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Permit Iii :.. , ii.:2- - .! CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT a ° COMMUNITY DEVELOPMENT Permit #: ELR2009 -00348 T E GARTY 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/02/2009 Parcel: 2S11ODCO23O0 Jurisdiction: Tigard Site address: 11535 SW DURHAM RD C -1 Subdivision: Lot: 0 Project: Liberty Tax Project Description: Install restricted energy for protective signaling. FEES Owner: HIP WILLOWBROOK LLC Description Date Amount BY TAX DEPARTMENT, PO BOX 2708 Restricted Energy Permit 12/02/2009 $67.84 PORTLAND, OR 97208 12% State Surcharge - Electrical 12/02/2009 $8.14 PHONE: Contractor: WILSONVILLE LOCK & SECURITY 8269 I SW WILSONVILLE RD. WILSONVILLE, OR 97070 PHONE: 503 - 682 -2323 FAX: 503 - 682 -5868 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: Y 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 ina rnrria ce 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. AyfE Ore• • I- . requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -00 0 010 through OAR 9:• -001 0 . • You may obtain a copy of the rules or direct questions to OUNC by alien or 1.800.332.2344. Issu d By: /` 4 /i.A.:=. - Permittee Sign re / /C:)\-- 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. • $1°[ICd ldllt$ E9►D1��Irva�t' �t.! D , 1 ,, ... , .. I� l I i. -1 I �� , � ,„, s , ■ 10E�VE :� N I ,..: . i.. : R..„,„.. A � riot , w : &� , . City of Tigard Da,e/B : AermitZQo.: E / ' , r n 13125 SW Hall Blvd, Tigard, OR 97223 - Phone: 503,639.41.71 Pax: 503198. t';! at C 0 12009 Other Penult: c,, Inspection Una: 509.639.417 « � 1 Nl ii , �P Sac Foga 2 lbr i reef latcmct: vKVw,llgtlyd�r -gov CITY OF TIGARD 31 4 1 1 114 mOntal Information - k:„ ., 1 : ' . L- Pt41 REVIEW — Now construction Addition /alteration/replacement me.ec k nib r (submit 3 seta o f pleas w /trees a eo>ced bolo CI Demolition [ Other: what, Service or reedit 400 amps or more 0 Building two three ataries. whale rho available flask current O Marina; sad twntyarda. ' CATEGORY OF CONSTRUCTION exceeds 10,000 amps tt IS0 volts or CI Floating buildings. CI tees to ;found. or oeeds 144100 0 Courmatial - use 1 • and 2 ±finally dwelling ► I Commcrcial/industrial (] Accessory builder; mopeds sgrieattura! amprior all mbar ins[dlstiana. buildings. 0 .Multi -famil ❑ Master builder • Other I: Fire pomp- D lnttallation of 75 KVA or JOB SITE HVF+ORMA k'ION AND LOCATION 0 �O my tyttma- Larger taptrrately derived arum% L9 Addition anew mater load of ❑ "A ". "13 ", "i ", "l -3", lob no - Job site address: 1 f 535 5(t )J . ;thin() rct . 100/IP armors, occupancy, Q 3bt orator* maidential unit,. 0 Raeraaaanal vehicle carnet. City /State/ZIP: 1 i (1(4 a 01,2 el '7- QHodth - oars Aidlities ❑ Scanty voltage for atom than 0 Ruudoua louden. 600 valor nominal. Suite/bldg. /apt. no. :`• I Project nem ; Li • • L.... q 0 .... v ❑ Semiedor600 amps ormore. DMZ Cross street/direetions to job silo: ! Semi.* m fo FEE S tirMIIIIVIMIMEMIggia New rasldential ainglo. or multi.