Permit (25) 14 _ CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00202
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/03/2009
TICaARD' Parcel: 2S113AB01400
Jurisdiction: TIGARD
Site address: 7358 SW DURHAM RD
Subdivision: Lot: 0
Project: Coram
Project Description: Connect duct detector to existing panel.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 08/03/2009 $75.00
#300 12% State Surcharge - Electrical 08/03/2009 $9.00
PHONE:
Contractor:
STANLEY SECURITY
15495 SW SEQUOIA PKWY #100
PORTLAND, OR 97224
PHONE: 503 - 968 -3353
FAX: 503 - 968 -3398
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: y
HVAC: N Instrumentation: N Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 L Notification nter. Those rules are set forth in OAR
952- 001 -0010 throu.1 1 VC OAR 952-0k1:0100. 100. t �� Signature: A N/ You may obtain a copy of the rules or direct questions to OUNC by calling 503.(46 699 or 1.800 332 2344.
By: Issued B : ` I Permittee Si nature: c -Q)a,L� -j -" °�� � �
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 an inspection that business day.
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 R �j CE i I D' - FOR OFFICE USE ONLY •
City of Tigard A� Date /Bed y' -L �^ i
•1 4 No.: ?a' `�'�/11)ci .0( 2+ Z
q IIIII 13125 SW Hall Blvd., Tigard, OR 97223 1 Li L 2 4 2009 Plan Review
- r� / i ,
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit `z t'v �Ql9 �j
T l GARD
Inspection Line: 503.639.4175 Date Read y/B a furls: See Page 2 for
Internet: www.tigard - or.gov CITY OF TI A,Ro., Notified/Method: 7 1 Supplemental Information
,D11`.G D.
TYPE OF W PLAN- REVIEW'
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF "CONSTRUCTION • 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 Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
- JOB sn ' INFORMATION AN - LOCATION ❑ Emergency system. larger separately derived system.
_ , , ❑ Addition of new motor load of ❑ "A ", "E ", "t -2 ", "1 -3 ",
Job no.: Job site address: 13s1 10R. t v Z.D 100HP or more. occupancy.
❑
0 Six or more residential units. Recreational vehicle parks.
City/State /ZIP: PR) ( N 0 22-1A ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Q t ? m ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
A1 N S 1 b � Limited energy, multi-family 75.00 2
k J \ \�� �� `,. residential (with above sq. ft.)
kr Services or feeders installation, alteration, and/or relocation
�(� � �K/i V �� ' 200 amps or less 80.30 2
* PROPERTY OWNER ' _ - - ❑' TENANT - .. • 201 amps to 400 amps 106.85 2
Name: (' _ 1 (-� �1 401 amps to 600 amps 160.60 2
P ^ �' VA u �`-�� \ �� 1 601 amps to 1,000 amps 240.60 2
Address: \ 21c So. s VO \ p p�g \ 7 Over 1,000 amps or volts 454.65 2
City/State /ZIP: E' Q.3 tiD , ez ��Q� Temporary services or feeders installation, alteration, and/or
relocation
Phone: ()1) (1)Z Fax: a5 r) - 755 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
' APPLICANT ❑ CONTACT PERSON:' . - above service or feeder fee, 6.65 2
�� 12,� 5 �v h am` , t � ^ Fee branch branch circuit
Business name: - / ..J�'L.�✓�lAv> B. Fee for branch circuits
Contact name: C=��� '13/11.)' � first bran crvi r or feeder fee, 46.85 2
first branch circuit
Address: ( 154x5 Sup '3. 00 ( to ( - -f �b...)1;\-) Each add'l branch circuit 6.65 2
City/State/ZIP: l ��i� 1 Q 1
Miscellaneous (service or feeder not included) 90.90 2
�.J
Phone:
Ci Each sc manufactured o
factured or modular
(Q - 55 Fax: ( ` ^ 3 dwelling, service and /or feeder
(� '� t Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR ' . Sign or outline lighting 53.40 2
Business name: S 1 1�1 C S Z�}} - , Signal panel, or limited -
1�. - r vi S��U��C energy panel, alteration, or
Address: \ 54c6 5u) ; .) o LP) r z rait)t)tQ ` extension. Describe: 1 Page 2 2
City/State /ZIP: 1 ���� cQ R722.4 Each additional inspection over allowable in any of the above
3 A � c Fax: 1 3 c �� 7 �c1
--- Per Investigation 62.50
Phone: ` (''il s (�l'V gattion ion per hour (1 hr min) 62.50
CCB Lie.: I =�., E lectrical Lie.: ` Suprv. Lic.: Industrial plant per hour 73.75
5G 7 3 ?'1GS�(c p
Su _ ELECTRICAL. PERMIT FEES.'.:.._, - .
Suprv. Electrician signature, required�c . Subtotal:
0
Print name: "` f /� n G , p „ o j V 7 Plan review (25% of permit fee):
, � ` ,/ � � ,� Date: I �) 1 y State surcharge (12% of permit fee): rs,
Authorized signature: ��`�"' ` ;�_ A FL Uuc cti/L_� TOTAL PERMIT FEE: � Lt. 0
14 , (you �E a ,� Date: This permit application expires if a permit is not obtained within 180
Print name:
S t ` ( . r tU q�L 00.__� / 1 "C'j days after it has been accepted as complete.
* Number of Inspections allowed per permit.
1 \Building\Permits\ELC- PermitApp doc 05/23/06 440- 4615T(11/05/COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK;ONLY: •
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
'COMMERCIAL WORK ONLY: -
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
Fire Alarm Installation C,6141LQT DlZ2 1L7L.UCUC„
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Building \Permits\ELC - PermitApp doc 03/23/06