Permit •,
CITY OF TI ELECTRICAL PERMIT -
RESTRICTED ENERGY
v DEVELOPMENT SERVICES PERMIT #: ELR2004 -00270
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/24/2004
SITE ADDRESS: 16600 SW 72ND AVE B -10 PARCEL: 2S113AD -01900
SUBDIVISION: OREGON BUSINESS PARK I ZONING: I -L
BLOCK: LOT: 009 JURISDICTION: TIG
Project Description: Limited energy for adding to existing fire alarm panel.
Job # 7240122807.
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: X OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES HONEYWELL INC
15350 SW SEQUOIA PKWY #300 -WMI 15495 SW SEQUOIA
PORTLAND, OR 97224 STE 100
PORTLAND, OR 97224
Phone: Phone: 968 - 3300
Reg #: SUP 941 LEA
LIC 150191
ELE 26- 207CLE APP. SAYS CI
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/24/2004 $75.00 Elea! Final
[TAX] 8% State Surchar€ 8/24/2004 $6.00
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.
Issued by /,, 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'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
AUG-20-2004 15:11 HONEYWELL 503 968 3398 P.04/04
Elect:fical Perrathrt FOR OFFICE USE ONLY
i -,•
City of Tigard Pmto
• ., 1. -0 Received lir - - y $ . /
eritl.:--- ._.., / d --- 1 0
13125 SW Hall Blvd„ Tigard, OR 97223 IC 1 ' Date/13 : i -
Plan Review ..
Phone: 503.639.4171 Fax: 503.598.1960 tiP=0. Doefa : Other Permit
Inspection Line: 503.639.4175 '. _a NI- , AI t' Date Ready/By: KM E0 See Page 2 tor
Internet: www.ci.tigard,or.us Ni ,„, .... Notificumethod: Supplemental information
1
c:...: . ]: - -.'''' : 1 §. - t:":::•17";=:.'•51::,•'::, 1 1F,'. 1 , ' Ai'**ii.E% : • • . •
! • , ,• . ..y... i ., d ,...;:,;;;;,::::,•::,,,,..:;, :: . •••••:: • , , • .: • :.• —
1=1 New construction Dir Addition/alterati 711421QhN Please check all that apply:
13 Service over 225 amps, comml ['Hazardous location
El Demolition 0 Other: .. ,, OService over 320 amps - rating OBuildng over 10,000 sq. ft.,
. T. . , .......:i 4i
J;;.:i thd ,7.ci:pi,..1.r of 1- and 2-family dwellings 4 or more new residential
:-.::;".;,:z.t.i. :::',..la'.1.-.L..:::,:itz;.ix,:li: .:t. -wet' 4,.-% .'''-'%
0 1.- and 2-family dwelling 41 Commerciallindustrial 0 Accessory building 1]System over 600 volts nominal units in one structure
['Building over three stories °Feeders, 400 amps or more
0 Multi-family • 0 Master builder 0 Other: °Occupant load over 99 persons 0Manufactured structures or
:! ofirj:530 . 1‘iiti / '. 449 ' t. ' •-• .1 DE pi RV park
,:...,.., . ...: .4434:t... ' :ii., i „...t.,: - .i.st :--' - .: :_1:24.4..... ' A .: .. ....-.4.,.. .,,,..... .. -..:.,,,'"7'.A.41.1.. • s,..,.
j 1 1 0 .121+01sigt4 Job site address: I UUtt'D 5*1 IPA Ali& 1:Health-care facility 00ther:
Submit 2 sets of plans with any of the above.
City/Statc/ZIP: 1 , 0\ On /44 The above are not applicable to temporary construction service.
..N...V4igik.i : ''. . ' • .. • '' '
Suite/bldg./apt. no.: Project narnc: /9 Id E'aryllA62) n I Qty. I Fee. j Tom! I -. .
Cross street/directions to job site: . New residential single- Or multi-family dwelling unit.
• — Includes attached garage. .
1,000 sc. ft, or less 145.15 4
_
Subdivision: 1 Lot no.: F.& addl 500 q. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.: • . Limited energy, non-residential 75.00 • 2
T EaCh titsnufaCRITCCi or modular
• dwelling, service and/or feeder 90.90 2
A 4
Air/Aa / All JO , ( .- ' Ili . 1 . 2 A Services or feeders installation, alteration, and/or relocation
• '44 hib 1/ £' tide tf ., I. :PA- , . 200 amps or less 80.30 2
t.'"Oz*Ini ••-. .:-:,..-:-.:•:,:
---.. • - • - ', 4 01".''''' ,. .: " IT' 201 amps to 400 amp s 106.85 2
:.::: -. ,...,.. :: :...;........, ...„..„... ...v.‘.0.,.. . .0. ,. • ....,*:..:, :: .. *.'.'`'''':'. -''' :'; 4•;;•••• 401 amps to 600 arnp , 160.60 2
— -
Name; 601 amps to 1,000 amps 240.60 2
000 a
O 1
ver ,mps or volts 454,65 2
Addrcss:
--- Reconnect only 66.85 2
City/State/ZIP: • Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps OT 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 600 amps _ 133-75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
.....
77-Illgeigtrtglax 3 . : ..zr,..,...T7'.2.1:4a.,!!7:4.0-<;,-NFILW4LMI'n'i,''.57,...X.;;;.:i-4-.::::;. A, Fee for branch circuits with
......,..-,:, ..--. , A:......).... [ ..411 . .:.0..=,::..'•%•.4.1.: service or feeder fee, each 6.65 2
Business name: branch circuit '- J
--
.. a Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
each branch circuit
2
Address: _ Each adt:19 branch circuit 6.65
. .
City/State/ZIP: Miscellaneous (service or feeder not included)
_
- Pump or irrigation circle 53,40 2
Phone: ( ) I Fax: ! ( ) Sign or outline lighting 53.40 2
.
E-mail: Signal circuit(s ) or limited-
, •
.•i•;:'ii;.,-::..'';:::,'":"..::;,•..y...:e!4i..'.ki':=Y.T'?•,:;::.;.ig..'.•.f.'atP...4 '1 .: ..,? energymmel, alteration, or
exterision. Describe: ( Page 2 " 6 2
Business name: 1+0 rleti 'J
AddresS: 11.15 stAi a - a o \ p • /tA iv iDo E.ch ad inspection over allowable In any of the above
Per inspection 62.50 .
City/State/ZIP: Poil1oty1 DIZ onni4 Investigation per hour ( i hr min) 62.50
Phone: (15)5) Clug, 53 D 0 Fax: ( 5 oil - 6?[.. Industrial plant per bout
' 73.75
:" i:•:• : ..
CCB Lic.: 15 0 161 1 .. Electrical 1111111/,6-7/6 Lic.: 6141tai Subtotal - 1t3
Suprv. Electrician signature, required: )41-ii(tV Plan review (25% of permit fee)
_
State surcharge (8% of permit fee) 0
Print name: .e../v-c, ),,tereilevms.c Date: €. PoibIt
- TOTAL PERKIT FEE g
. , .. ,, _.--
Authorized signature: i&C,../ / This permit applicadon expires if a permit is not obtaiae i within MO
. . /../.
, . . , days after it has been accepted as complete
Print name: 61 rytorzkurvuye.... Date: $ 7,01 bq • Fee methodology set by Tri-County Building industry Service Board
- - '• Number of inspections per permit allowed-
TOTAL P.04