Permit 74 a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2009-00351
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/08/2009
Parcel: 2S102CB00300
Jurisdiction: Tigard
Site address: 13145 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Schucks Auto
Project Description: Install restricted energy to replace security system.
Owner: FEES
CHUNG, HENRY Description Date Amount
PO BOX 19063 Restricted Energy Permit 12/08/2009 $67.84
PHOENIX, AZ 85005 12% State Surcharge - Electrical 12/08/2009 $8.14
PHONE:
Contractor:
GLOBAL SECURITY INC
3212 MAIN ST
VANCOUVER, WA 98663
PHONE: 360 - 693 -1900
FAX: 360- 906 -9692
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: Y 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 Not Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 -0001 -0100. You may obtain a c pyyyoff rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: X �I X / LLJ Permittee Signature: . , J0
�l vu
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.
12/07/2009 MON 11:40 FAX 3609069692 Global Security 0002/003
4
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Electrical Permit lication 9'c IIV �p OFF, ,, o a.
Cit of Ti a ecetvui
Y g D / I P No.: f p 2oC j s O. 5) _ VD
" 13125 SW (tall Blvd., d T igard, OR 97223 DEC ® ¶ 2009 plan Review — 1 " L
I'ltonc: 503.639.4171 Pax: 503.598. ! 960
Date/13y: ' Other Permit:
Inspection Line: 503.639.4175 y p p� Date Ready /13y: s: El Sec Page 2 for
Internet: www.ligard oc'.gov CITY OF TIGARD Notified /Method: r, Supplemental Information
W
,PI OF f L LDING DIVISION PLANREVIEW Plcasc check all that appy(submit 2 scts of plans w /ilcros checked below):
New coast action ition/alteration/replacement
❑ Service or feeder 400 amps or mote ❑ Building over Once stories.
❑ Demolition ❑ Other: where the available faun current ❑ Marinas and boatyards.
CATS ORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess Io ground, or exceeds 14,000 ❑ Cnnunercial -use agricultural
❑ 1 - and 2- family (,welling Commercial /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.
300 SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A" "E", ••I 2" "1-3",
Job no.: Job site address: ) 31 L(� I_( [ ,0011110r mole. occupancy.
Std 5��� (� (7 W rJ ❑Six or more residential units. ❑ Recreational vehicle parks.
V
City /State /7111: (f; 2 ❑ 1icaitlt -taro facilities. 0 Supply voltage for more than
- - - - -- - -- ! son , [ '� � ❑ I Iara xlous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name:c e 1 /.',l,h � �x 1,4 � ❑ Selvicc or fccdcr 600 amps or more.
f c�1 FEE SCHEDULE
Cross street /directions t0 job Site: Description Qi 1 Fee. 1 ','elan ' '
New residential single- or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl. or less 168.54 4
Ea. add'l 500 sq. 11. or portion 33.92 I
Tax map /parcel no.: y_ Limited energy, residential
DESCRIPTION OF WORK (with above sq. a.) 67.84 2
Limited energy, multi- family
Jeavt �. /'f C M fie) tv A ( residential (with above sq. ft.) 67.84 2
C
Services or feeders installation, alteration, and /o relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ '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 /LIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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, rcpt, 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. Pct for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or fccdcr I'ce,
each branch circuit 7.42 2
Business name: 13. Fee for branch circuits
without service or fccdcr fee, 2
Contact name: lust branch circuit 56.18
Address: Each add'! branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or fccdcr 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 2
Business name:
Signal circuit(s) or limited-
b � . —_ -- energy panel, alteration, or h(/
Address: 12_ N`.A l n P 1 extension. Describe: Paget �� J� 1 2
City /State /ZIP: (,t 3 Each additional inspection over allowable in any of the above
Per inspection 66.25
/PCCB hone: (V )0 '' ` —16190 — Fax: ( ) y D6 9A2 Investigation per hour (I lir inin) 66.25
Lie.: 070,c Electrical Lic.:,6 c k Su Lic.: lc 12 LOy Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: f C `. ,1 y Subtotal: 6 -7,(( -(
w t Plan review (25% of permit fee):
Print name: I Jf ei'i. 1'fl( 1 Date: 12. - 0 7.. D(
State surcharge (12% of permit fee): R , icf
Authorized signature: )0 " TOTAL PERMIT FEE: - 7c. Rg
—
r — I{ -- -- _ This permit application expires if a permit is not obtained within 180
Print name: In 5,� IU Date: �2 - 3 - (7p days after it has been accepted as complete.
( tY � ° Number of inspections allowed per permit.
h\I 3ui1ding \PcuninVii.C- PcnnirApp.dm 10 , 140- n6I4f(1I /05.CON/W8a
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