-family dwelling unit, 'Deludes smogs fatale, 9ubdiviaion; Lot no.: 1,000 s , ft. or leas _ 145.15 - Ea. add'1800 sq. R or portion 33.40 Mill Tex mttplparoel rlo.: Llmito�an 'erg, residential DESCRIPTION OF WORK with above R. 75.00 � © a 1L m red energy, null -, i its 75,00 .1.11 d _../.2 .. i rosidartial (with shove eq. R.) Services or theism installation,, Jtera • on, and/or _200 mps 400 80.30 MO 0 PRomarn owns d T�TIA1t1T 201 , s 10 to 400 amps 106.85 Name: 401 amps to 600 amps In 160.60 MIMEN 601 810 to 1,000 amps 240.60 Address; Over 1.040 amps or vole r 454.65 H City /State/ZIP: tmporely service nr feeders installation, alterbtion, and /or relocation Phone: ( ) Fax; ( ) 200 amps or lcsa 66.85 1 Owner installation; This installation is being mad* on property that I own which is not 201 " •• to 400 .a I00.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 • to 599 afttpa . WM Ul u • tirenite — new sit t . n or exttension Owner signature: Date: , p !yaw A. Pee • trench s fi ❑ APPIdGN CI Ca0►IV'lt'AtC1' PERSON above eetvitx or r Punier lice, 6.65 2 each branch circuit Ruttiness ntuno: 13. tree for bmnnl, lmiaits II Contact names wfrhn>d service or ibmdcr fm, 46.55 first lnanah chunk Address: Each aed•1 breach circuit 6.45 2 City/State/ZIP: 1Nlsegpsne0o Jserviee or feeder not included dwelling, service e or r Snider modular 91190 dwelling, ;cruis md/or lbeder Phone: ( ) Fax; ; ( ) Roconnat onl 66.85 E •mail: • . or iTrl elicit circle 1111 53.40 2 C0'ITRACTOR Si .•■ er oral lea • .' 53.40 2 Business name: \, i 166i 1 ■/i I k2 Lusk `>~ cig i'�' Ina. Signal ' • . or united- ,,•-�� energy panel, alteration, or Address; S 2k 16lAl. i' 16O nt/l I 1 . T-�"s. ; salon. Deyerite: paw 2 4 ti " 2 �'/ fled✓ 5,...,4, _. ,. IN l C1ty/StatcIZIP; f ls6nv j j 12 71? 9i7(p'10 Zaeh additional inspection over al owable In a of the ab Phone: (593) frfd•Q - . 3c23 Pax: (505) be..Q.50, Per inspection 62.50 UP"' . • Invanti par heue hr min) 62.50 ` CCD Lic. :`I I rn 3 f Electrical Lic.:3 -rL Suprv. Lic. :4gel IndWn1N phort per hour 73.75 $uprv. Electrician signature, required: �Y' PERMIT 1?lGLS p �� Subtotal . do" 71 , O1L Print name: 501)44- h Ve bLi `• Oates Plao review {25%0fpermit•P4 " State aurchatga (12% ofpemtli ibe): 6 .14- Authorized signature: TOTAL PE RMIT P EE CJ AS Print name: D om: - • a permit application aspires If is permit Fri not • • • - within 180 daym altar tt has been accepted w complete. t Number of impatiens angered per pamdt. LouIdlegermfusEtrSfirmlt4up. 61/10/06 44 u.o61Srp 1tOSACO AYED Electrical permit Application - City of Tigard 2uv �- 3q Page 2 - Supplemental Infoi atiutl LIMITED ENERGY PERMIT FEES: RESIDENTIAL WARS ONLY: Fee for is residential systems combined..... $75.00 Cheek Type of Work Involved: ❑ Audio and Stereo System* ® Burglar Alarm ❑ Garage Door Opener* Heating, Ventilation and Air Conditioning SyFtem* ❑ Vacuum Systems* ❑ Other; CQMAtaCIAL WORX ONLY: Fee iot each commercial $75.08 (SEE OR 418 309 - 0000) Check Type of Work involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fitt Alarm Installation ❑ NVAC. ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nutsc Calls ❑ Outdoor Landscape Lighting* Pmtectivc Si • Other Total number of cominorciai systenna: No • Licenses are required. Licenses are requited tbr all other installations EkBOiIdIGAPmmltalQLC .PmmitApp.doa ona/O