Blvd.,Tigard,OR 97223 J U L sy 2�S if Plan RDate/Beview ��
Phone: 503.718.2439 Date/B : F�'%y /
Email: TigardBuildingPennits@Tigard-or.gov ;-Ready Date/By: Juris: ® See Page 2 fo
I I G A K D Inspection Line: 503.639.4175 Internet: wW)v tigard-or gav .tified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
r
w construction ❑Other:on/alteration/replacementPlease check all that apply(submit a sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
molition ❑Outer: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
0 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
'M slti-family ❑Master builder D Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
1...:61
..�'� � /j kJ 7 4 ❑Addition of new motor load of system.
Job#: Job site address: Tt� /1 ye , 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: / o%Q r-( /4 % .Z2 0 Six or more residential units. occupancy.
Health-care facilities. 0 parks.
Suite/bldg./apt.#: Project name: $.....
JRecreational vehicle 0 Hazardous locations. 0 Supply voltage for more than
7� � /04/4,,,,/ ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. 1 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'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY/ OWNER /� 0 TENANT Services or feeders installation,alteration,and/or relocation
Name: 7 e Ill?!41 j1 nil L-� p i ,J/ 4-1-C, 200 amps or less 100.70 2
Address: 4 g 0 �f_,4,,f.�*s / / ,_.�/ ` /�/� 201 amps to 400 amps 133.56 2
Jt/ �te� r6 r/��'1 Q/ 401 amps to 600 amps 200.34 2
City/State/ZIP: fir,.I/ztn`* , OA 97227 601 amps to 1,000 amps 301.04 2
Phone:( ) 7 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,per panel
❑ APPLICANT ❑ CONTACT PERSON
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first
Address: branch circuit 56.18 2
City/State/ZIP: Each add'I branch circuit 7.42 _ 2
Miscellaneous(service or feeder not included)
Phone:( ) Each manufactured or modular 67.84 2
Email:
dwelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: di
or outline lighting r 67.84 ' 2
F •S Signal circuit(s)or limited-energy ,,,/��Page 2 2
Address: /�/�!, �, ��.,.;� �, panel,alteration,or extension. �
City/State/ZIP:`saj nt /7306 Each additional inspection over allowable in any of the above
��11 Additional inspection(1 hr min) 66.25/hr
Phone: ,��) ' /„- 15 ,L-1.5 A?- We-t2.92
Investigation(1 hr min) 90.00/hr
/ Industrial plant(1 hr min) 78.18/hr
Email: it jel-4_1a I_#f3C,, . c�,,,7 loz 7�
.�// '�/ Inspections for which no fee is
CCB Lic.:/4 / 5 9 q— Electrical Lic.:CL /I,/ Suprv.Lic.:/ S�� specifically listed(Y�hr min) 90.00/hr
/� / ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: /� 7� Subtotal:
Print name: /(217‘24—/ l ,,2 `0"�� L Date: / 0 Plan Review Required(25%of permit fee):
(/V /�� / State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
IMIDr FEE SCHEDULE _ _.
#. .Tltil! �X,� l�i�'ONL : Description.... I Qb. I Each Total I *
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
n 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
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 over 25 7.42 3
n Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n 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(/2 hr min)
OMMERCIAL WORK ONLY .
tilienticAL PERMIT FEES
Subtotal(Enter on Page 1).
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
ata Telecommunication Installation
ire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
protective Signaling
❑ Other:
Total number of commercial systems:,3
*No licenses are required. Licenses are required for all
other installations
1:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 10/26/2017