Permit - ;} 'a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR201000034
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/23/2010
T[ G i�R D Parcel: 1 S 136CD01000
Jurisdiction: Tigard
Site address: 11745 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Aarons Furniture
Project Description: Install restricted energy system for burglar alarm.
FEES
Owner:
MONAGHAN FARMS, INC Description Date Amount
14120 EAST EVANS AVE Restricted Energy Permit 02/23/2010 $67.84
AURORA, CO 80014 12% State Surcharge - Electrical 02/23/2010 $8.14
PHONE:
Contractor:
GLOBAL SECURITY & COMMUNICATION
3212 MAIN ST
VANCOUVER, WA 98663
PHONE: 360 - 693 -1900
FAX: 360 - 906 -9692
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: N
Security Alarm: Y Other: N
Other Desc:
This perrnit 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 Not Center. Those rules are set forth in OAR
952- 001 -0010 through 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: Q .c _CLA V , 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.
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.
02/22/2010 MON 10:19 FAX 3609069692 Global Security 21 001/003
Electrical Permit Application ,) , - y :FOR�OFFJCE usE ONLY r ,:
..,ka,�,... a,�..41w2t, 4'..r,..,U +. _ s„ .. . ,, rw:,. d ,..va.. ,...r..:sv'.'!.i.s,,:" . .
� { � "; j� licccivcc �
- `isa: elf Of Tigard al'd , 1 /) � Permit No.. (�.�,F�W V coo-3 if,
" ;' : `. ., Y Date
.. 13125 SW Hall Blvd., Tigard, OR 97223 FEB 6 D S ) cvic,v
u'- ` '.,., Phone: 503.639.4171 Fax: 503.598.1960 r CD r5 � c 3y t Other Permit:
Ins lccuon Line: 503.639.4175 Date Ready/13y: liars El See Page 2 for
!:TIGARD' I
a 0.i.:A Internet: www.tigat'd- or.gov IV Notified /Method: c Supplemental Information
;TYPE OF WORK ;,, , - . . PLAN REVIEW
❑ New construction Addition /alteration /replacement Ilene check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or mom ❑ Building over three stories.
❑ Demolition ❑ Other: whew. the available fault current ❑ Marinas and boatyards.
— -- CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14,000 ❑ Conm,e tial -use agricultural
El 1- and 2- family dwelling ,❑( 'Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pimp. ❑ Installation of75 KVA or
--- ---- --- ----- ❑ I:nergcllcy system. larger scpamtely derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new moto load of ❑ "A "," F:', '1- 2 ", -3 ".
/ 71-614 �, r !} • r 1 ),,,, r max , occupanc
Job no.: Job site address: I I ( QCI f f L
❑ S ix or more resie units. ❑ Recreational vehicle parks.
City /State /ZIP: "TTC• Vl� (ci?9_Z: ❑ l icalth -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
V
Suite /bldg. /apt. no.: Project name: 24
e: Aaron, 1 , �q , 1- c , l, mp
❑ Service or Iccdcr 600 as or more.
1 a FEE SCHEDULE
Cross street /directions to job site: Da�crj 1 Qty. 1 Fee. J Total 1
New residential single -or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 11. or less 168.54 4
Fa. add'1500 sq. It or ponion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 67.84
I Limited energy, mull(- family 67.84 2
J residential sid cntial (with above sq. I5.)
__ Services or feeders installation, alteration, and /or relocation
200 amps or Icss 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps y 133.56 2
401 amps to 600 amps 200.34 i 2
Name: 1
601 amps to 1,000 amps 301.04 2
AddreSS: Over 1,000 amps or volts 552.26 1
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps I 125.08 2
Owner installation: This installation is being made on property that 1 own which is not - 2
intended fm' sale, lease, rent, 00 exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps j 168.54
Branch circuits — new alteration, or extension, per panel
Owner signature: Date: I A. Fcc for branch circuits u-ith
❑ APPLICANT _I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: 13. Pee for branch circuits uddmul
service or Iccdcr fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Cit / State /ZIP: Each manuf'acuned or modular G7 R4
Y dwelling, service and/or feeder
Reconnect only 67,84 2
Phone: ( ) Fax:: ( ) - -_. -- - -- -- --
Pump or irrigation circle 67.84 2
E - nail: 2
Sign oroutlinc lighting 67.84 .J
CONTRACTOR .__________
circuit(s) or limited - energy // p f
/, / ( >oG panel, alteration, or extension. � 1 Pagc 2 P. a y 2
Business name: ( � C � j
�t f a y Each additional inspection over allowable in any of the above
Address: "Z!2 (,( r _ , ^ / t ' } - Additional inspection (1 hr min) 66.25/ hr
l tit � ge=l Investigation Industrial plant ali (t (I hr min ) 73. 4/ hr min) 78.28 /li �—
Cit y /State /ZIP: U `1
�(� t. - --- J
1
Phone: (360) 6 5 — j 1°° Fax: ( W) 9I F6 72 Inspections for which no ice is 90.00 / hr
/
specifically listed ('/_ In min)
CCB Lie.: ..s Electrical Lie.: , //G� Suprv. Lic.:3a•, 4 �� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: e ....___
-- _ .....
Subtotal: 47• kt7 Plan review (25 °/o of permit fcc): _ Print name: " k [ D a t e: 22 . 1 I State surcharge (12% of permit fee): /U
�� TOTAL PERMIT FEE: "75 t
Authorized signature: «_
This permit application expires if a permit is not obtained within ISU
�' /` ✓�� days after It has been accepted as complete.
Print name y{ • r K —1-- no Date: f (ll 1 " Number of inspections allowed per permit.
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