Permit V
•
1, CITY 4 T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00117
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/4/2007
PARCEL: 2S 102CC -00700
SITE ADDRESS: 13599 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TIGARD ANIMAL HOSPITAL
Project Description: Security low voltage.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: • Contractor:
GANO, THEODORE H + HELEN E BRINKS HOME SECURITY
8914 NW LAKESHORE AVE 8080 SW CIRRUS DR
VANCOUVER, WA 98665 BEAVERTON, OR 97008
Phone: Contact #: PRI 503- 641 -0666
PM 641 -0574
FEES Reg #: ELE 34- 166CLE
LIC 44421
Description Date Amount SUP 3430LEA
[ELPRMT] ELR Permit 5/4/2007 $75.00
[TAX] 8% State Surcha 5/4/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: c,„ 4-,.....t)r-Gc—
V6 Permittee S ignature: w (----
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:
r
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 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.
,7 EIVED
' Electrical Permit Amlat Fo12 OFFICE USE ONLY
�,,,� /� // 7
City of Tigard r \,, `1 'too Received / Permit N� �,��_ (/
II
° 131 Hall Blvd., Tigard, O R 972;3, T Date/By:
v 1 / �� Plan M Phone: 503.639.4171 Fax: VIDV6O 1 G ,,, Date/By: Other Permit:
T 1 G A R D Ins Line: B 03 . 639g .4,�, 91411-DING DIV 1 ° IA N Date Ready/By: Juris� Iii
See Page 2 for
Internet: www.ti and - or. d� Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
® New construction ❑ Addition /alteration/replacement
❑ 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 ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: 70505504 Job site address: 13599 SW Pacific Hwy I or more. occupancy.
❑ Six x o or r more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard / Oregon / 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Suite C Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. R)
Low voltage Alarm Installation Limited energy, multi - family 75.00 2
g.� •� residential (with above sq. ft.)
Q Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER .I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Tigard Animal Hospital 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits— new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Brinks Home Security Signal circuit(s) or limited -
energy panel, alteration, or
Address: 8080 SW Cirrus Dr extension. Describe: 1 Page 2 75.00 2
City /State /ZIP: Beaverton, Or on 97008 Each additional inspection over allowable in any of the above
Phone: (503) 641 - 0287 , 1 I Fax: (503) 641 - 0960 Per inspection 62.50
` 1 I ax: ( ) Investigation per hour (I hr min) 62.50
CCB Lie.: 044421 / I Electrical Lic.: 34 66CLE J Suprv. Lie.: 1$1.0
. Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: a...."--"....._.. 7c,.., Subtotal: 75.00
Print name: �,o Date: j I y R Plan review (25% of permit fee):
r"'�- vi A_ G ! / State surcharge (8% of permit fee): 6.00
Authorized signature: l —rte \ TOTAL PERMIT FEE: 81.00
Print name: ,4 ' • 1 I Date: (� This permit application expires if a permit is not obtained within 180
{�`� 1 J 1 (X !� days after it has been accepted as complete.
K • Number of inspections allowed per permit.
1: \ Building \ Permits \ELC- PermitApp.doc 05/23/06 440 61 1/05 /C OM/WEB
CITY OF TIGARD
BUILDING DIVISION ° - PERMIT #: ELR2007 -00113
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/4/2007
Phone: (503) 639 -4171 A • •
Inspection Requests (24 Hrs.): (503) 639 -4175 — 'iIJ
INSPECTION WORKSHEET FOR DATE: 5/15/2007 TIME: 7:00AM PAGE: 70
SITE ADDRESS: 13599 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD ANIMAL HOSPITAL
DESCRIPTION: Security low voltage.
OWNER: GANO, THEODORE H + HELEN E, PHONE #:
CONTRACTOR: BRINKS HOME SECURITY PHONE #: 503- 641 -0666
Inspection Request Scheduled For: Date: 5/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
— +ate —L-aarveitage 048285 -01 503-641 -0287 N
Corrections /Comments /Instructions:
1 (1\ , )
'.I5 ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1066 L Date: G 16' Q 1 Phone #: (503) 718- 2*-1/