Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00362
T,t GARL? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/18/2009
Parcel: 1 S 135BA02800
Jurisdiction: Tigard
Site address: 10380 SW CASCADE AVE
Subdivision: Lot: 0
Project: Beaverton Motorcycles
Project Description: Install restricted energy for CCTV.
FEES
Owner:
LANPHERE ENTERPRISES INC Description Date Amount
12520 SW CANYON RD Restricted Energy Permit 12/18/2009 $67.84
BEAVERTON, OR 97005 12% State Surcharge - Electrical 12/18/2009 $8.14
PHONE:
Contractor:
DYNASTY SECURITY & COMMUNICATIONS
LLC
4420 SW 110TH AVE
PHONE: 503 - 808 -9010
FAX: 503 - 808 -9018
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: Y 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: 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 Notification Center. Those rules are set forth in OAR
952 - 001 -0010 th oug 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: Perm ittee 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' Q 1
AoP Date:
LICENSE NO.
CaII 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.
-i
' Dec.. 17 2009 11: 42RM HP LRRI D p. 2
EleetricaLPermit Application ` y = : 3 S t
�P DEC 17 200 4 I-, - * �... _. 1 .tit ., r'- 4 „. • f.,,
W 4 . City of Tigard rtoceived Pet No.:
C I TY OF TIGAR Pl Review ¢ 1 I 127 Q noi G 022
13123 Hell Blvd., Tigard, OR 97223 mu
•. r. ~ Phone; 503.639.4171 Fax: 503.598.19 r D ° '�� other Per nit
1 �^ Ins pecGonLine: 503 ,63 9.4175 �U ILDING IVISICI',ai Rea : . ® See Page 2fbr
• Internet: www.tlgard- or.gov Notified/Method: Jr. I G Supplemental Information
1� 1 I�(IIIIIj��p��I ,r rnr�.t iij}Jf a� q ��� k j � r �m�p ar�� F I
!�',ttlr!1,t i. 0!Li411" �. 1i� :t Stn�,r�o�Ktu4lYleiitP� �xh`vZtt +tt'l�"�I� I , 1..i G/q! . a 'y'Ij114 4 m .' u` . wiai • It�RA.tl,4,:'E '1�u iL?e'fi���l�iili r u liinr . +1 q ..{
❑ New construction Me Additionlalteration /replacement Please check all that apply (submit 3 it of plane w/items checked below).
❑ Demolition ❑O ther: ❑ Service or feeder 400 amps or more 0 Building over three stories.
p! `pI �� where the available Sulk current ❑ Marinas and boat ards.
U Ir�flsll'
';1, `11I11q�� ` '' 1 m cr -f • , 3 0 • z�a f t, Ip J i1 I f i'4 :� encode 10 amps at 150 volt or
. ,r} .: ii PISI si ) 1 il INd�lfrl?�` t > 1��tm�li qq � i.' > d 1l� +' C tI'ir )I � �af� ❑FloatioQbuildings.
less to ground, or exceeds 14,000 ❑ Cammercial•uee agricultural
❑ 1- and 2-family dwelling M /industrial ❑ Accessory building amps fbr all other taetailatlons. buildings.
❑ Multi famll ❑ Master builder ❑ Other: ❑ Pire pump, ❑ rnetallatfor. of 75 KVA or
r f l
� ' , m Ww! r�t�� r�{+n p aemp,. a]p y ,, y� El Emergency system, Ur r se aratel derived s stem.
1 ,' i I1 s I :i�e1,,Bi tl : 1 1�p C "riAYfw� t a ' e7' +V -4 tif9) E ur L I i 1 E AFL!: ❑ " A .: .. 2. Y
I t s � �u � ❑ Addition of now motor load of
Job no Job site address: y � � • 100HP or more. occupancy.
�[t- .� � I er 7 r • Al ❑ Six or more residential unite. ❑ Recreational vehicle parka.
