Permit ti CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00031
TIG 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/4/2008
PARCEL: 2S 101 AA - 09100
SITE ADDRESS: 12447 SW 69TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT: 030 JURISDICTION: TIG
PROJECT: HSBC -
Project Description: installing CCTV system
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:
INSTRUMENTATION: OTHER: CCTV X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD CORPORATE CENTER SELECTRON INC
LTD PARTNERSHIP 7225 SW BONITA RD
ATTN: GREG SPECHT TIGARD, OR 97224
BEAVERTON, OR 97006
Phone: Contact #: PRI 503- 639 -9988
FAX 503- 684 -4357
Reg #: ELE 26- 497CLE
FEES LIC 64341
Description Date Amount SUP 974LEA
[ELPRMT] ELR Permit 2/4/2008 $75.00
['AX] 12% State Surch 2/4/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
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 B � �� ,_' /� / � i • • mittee Signature: o� �/���G�� ✓
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'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.
' rl al Permit A IICat �� I "'D �' • F.OR OFFICE USE ONLY
Received Eit ct C [JXl
i 1 ''.__
C of Tigard FEB 0 1 2008 Date /Bv: d / O/ F j Permit ,L
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �L
Phone: 503.639.4171 Fax: 503.5q���9fj0 Date /By: Other Permr. — — Gt�t,C)�7— w5
.. V, , $ !umn 7 J uris:
TIGA Inspection Line: 503.639.4175 7 `� ` lh�� /± Date Ready /By: 8 Sec Page 2 for
- Internet: www.tigard- or_gov PLaNrl �Q1 Notified/Method: Supplemental Information 1
TYPE OF WORK PLAN REVIEW
Pl check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction: addition /alteration /replacemert i
❑ 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 Commercialiindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire ptunp. ❑ installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORtMLATION AND LOCATION ❑ Addition of new motor load of ❑ "A "8 ". ' 1 -2 "1 -3 ",
y f',� Nye 1-1P or more. Occupancy.
Job no.: Job site address: i 2./.41-11 ] SW i-'� 0 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TQard OR q'-i , �3 ❑ Health -care facilities. ❑ Supply voltage for more than
J ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Proje -ct name: 14.5 + ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total i '
New residential single- or multi - family dwcCiog 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
r .��,,,� � 1 � 75.00
DESCRIPTION OF WORK (with above sq. 0.)
C 'ra- &AA t h C_ i 1..-CJ,�
Limited energy, (with above sq . ft 75.00 2
J residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 30.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
J N / /� / 401 amps to 600 amps 160.60 2
Name: L(/Y /r'vI� CY/1i 240.60
601 amps to 1,000 amps 2
Address: / / r ,. -`r- 4j,• Over 1,000 amps or volts 454.65 2
City /State /ZIP: /,� �� ' — A L ) Ca Temporary services or feeders installation, alteration. and /or
/ relocation
Phone: ( ) 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 I I 133.75 I I 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
46.85
Contact name: first branch circuit
Address: Each add'l branch circuit 6.65 l 2
Miscellaneous (service or feeder not included)
City /State /Z1P: Each manufactured or modular I 90.90 2
dwelling, service and /or feeder
Phone: ( ) 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: SELECTRON, INC Signal p a nel t(s) or limited -
energy panel, alteration, or
1 75.00
Address: 7225 SW BONITA RD extension. Describe: Page 2 2
City /State /ZIP: PORTLAND, OR 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 639 - 9988 Fax: (503) 684 -4357 Investigation per hour (1 hr min) 62.50
CCB Lic.: 64341 Electrical Lic.: 26497CLE Suprv. Lic.: Industrial plant per hour 73.75
i ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
Plan review (25% of permit 75.00
Print name: JiM LEPPER ..-7 Date: [ I2Gl lb0 rmit fee): �/�
U I b)b, State surcharge ( o of permit Fee): q,(�v
Authorized signature: TO1 - L PERMIT FEE: ru,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
1: \Building \Permits \ELC- PermitApp.doc 35/23/06 440- 46/5T(11 /05 /COM/WEB