Permit Electrical Permit Application bolt OFFICE USE ONLY
City of Tigard Received
DateB : I Permit No.: 0 4 11 . qi • 00 1
13125 SW Hall Blvd., Tigard, OR 9 �Pj� Plan Review
Phone: 503.639.4171 Fax: 503.59 IV ED
Date/B Other Permit:
I I G A It D Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard or.gov J AN 0 5 2010 Notified/Method: IME Supplemental Information
TYPE OF WORK T PLAN REVIEW
❑ New construction 4Addition/altetQMi t ct . Please check all that apply (submit 2 sets of plans w /items checked below):
ID Demolition El Other:
B UILDING D ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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 SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Wk- SCH 4 Job site address: 1'(5C' 3 SbJ ----7-2.)-..1 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: - T - 1, 36y - d DR q-7 - DD .t., ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no. : I Project name: Sa..Cec, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description P I Qtr. 1 Fee. 1 Total I"
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy, multi - family
/ tt ( r r res idential wi 67.84 2
IAA 1:0/ �1L d e� p pk-4 t I ( th above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
—
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 168.54 2
Branch circuits— new, alteration, or extension, , er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 56.18 2
Address: Each adc'I branch circuit 7.42 1 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 12
Business name: Signal circuit(s) or limited -
Cu f l OrL�.4 p energy panel, alteration, or
Address: zbb_I s, J R. 1S extension. Describe: Page 2 5511 2
City/State/ZIP:eave,H b e "O Each additional inspection over allowable in any of the above
1`5 �) ( _i q Fax: b I' Per inspection 66.25
Phone:
�I I� �S� �� t�� Investigation per hour (t hr min) 66.25
CCB Lic.: IM-,14_ I Electrical Lic.: ,2/ 4gxat Suprv. Lic.: 31(1 LE p Industrial plant per hour _ 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: (o `- ; ,j4
•
Print name: _ S *: Date: ��—a Plan review (25% of permit fee): —
�� — State surcharge (12% of permit fee): 1 ��
Authorized signature: TOTAL PERMIT FEE: % b
Print name: Date: This p ermit application expires if a permit is not obtained within 180 '4
days after it has been accepted as complete.
" Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermilApp. 10 /01/09 440 4615T(1 /05 /COM/WEB
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2010-00001
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/07/2010
Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16505 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Safeco
Project Description: Install restricted energy for access control.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 01/07/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 01/07/2010 $8.14
PHONE: 503-624-6300
Contractor:
ARONSON SECURITY GROUP
8089 SW CIRRUS DR
BEAVERTON, OR 97008
PHONE: 503-639-9988
FAX: 503-684-4357
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: N
HVAC: N Instrumentation: N Total $75.98
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: Y
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 Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 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 603.639.4176 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.