City /State /ZIP: r 4 r 1 . • 2.2Z ❑ Haalth.care 1ieilitier. ❑Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Projcct name: * , , �� Service � artteeder 600 amps ��or��more, �d
r. f lest _ ,�. ' alli''��1�f�rll t a + �k'� iii 1 ;4 i::,i l�.t i l 4 4 I''i4r, n r 1 11 ?
Cross street /directions to job site: a, ,l
12v I rite Tent -
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Tess i 168.54 4
Ea, ndd'1500 sq. ft. or portion 1 33.92 1
fax map/parcel no,: ��p } � .
t�11 11 'iii 1 Ise p I Limited energy, residential
la � 1 l h I q) >,, Alin,il h � Il! IS Ilmtinr5' tr ,`4v�,lh ��iiGMJ� � d.m ,i. ' ! �.I I I In �( ; /9tr�'�i,'� I (with above sq. R.) 67,84 2
Limited energy, multi- family 67.84 1
residential (with above eq. ft.)
Services or feeder! Installation, alteration, and/or relocation
i t� ` #ii gq ��� y . 161. � > (� 200 amps or less 1 100.70 2
I!t"r: �, �?�II6 J Tin a� 'N t l k. �'i011i>;g11llt€ 'il j31i6111iia] 1 201 amps to 400 amps 1 133,:6 2 ,
Name: 401 amps to 600 amps 1 20034 2
601 amps to 1,000 amps 1 301 04 2
Address: Over 1,000 amps or volts' 1 552.26 I 1 2 •
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation _
Phone: ( ) Fax: ( ) 200 amps or less 1 59.36 1 1
Owner installation: This installation is being made on propert that I own which is not 201 amps to 400 amps 125 08 2
intended for sale. (ease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 1 168,54 2 .
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: 1+p y�, A. Fee for branch circuits with
:I B/a{Slf 1,p�a. MO r1 '1 r 101 l6mar111! r v r 4 �.
"i if'.;ry .r i .ti , ildn {51 �� I fM�11,j �,� i•�lipll�''r i�i1Idi ;')',2
I "i �� II``, U dl e UJ �t 1,1 . , . . above service or seder fie, .
.oh7�wil. . �rh �.Ia��._i "" 7A2 2
each branch circuit
Business name: B. Fee fbr branch circuits
Contact name: without service or feeder fee, 56,18 2
first branch circuit
Address: Each add'/ branch circuit 7.42 _ 1 2
Miaeellaneous (service or ]beder not Included)
City /Staate/ZIP: Each manufbctured or modular 67.84 2
dwelling, service and /or l cdcr
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail> Pump or irrigation circle 67.84 2
•
" i`' ' K tMES at"A'i1Yi�7YH1i M .S.i ' .IIn1 If n Signor outline lighting 67.84 2
A Signal circuit(s) or limited -
11 .. .0:.6 ' !' . O 1 -_ . - . II . - energy panel, alteration, or
Address: - ` , extension. Describe:, / ?age 2 2
r.r tai �: a f 1� d�� Each additional Inspection over allowable in any of the above :
Per inspection 1 66.25
Phone; ( j 1 'Zit,: / I 4 Investigation per hour (1 hr min) 1 66.25
M M Electrical Lic.: ' CAL uprv. Lic.: " 7" / ,A Industrial plant per hour 78.18 ;
P B ". A i , �,tf .r I'':fr MC ' >i io l !'.. .L�..t ,! .s.'1 ., a' 1 �0�� ?'• i; I'' „ :
1
Su rv. Electrician signature. ,ir �I� , Subtotal: ( -.+ .
.�� 1u1• Plan review (25% of permit fro):
I 1 o� State surcharge (12% of permit the): q ; l0
Authorized 911 attire. /i / ' r / � 1 TOTAL PERMIT FEE:
nil,_.+ A _.�ntao_ J. _. _ � �
`` This permit application expires It a permit 1s not obtained within 180
i t t Date; '� �11 dart after it has been accepted w complete.
•amber of inspections allowed per permit.
Ilanil di: lg'Pamit.lffi.0 .P. ifilf dm 10/01 /C9 440 461ST(litus /C0.M/wns
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