Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a
• a COMMUNITY DEVELOPMENT Permit #: ELR2009 -00360
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/15/2009
Parcel: 2S112AD00200
Jurisdiction: Tigard
Site address: 6830 SW BONITA RD
Subdivision: BONITA GARDENS Lot: 4
Project: Next Level Martial Arts
Project Description: Install restricted energy for alarm.
FEES
Owner:
UNION PACIFIC RAILROAD CO Description Date Amount
PROPERTY TAX, 1400 DOUGLAS, STOP 1640 Restricted Energy Permit 12/15/2009 $67.84
OMAHA, NE 68179 12% State Surcharge - Electrical 12/15/2009 $8.14
PHONE:
Contractor:
BROADVIEW SECURITY INC
8080 SW CIRRUS DR
BEAVERTON, OR 97008
PHONE: 503 - 641 -0287
FAX: 503 - 641 -0960
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 Notification Center. Those rules are set forth in OAR
952- 001 -0010 through *AR 952 - 0010100. 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: u 4 0 . . .L 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:
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.
. .
12/14/20E19 22:35 5036410960 BRINKS HOME SECURITY PAGE 01/03
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Electrical Permit Application RattIVE 1 FOR OFF1C:E 11SE ONLY
City of Tigard Received
D EC „cm , lig PerMit NO.: 64 , - - f °Set
.., . 1r wil -
111 n 13125 SW Hall Blvd.. Tigard. OR 97223 EC 15 2 009 Plan Review
• Phone: 503.639.4171 Fax: 503.598.1960 pot/r1',': Other Permit:
T 1 G AR 0 Inspection Line: 503.639.4175 CITY OF TIGA ' I
_ Date Ready/By: ,itgivi 63 See Noe 2 for
Internet: www.tigard-or.gcry
RI III DING DIVISI 1 siotificarvT&I,nd: H 0 Supplemental Information
'''.' ::.'.. ... '•'. .. : '' ''-.,'''';','''''''''''''' .; ' ..' tirPt. OP ; ;WORk ' ol ',''.,,, •,'',.::''=:.: ,:. .7 '' ,.. :: ,";::::'`. ;';: ,:..!:: .,•;-•!:•
Please cheek all OW apply (submit 1 sets of plans w/items checked below):
CI New construction IE Mdition/alteration/replace-ment
0 Service Of feeder 400 nmos or more 0 Building over three storieS.
0 Demolition 12 Other: where Me available fault cuncnt I:I Marinas nnd boatyards.
.:: ,':''''' ,,” .,‘': ::• i'! : '-'''''. '-':::. CATIrtdol4 i de.fttittrtiltIN ':'. s . .': : '''' ,..:'. ' ,' ' • :'''' exceeds 10,000 n mpg 1( 150 volts or in Floating Imildings.
. IC 5S to ground. or metric 14,000 0 Commercial-use agricultural
El 1- and 2-family dwelling El Commercial/industrial 0 Accessory building amps for all other installation. buildings
ii Multi-family CI Master builder 0 Other; Prim pump. 0 Installation of 75 KVA or
0 Emergency system. larger separately derived system.
tin gift tiNftbiltilAtitiN.! Alio* :. '': : ' ' '' :.. '' - ' ' .' 0 Addition of n motor load of
1
Job no.: 91235386 Job site address: 6830 sw Bonita Road 0014P or more. occupancy.
0 Six or more residential mits. 0 Recreational vehicle parks.
City/Statc/ZJP: Tigard. Oregon 97224 0 Health-carc facilities. 0 Supply vol Mae for more tlinn
0 Harardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Next Level Martial Arts Gservice or fccdor 600 amps or more.
fftE : SCREVCCE 4 ''''''''''''''''''''' ." ' •
Cross street/dircctions to job site: 72 Avenue De•crIption 1 011•• j Totill 1 •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less ! 168,54 4 I
Ea, add'l 500 sq. ft. or portion 33.92 1 1
Tax map/parcel no.: Limited energy, residential
67.84 2
.,';!. ' . ':-. '-: ''' ,■;;: \.':'''.' ,!; ..:..''' ' ..':', — ....! '.'... :. : .''' , 7'i` ' (with above SK1. 0 .)
Limitcd energy, multi-family
Low Voltage Alarm Install residential (with above sq. R.) 67.84 2
Services nr feeders installation, alteration, and/or rckrnatin
200 amps o 1
I' l ess 100.70 2
0 .:PROPE141"Po;fAVNE1 t: -,..,' •:'., '::, • '. :., tEr TENANT •:,:- ''' • ,'' . , : 20i amps to 400 arnps 133.56 2
Name: Greg Thompson 401 amps to 600 amps 20034 2
601 amps to 1,000 amps 301,04 2
Address: SAME Over 1.000 amps or volts 552.26 2
City/State/ZTP: Temporary services or fccdcria installation, alteration. and/or
relocation
Phone: ( ) Fax: ( ) 200 amps (11" ICs 59.36 1
Owner installation: This installation is being made on property that I own whi 201 amps to 400 amps 125.08 2
ch is not - ,
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, pnnel — 1
Ovvner signature: Date: - per A. Fcc for branch circuits with
aApputANt :: :,,,,,,,:. i.i• - " , ,,. , ..., Eitt PERSON • - .', :•;":.: above service or fccdcr fcc,
7.42 2
each branch circuit
Business name: Broadview Security B. Fee for branch circuits
Contact name: Delta Danielson without service or feeder fcc, 56.18 2
first branch circuit
Address: Each add branch circuit 7.42_ 2
• Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
67 i 2
dwelling. service
Phone: (503) 641-0278 Fax: : (S03) 641-0960 and/or feeder Reconnect only 67.84 ' 2
E-mail: delta.danielson@broadviewsecurity.com Pump or irrigation circle • 67.84 2
.:.%':'-''''.!: '.'..:.' ..,.. : '''..:'''., ':.'.":,!':... '"'. EtINTR`ACTOR-.:"..,•:, • , .',, ': ..,..' ' ": - '' :: . l'::'''...7, . ,., Sign or outline lighting 67.84 2
-
' Business name: Broadview Security Signal circuit(s) or limited
energy panel, alteration. or 1 67.84
Address: 8080 SE Cirrus Drive extension. Describe: Page 2 2
City/State/ZIT': Beaverton, Oregon 97008 Each additional inspection over allowable in any of the above
Per inspection 1 66.25
Phone: (503) 641-0287 Fax: (503) 641-0960
Investigation per hour (1 hr min) 66.25
CC13 Lic.: 44421 Electrical Lie.: 34-166CL Suprv. Lic.: 3213LEA 'Industrial plant per hour 78.18
.. ..,',...;'..,.:: ';j '.; !.:.,.: .; ,,. •
Suprv. Electrician signature, required: Subtotal;
Print name: Kevin Tucker Date: 12-15-09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 8.14
Authorized signatu c: \ .
TOTAL PERMIT FEE: 75.98
Print name: Don Wolfe Date: 12-15-09
Tills permit application expires if n permit is liot obiroincd within tan
dnys after it ho% been accepted :IA complete.
. Number of impeCiiOnS allowed per permit.
P1BuildirtsfflermitaNELC-PertnitAp.doe 10/01/09 440-461.5T(11O15/COMME13
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