Permit ., . CITY OF TIGARD
g'it II 0 171 o_ii .
ELECTRICAL RESTRICTED ENERGY PERMIT
1 . ' I/ COMMUNITY DEVELOPMENT Permit #: ELR2010 -00073
r1 G A R P 13125 S H all Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/29/2010
Parcel: 2S112AA00500
Jurisdiction: Tigard
Site address: 14344 SW 72ND AVE
Subdivision: NELSON BUSINESS CENTER Lot: 0
Project: Leif's Collision Center
Project Description: Security alarm system.
FEES
Owner:
WALTON CWOR NELSON 13 LLC Description Date Amount
BY TTA/EPROPERTYTAX DEPT 735, PO BOX Restricted Energy Permit 04 /29/2010 $67.84
4900 12% State Surcharge - Electrical 04/29/2010 $8.14
PHONE:
Contractor:
AMERICAN SECURITY ALARMS, INC.
5411 SE MCLOUGHLIN BLVD
PORTLAND, OR 97202
PHONE: 503 - 231 -0303
FAX: 503 - 230 -1044
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 in accordance wi 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. ATTENTIO • regon la - ,requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 ough OAR 952- 001 -a Of o ma obtain a copy of the rules or direct questions to OUNC by calling 50 _6.6699 or 1.800.332.2344.
/ /�� T '/
`� ._ „,d L/
Issued y: Perm Si. • . �_
/
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.
ELECTRICAL RESTRICTED ENERGY PERMIT
'_ if CITY OF TIGARD
ARD
` �I t
� COMMUNITY DEVELOPMENT Permit ELR2010 -00073
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/29/2010
,TIGAFLD, Parcel: 2S112AA00400
Jurisdiction: Tigard
Site address: 14280 SW 72ND AVE
Subdivision: NELSON BUSINESS CENTER Lot: 0
Project: Leifs Collision Center
Project Description: Security alarm system.
FEES
Owner: Description Date Amount
WALTON CWOR NELSON 13 LLC
BY TTA/EPROPERTYTAX DEPT 735, PO BOX Restricted Energy Permit 04/29/2010 $67.84
4900 12% State Surcharge - Electrical 04/29/2010 $8.14
PHONE:
Contractor:
AMERICAN SECURITY ALARMS, INC.
5411 SE MCLOUGHLIN BLVD
PORTLAND, OR 97202
PHONE: 503 - 231 -0303
FAX: 503 - 230 -1044
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 I Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 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 throu A -00 1-0100 . 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: / / Permutes Signature:
-0AC /97 i e�i Io/1
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.
Electrical Permit Application �. t i F ' i. r() 1b()I ().\ '" t tv ,
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mm 111 City W Ha Ht ltd Date/By: y/ /0 - Permit )4° .a 6 /6 O Z-S
y o 13125 SW Hall Blvd., Tigard, OR 97223 a Phone: 503.639,4171 Fax; 503,598,1960 APR 2 6 2 i
Plan
I# 0 l4e n Re other Permit:
its° Inspection Line: 503.639.4175 D ate Ready /By: lurix g1 See Page 2 for
, Trl t n 'lt�l�' , /'
t r Internet! www.tigard- or.gov CI OF TIG' ddakfed/Madtod: j [ . � Supplemental information
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} 1 [r�r } { "� k 4 r , t:T t eU 1r (s ' > r t s , itt ash t''1,: ri A r e i 1 91 s+ e lt�T I :'X ot tt. Fl r
/ •,I 1 A'+ Cf'... : ) i. 1 #. :Y.:s. �! = .� t. xS w; S.E..s`d`> fn. '( G+ f F. -'d12r �' 16 6a: r
,k ��,�q���., lr$1 /.w t,Et1,.r -t7. ..un P .? r }.- � ;- ;l �. e4t�. 11i�d1 r 7' �t t :fir r !7fA �:
[) New construction P.1 Addition /alteration /replacement Please cheek ell that apply (submit 2 sots of plans w /items checked below):
0 Service or feeder 400 amps or more ❑ Building over throe stories.
0 Demolition 0 Other where the available fault current
;,r � ❑ Mains end bo9lyerds.
1 ',c i • s ' , t T 1(17 t4 � i J x Q , r1 'xqr r a t�v 1t s) l• ;t rrtZ ra;si''.f rtw p' P B buildings.
' Y �� � � t , , , . „, '�„r 4iL ya�i'' � Q exceeds 10,000 am sat 150 volts or ❑ F loatin
.. k. - `. r'r�.( ,.,: A a ¢ :.- 7 .ref - 4 , & f JISii`� r:t lbk, ;"Przt.gt Eligat !an .
t ': .
Tess to ground, or exceeds 14,000 El Commercial-use agricultural
O 1- and 2- family dwelling 1,4 Commercial /industrial 0 Accessory building amps tot all other installations. buildings.
O Multi - family 0 Master builder 0 Other: ❑ Fire pump, ❑ Installation of 75 KVA or
/ ,�f�i,t pp - si c r - m sp, -y- S r '/ r. , ❑ Emergency system. larger separately derived systei1.
