Permit � CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGYPERMIT
. TI , g '- COMMUNITY DEVELOPMENT Permit #: ELR2009 -00347
13125 SW Hall Blvd., Tigard °OR 97223 503 :639.4171 Issued:. 12/01/2009
Date
T' G A RD
Parcel;;, 1S136AD06503
Jurisdiction: TIGARD
Site address: 10900 SW 68TH
Subdivision: WAY LEE Lot: 2
Project: Changs Mongolian Grill
Project Description: Install restricted energy for security system.
FEES
Owner:
WAY W LEE GENERAL CONTRACTOR Description Date Amount
5210 SE :26TH AVE Restricted Energy Permit 12/01/2009 $67.84
PORTLAND, OR 97202 12% State Surcharge - Electrical 12/01/2009 $8.14
PHONE:
Contractor:
MASTERTECH SECURITY SERVICES INC
PO BOX 1005
ESTACADA, OR 97023
PHONE: 503- 630 -2565
FAX: 503 - 630 -6630
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 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 thr gh 0 R 952- 001 - 0.100. 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: -12 0W l.0 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:
LL CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 41401—'
C . /J✓`"_ Date: 1 Z - / ' 0 of
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
Approved plans are required on the job site at the time of each inspection.
Permit Application R ECEIVE- FOR OFFICE USE ONLY
-Electrical .
City of Tigard DEC 01 2009 Received
DateB : Permit No.:
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGAR DateB : Other Permit:
Inspection Line: 503.639.4175 , IJILDING IVISI to Ready/By: 1w 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction [J(~ Addition/alteration/replacement Please check all that apply (submit z sets of plans w/items checked below):
❑ 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 El Commercial-use agricultural
F1 I and 2-family dwelling ®Commercial/industrial El Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system, larger separately derived systen
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ °A", "E", "I-2", ° 1-3",
Job no.: Job site address: d cl p a S W Ufi ~ 1- W14 or more. occupanc y.
El Six ix or or more residential units. El Recreational vehicle parks.
City/State/ZIP: ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: C H ' S o o I. qK i ❑ Service or feeder 600 amps or more.
%j V FEE SCHEDULE
Cross street/directions to job site: L; W Description Qty. Fee. Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'1500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Q Limited energy, multi-family
IC t Q L►K h bVs b t e L-,A / S CH residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
I"~R OWNER ❑ TENANT , 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 56.18 2
Address: Each add'1 branch circuit 7.42 2
Miscellaneous (service or feeder not included
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR
Signal circuit(s) or limited-
Business name: a'5 t-U 1 e S l C ( y; f TV IC energy panel, alteration, or
Address: 303 S W Zo bV S ~`~~QS extension. Describe: 1 Page 2 2
City/State/ZIP: F S +4 c t.4 O (Z 1 Z 3 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (603) 4 30 - a S (o S Fax: ( So 3) (9 3 O (o t0 3 0 Investigation per hour (1 hr nun) 66.25
CCB Lic.: S I Electrical Lic.: 3 -)1') CL Suprv. Lic.: 3 (o 31 LtA Industrial plant per hour 78.18
, I d
-7 1. AI 1d 111 ELECTRICAL PERMIT FEES
Suprv. Electricia siV-nat re, required: /&4 Subtotal: (Inr-7. A41
Plan review (25% of permit fee):
Print name: a " i 4 N G " V T Date: i2 I q State surcharge (12% of permit fee): .14
Authorized signature: TOTAL PERMIT FEE:
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.
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