Permit (3) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELR2019-00218
Date Issued: 12/17/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112AA00600
Jurisdiction: Tigard
Site address: 6713 SW BONITA RD 270
Project: Parr Lumber Subdivision: None Lot: None
Project Description: CCTV and security systems.
Contractor: ABSCO ALARMS INC Owner: ICON OWNER POOL 1 WEST LLC
PO BOX 2246 BY RYAN
LYNNWOOD,WA 98036 PO BOX 460169
HOUSTON, TX 77056
PHONE: 425-771-1166 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/17/2019 $150.00
12%State Surcharge-Electrical 12/17/2019 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
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: 1 Other: 0 Total $168.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a cog or direct questions to OUNC by calling 503.232.1987 or .332.2344.
haul@$...
Issued By: ✓ _r► ;ermittee 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.
^4c 37
Electrical Permit Application FOR OFFICE USE ONLY
Cityg ofTigard RECEIVED Received
DateB : / 1 riliIIII M i •
4 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
11 Phone: 503.718.2439 Fax: 503.598.196°DEC 17 2019 Date/B : Related Permit#:
Inspection Line: 503.639.4175 Ready Date/By: IMIE ® See Page 2 for
1 lGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
CITY OF TIGARD
TYPE OF w IALDING DIVISION PLAN REVIEW
0 New construction Vi_Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 1=1 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 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
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: I Job site address: (-'7 1 '3 4s . 3 J o .— - 2'77 100HP or more. ❑"A","E","1-2","l-3",
City/State/ZIP: /�,,/� ❑Six or more residential units. occupancy.
T fTIH f 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: 270 Project name: 1) f r WJ rlclolti I,yf/eAcij ❑Hazardous locations. ❑Supply voltage for more than
� / ❑Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: ,!-IN f00.1.0( PALO( FEE SCHEDULE
tDescription I Qty. I Each I Total I,.*
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'!500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
( (with above sq.ft.) 75.00 2
I `ST1� L{410A`�Fm 4 (ti� I' LI,s\4 7 1"�_ - Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER I TENANT Services or feeders installation,alteration,and/or relocation
Name: fat( r' 200 amps or less 100.70 2
r r 201 amps to 400 amps 133.56 2
(Q
Address: kL 'aFti fu .B 1vard 401 amps to 600 amps 200.34 2
City/State/ZIP: iiiii6 AGro O,...1 '7712!^t 601 amps to 1,000 amps 301.04 2
Phone:(3?2 3 )(ojq_257,0 I Fax:(3123)6 1—05-00 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
,APPLICANT I 0 CONTACT PERSON ': ' Branch circuits—new,alteration,or extension,per panel
iA.Fee for branch circuits with
Business name: t 6010.i.,'04,4, above service or feeder fee, 7 42 2
Ai �// each branch circuit
/l
Contact name: t a N Zewtot.e r B.Fee for branch circuits without
` ��e // service or feeder fee,first
Address:
6-W Nii M 4C5 A. 64106 ,1- is branch circuit 56.18 2
City/State/ZIP: , ver-Tiii 0 1 `YS Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(5'03 )if 7_T,^f gZ I Fax: :( ) Each manufactured or modular 67.84 2
p dwelling,service and/or feeder
Email: /I�-c , 2:040,e t1b O.' O V+io/16* Co)vi Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: tip5011A-10 bi•-.1J Sign or outline lighting �y� 67.84 2
Signapanellalteration,00rle extension.Address: ¢ J�"ee Page 2 f5o e. 2
V c��O � �I v�hl3vl S �-^�, �'I-`ate] °�=13 p
Each additional inspection over allowable in any of the above
City/State/ZIP: gbti C'?--- 9 7Additional inspection(1 hr min) ' 66.25/hr
Phone:(5b3) 5-05--_-7 3 k Fax:( ) Investigation(1 hr min) 90.00/hr
Email: _ I ,,.11 ^ ,w, II 11 S Industrial plant(1 hr min) 78.18/hr
N ATE •Z N Q- �S33�f7" I�t t (1) Inspections for which no fee is
CCB Lic.: 11110 Electrical Lic.: L 7p j Suprv.Lic.: 53 specifically listed('/2 hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signaa4,?Ic fired: : t ft) `"?4i
Subtotal: 15v,.:e..,
Print name: n1'. Date: ' 2_,2_1.10 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): t g, '
TOTAL PERMIT FEE: l
Authorized signature: (.4i‘V.--'
This permit application expires if a permit is not obtained within 180
Print name: , j hh 744 dl Date: /2_ ( —(Q * days after it has been accepted as complete.
r V ( 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:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each 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
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
n Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n H• eating, 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:
n Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr 1
Inspections for which no fee is 90.00/hr
specifically listed(%z hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
$75.00 Subtotal(Enter on Page 1):
Fee for each commercial system: * 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
❑ D• ata Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ M• edical
n Nurse Calls
n Outdoor Landscape Lighting*
Protective Signaling
a-Ciier: CC
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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