C `r ( r is " w a $„ Z ,.:F" pp t o
a �' r.1.lt� av . 1/ 1itos lt t l A ii AL tI U . j.' �+( � , '' r ❑ ❑
t`.�� :...... iZ4' rs �. 1 ro+ lfb�cYYr...,6ti.�lx2§:�.rS;itirm �.f a:neY v , Additi of new motor lo of "A" "B" "i - 2" "1 - ",
Job no.: Job site address: t 1 100HP or more. occupancy.
_ ��� 51� �a vult� ❑ Six or more residential units. Q Reerea000al vehicle parks.
City /State /ZIP: (�(� �x(d > CR , 91 D ❑ Health -care facilities. ❑ Supply voltage for more than
J ❑ Hetardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name: Le..4 N3 I t`j ❑ Service or feeder 600 amps or more.
tar. �.,. C,4` �� n� 9 a'`' s'f {:,�!'^",rr `a!
`rui31s"'ffti3'�i�%. °e�lyir -a. r.,a
Cross street/directions to job site; Decrtpllon QIy. .Pea TOW '
New residential single or multi- I dwelling unit.
Includes.attached garage.
Subdivision: 1 Lot no.: 1,000 sq, R. OT less 145.15 _ 4
Ea. add'! 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited 4' energy, residential
'iy%.v'"'t1 t� '4m tilc;'4;5'rr�.j� .,. rph:A� martr�rc ��n ' f IN t �1
+; , ,.0.4 t } .r. ; . � idr1ihanl s 10.,1 L'� Ii ka w' ,.�w.li✓ Zr ; >k�i (with above sq. fl.) 75.00 2
,/� (,Zn L multi-family
, L,.ykS U C\ {Lt t�1 t,Y r N v 1 al � l X1�I residential (with about a sq. B.) 75.00 2
Services Or feeders installation, alteration, and /or relocation
200 amps or less . 80.30 2
'�� , i 7' 'A4'T, ''r� ti'?'1±��' ' thr.+ �bc r +-t � f ; ri,�'i ..
,;b,,.$ 4'1131.f'. �.; { ° �' �r=c�: "!k' EZEggtai ' l�itlpi R `,t� Pi+ till li. I. x ,., ,:i'• 201 amps to 400 amps 106,85 2
Name:
.% i ► 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 24040 2
Address; Over 1,000 amps or volts 454.65 2
City / State/ZIP: Temporary services or feeders Installation, alteration, 2nd / o r
relocation
Pilo": (SO3) (2,o-- 574 3 1 Fax: ( ) 200 amps or less 66,85 1 I
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 1 33.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, er panel
A. Fcc for branch circuits with
- /rNe17. FI VUE K F it I''J e e ,l. c C tl'.; rN o ' al '' r ` above service or feeder foe,
N E�. p'� `A . 645 2
�
eaoh_ circuit
Business name: ArvivActoik - LUt1 - � jar's, The,. B. Fcc for branch circuits .
So k
without an crvice or i feeder fee,
Contact name:
S V first branch circuit 46.85 2
y
Address: 54U i ' a 1,Q v Each add'! branch circuit . 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: 'f6-& , r - p4 1. Each manufactured or modular
90.90 2
dwcllinkservice and /or feeder _
Phone: ( 5o3) 2 ' . - b '103 Fax:: { sc p.- - 104q. Reconnect only 66.85 2
E -mail: . a , ` Q. . t15 . . ►aa � Pump or irrigation circle 53.40 2
p r -a, ��. ar , .r r � e
i ft. -. i ter' ' a ; Kit., , m� s r �l ?x� ;ml d'e``a�iF r Sign or outline lighting 53.40 2
•
Business name: / Signal circuits) or limited- _
YV14'iYlCIQ,1/1 ( loin energy panel, alteration, or i
Address: 5 9 1` 5 E �- Led l A, extension. Describe: J Page 2 �� 2
City / State/ZIP: Each additional Inspection over allowable in any of the above
Pcr inspection 62.50
Phone: ( ) t� Fax; ( ) �1`(\ t 0 I1 4t
Investigation per hour (l hr min) 62.50
CC$ Lic,: Garti40 ' Electrical ic.: 2(- Suprv. Lic,: 7 ()4 Industrial plant per hour 73.75
Suprv. Electrician signature, required: . ; Subtotal: 15 ,01) X0 , yy
Print name: J a YYl C;5 Date: 4 ' 0� 1 V Plan review (25%of permit fee): i.// et /
State surcharge (12% of permit fee): . (J(-,) f',/1/
Authorized signature: TOTAL PERMIT FEE: ',a .6)
Print name: Date: This permit application expires if a permit is not obl red within 180 95- 7rr
i days after has bbun ain. as complete.
' • Number of inspectilions ns allowed Wain.
per per
1.! BuildingTermitr\E1.C- Permu App. • • • 15/21/06 440- 4615T(111051COM/WE9
. d 17 o:- 'I Wd8q:8 @L0 '9z '
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
g o El�lyXr�r4�11/
Fee for a ll residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other;
1
aa �.
;� �^ry,.ci � " 1 n ti � F, n r �
r f 11'C.']� i v�l' •.�4..� Y. u^Cfl;ra.�u�u� �...L W
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
rk .. Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
P « ti 0 9 L o N„� AV 8 ti: 8 4 l U Z