Permit C FEY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
;L • COMM UNITY DEVELOPMENT PERMIT #: ELR2007 - 00477
TIGARD` 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/24/2007
PARCEL: 2S114AA
SITE ADDRESS: 16285 SW 85TH AVE 302 ZONING: I -P
SUBDIVISION: DURHAM HALL BUSINESS PARK LOT: JURISDICTION: TIG
PROJECT: QUALITY CONTROLS
Project Description: Low voltage. Burglar alarm install.
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: BURG ALARM X
TOTAL # OF SYSTEMS:
Owner: Contractor:
BIRKEMEIER, BRENT T /JANET D TRS PROTECTION ONE ALARM MONITORIN
BY THE BIRKEMEIER FAMILY TRUST 15500 SW 72ND AVE
10573 SW NAEVE ST PORTLAND, OR 97224
TIGARD, OR 97224
Phone: Contact #: PRI 503- 624 -0244
FAX 503- 443 -2927
FEES Reg #: ELE 34- 428CLE
LIC 116325
Description Date Amount
[ELPRMT] ELR Permit 12/24/2007 $75.00
["TAX] 8% State Surcha 12/24/2007 $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 questi• s to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: / I Permittee Signature: 01^1 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'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.
•
..„ 21. 2007 9:24AM „ . . NO. .
Electrical rerun' i.kpPlicatioll'-- -:: :• ' 7( ' .., , FOR 0 FFIC 091 P 2
C . ._ ., _ , ' .
Citytd Tigard -i I - ri.
• ._.--- 10 13125 Hall Blvd., Tigard, OR 97223 .:- .':---- - \ PlanRe e '
IN ea
• ,. Phone: 503.639.4171 F other Permit:
ax: 503.598,1960 bt.L ''/) ' 201 "(dB : 0 Pezmit N' ' : - op V -op
SW
,„..
. , A R n Inspection Line: 503.639.4175 ---' - - ..ifiEEE g See Page 21br
Internet: www.tigard ' Viral sucidementionformatton
, t /
..•.
TypE p ,. Wt .. ,....„ \`-.' - 7 Aw , , p) , :',7)., , VP , :: k3, ,,,. .' , ":4:1 1 1[AN . REVELIY — ,:' ' • '-' ':' ';,'' '
0 New construction I! Additiontil ' ail: • ' ani .Lx 1 A 6 ,, ,,..,';.i., Please check all that apply (submit 1 sets of plans w/items checked below):
— '-" "' 0 Service or feeder 400 amps or mare CI Building over three stories.
El Demolition 0 Other: where thc available fault currant 0 Marinas and boatyards.
;' ',...„•:', .1 ; ,. . '.,,, S. CATEQQRY, OF CONSTRIICII0N1.:,.,:::',..;,.:f1Z:i> =
7 p.. ;Z:-...':-','.:,:.-11'::::'.s.
g.:,:, ....„..,,,,..0,";%. weds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14.000 CI Commercial-use agicolturel
D 1- and 2-family dwelling 2"Commercial/industrial 0 Accessory building amps fbr all other laminations. buildings.
0 Multi-family 0 Master builder 0 Other; °Fire pump. 0 matallation 075 KVA or
, : 0 Emergency aystem. larger separately derived system.
, : • • , .. • 10B SITE INFORMATION AND LOCATION: ';'::' ''!.'''''':!,:,:: ',0• El Addition of new motor load of 0
,
10011P or more, ocouPericY,
CI Sis or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: ---- Paetk_frLN , OR. q:4_.Q0.14- .Hcalth-care &Wiles.
0 Hazardous locations. CI Supply voltage tbr more then
600 volts nominal,
..
Suite/bldg./apt. no.: ' c)a I Project name; Cl` C teoLs 1:1Seivice or fccdcr 60e amps armorc.
' . s' :, -:. '. ,:',:' •:.:! :FEE: SCHEDULE ".,.;:. : ; .' ':. - s : '
Cross street/directions to job site: Deseriodea _1_91 Pm I Tod 1 *
New residential single- or multi-fiddly dwelling unit.
Includes attached garage. .
Subdivision; Lot no.: 1,000 sq. ft. or less I 145.15 4
Ea. add'll 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limitcd energy, residential
--. 75.00 2
; ' , • -,.. ,;: ':.. • ' ..''.': • . • '; 2 .
DESCRIPTION . OF WORK : „ :: : : ::;..•::',•• iyg;;;;', (with above sq. 0.)
, Limited energy, multi-family 75.00 2
221.W(g„RtijetlajilaSinle24-14P 0. t. residentially/1th above sq, ft )
Services or heders installs don alteratio and/or relocation
200 amps or less 80.30 2
„ \ • , ;.• 0 PROPERTY OWNER ': . . , ' : : . Cl: TtNAPO:;. ::',.:;:'"ri.:`,•:j:::!...., .. 201 amps to 400 amps 106.85 2
Name 401 amps to 600 amps 160.60 2
'.
601 amps to 1.000 amps 240.60 2
Address: . Over 1,000 amps or volts r 454.65 2
-
Temporary services or feeders installation, alteration, and/or
City/Statc/ZIP: — relocation
_
Phone: ( ) I Fax: ( ) 200 amps or Ices 66.85 1
s
Owner Installation: This installation is being made on property that I own which is not 201 amps *0 400 amp 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, alteradon, or extension, per panel
Owner signature: Date: A, Fee for branch circuits with
APPLICANT' •,.....:: ..' .,;:' : - • - 0 coNrAcr. Otis° ;1,, above scrviCt Or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee fbr branch circuits
without service or feeder fee,
Contact name: first branch olrouit 46.85 2
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Bach manufactured or modular 90.90 2
dwelling, service and/or haler
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
: : ' - • ,.. . •:.:, . t : . • . , ;‘ • ' • „ CONTRACTOR . .:'" . :: ", ':: 1 ; ':::.".':'' ,'' ...;'''.:.'?2 : .. , Sign or outline lighting 53.40 2
Signal circuit(S) Of
Business name:' name: l 'e s.) Negl&tariLiidaialn___ energy panel. alteration, or
Address: l `E extension Describe: Page 2 2
cao-- ori-aa,Li- Each additional inspection over allow hie In anrof the above
Per inspection 62.50
Phone: (6,S) L2s4,..02),44 Fax (,P) PO. - c7 t C i g5 Investigation per hour (i hr min) 62,50
CCB Lic.: \ \ , . Electrical Lic.: 54.4.kvseizSuprv, Lie.: Industrial plant per hour 73.75
- .' ' - A ., . :...; ELECTRICAL PERMIT' FEES:.e.: ' ...,
Suprv. Electrician signature, required: 621C,..- j ..,.- --'.- —
Subtotal:
Plan review (25% of pcmlit fcc):
Print name: er,i 6., por-- Date: ) z 2J - b7
State surcharge (8% of permit he):
/ c 19
Authorized signature: i.
di:, ....../ it,iffrZei TOTAL PERMIT FEE;
'
Print name: .
— lea Date: )P191101 Thi% permit applicetion apes if a permit is not obtained within 180
days after it has been accepted as complete.
la • Number of inspections allowed per permit
1,1BuildingtPterniiale-PCiniltApp,doo 05123/06 440