Permit IN - �� OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT
Permit #: ELR2009-00344
T f C A R)? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/18/2009
Parcel: 1 S 135 BC00700
Jurisdiction: Tigard
Site address: 10831 SW CASCADE AVE
Subdivision: Lot: 0
Project: Comcast
Project Description: Install restricted energy for access control.
FEES
Owner:
CH REALTY III /PORTLAND INDUSTRIA Description Date Amount
BY THOMSON PROFESSIONAL & Restricted Energy Permit 11/18/2009 $67.84
REGULATOR, CONTROLLING OWNER OF 12% State Surcharge - Electrical 11/18/2009 $8.14
PHONE:
Contractor:
ENTRANCE CONTROLS, INC
1923 E 5TH ST SUITE D
VANCOUVER, WA 98661
PHONE: 503 - 283 -2533
FAX: 360 - 256 -4939
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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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: J __f 2i \ .. CU.j( J cAilJ ' Q `L ' 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: / /_, 1 _ c.)-7
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 Applicati4RECEIVED FOR OFFICE USE ONLY .
City of Tigard NOV 1 S 2009 Received
DateB : . .J permit No.: e • • S. •l ■ /
IIII " 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
.
Phone: 503.639.4171 Fax: 503.598 156 OF TIGARD Date/By: Other Permit:
Inspection Line: 503.639.4175 1 Date Ready/By: See Page 2 for
TIGARD g g BU ILDING DIVISION No tified/Method: C Supplemental Information
Internet: vvww.ti azd -or. ov \"?
TYPE OF WORK PLAN REVIEW
❑ New construction irl. 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 Cotnmercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ",
1OOHP or more. occupancy.
Job no.: Job site address: /dgr3/ l s4�. 4,, ❑ Six or more residential units. 0 Recreational vehicle parks.
ID Health-care facilities. ❑ Supply voltage for more than
City /State /ZIP: � � 4 O ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more
� /'" •; f t• ;e �''^ g' FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total l •
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 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
/ c -f i . �� ` /
Limited energy, multi - family 67.84 2
`7YC residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER Da' TENANT 201 amps to 400 amps 133.56 2
Name: /` 401 amps to 600 amps 200.34 2
C .O/• •Cut s° 601 amps to 1,000 amps 301.04 2
Address: /612 3i
6;.s- Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP:
4 - i .._,/ OK. relocation
Phone: ( ) 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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT l . CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: _Li«• -.mac i-�'b I S B. Fee for branch circuits
( without service or feeder fee, 56.18 2
Contact name: CV`,.- /(.�jl first branch circuit
Address: /9, 3 q s f si_- Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: . o /yd e,/4 9f•6 / Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (5-t,) )) 0 . s 33 Fax: : (7 60) t '/ - 37 Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
• Signal circuit(s) or limited -
Business name: r ( w 6,,..... JS energy panel, alteration, or ( Address: // 3 z S �' 5.4_. extension. Describe: l Page 2 67 e • 2
City/State/ZIP: 9/66' Each additional inspection over allowable in any of the above
ty «" '�� Per inspection 66.25
Phone: (3 ) ..2,3 3) Fax: (3Gc) ) 4 — 1/7 . ?T Investigation per hour (1 hr min) 66.25
CCB Lic.:/-2/4,5- Electrical ���
Elical Lic.: ,� / 0 Suprv. Lic.: 7/ j ��'` Industrial plant per hour 78.18
� ELECTRICAL PERMIT FE J
Suprv. Electrician signature, required: .14,. Sr .„( Subtotal: • �d 1
Plan review (25% of permit fee):
Print name: >,. � 6t�\ S •f Date: 1/....- �' /7—di State surcharge (12 °/n of permit fee): if,
Authorized signature: TOTAL PERMIT FEE: 75
This permit application expires if a permit is not obtained within 180
i pri^t name: I Date: 1 days after it has been accepted as complete.
1 • Number of inspections allowed per permit.
t\ Building ∎Permits\ELC- PermitApp.doc 10/01 /09 440- 4615T(11 /05 /COM/WEB