Permit . CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELR2010 -00143
T [ GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2010
Parcel: 1 S135BC01100
Jurisdiction: Tigard
Site address: 11131 SW GREENBURG RD
Subdivision: Lot: 0
Project: Jump Sky High
Project Description: Security alarm.
Owner: FEES
ROBINSON FAMILY TRUST Description Date Amount
BY E LEE & EVELYN L ROBINSON TRS, PO Restricted Energy Permit 08/04/2010 $75.00
BOX 91305 12% State Surcharge - Electrical 08/04/2010 $9.00
PHONE:
Contractor:
AMERICAN SECURITY ALARMS, INC.
5411 SE MCLOUGHLIN BLVD
PORTLAND, OR 97202
PHONE: 503 - 231 -0303
FAX: 503- 230 -1044
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 $84.00
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 permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicabp 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 suspe
ed for more the .180
days. ATTENTION: Oregon law requires you to follow the rules - •o•ted by the Oregon Utility Notification C= - er. Those rules e set orth -ircOAR
952 -001 -0010 through O - = :52 001 - 0100. You may obtain a cosy of I e rules or • =ct questions to OUNC by calling 503.24•.66 ^9 •r 1.800.33 .2.2344 /
Issued By.
loo"-- , r ,_ �. Permittee Signature: ' 9 _g7 T 5i i
OWNER INSTALLATION ONLY
I/ -w••
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.
Aug. 3. 2010 2:27PM
y " 1.()
Ir 01:11( t, l s No. 9522 P. 1
Electrical Permit Application � � . .,. Receives 3 ; ao [o 3
3 Permit No.:
City of Tigard »a
•1 -
3 - 1 d , . tt'V Plan Review Other Permit, �, 1(f Z�
1312 SW Hall Blvd., T i g ard, OR 1 Date/t3
■ Phone: 503.639.41 Fax: 503.5 6P ~ , A • See Page 2 for
Line: 503 „ Date Readynsy: Supplemental 2 information
Inspection Lin 639,x175 '4 ' .4 ottfied/Method,
r ic.,�r,t .ti ardor �. �:''”, —
I ntemet: vvww g g ov r• ;
,,, ,�y, * Y: i 3 , g Phi . .., . y:s ,' q v . . ;..h be10W
i � � U= W ' A Please check a that apply (submit a seta of plans withers checked )
Addition/alteration/ i • t �t ❑ Service or feeder 400 amps or more CI Building over three stories-
❑ New construction r y :. r
D Other } whets the available fault current ❑ Marines and boatyards.
❑ Demolition , ; ;; ;,.- exceeds 10,000 amps at 150 volts or d Floating buildings.
z lase to ground, of exceeds 14,(}00 ❑ Commeroial-use agricultural
El 1 and 2 family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Fire pomp ❑ installation of 75 KVA or
r �I Master builder C] Other: 0 Emergency system- larger separately derived system.
{�I MUItI-fati111y .' :-, , motor load of ❑ "A °. "E'. "'1 -2 ", "1-3",
P r., `) to6krio Addition of new m
JO$'SiTE' It•I } . , • - I U AN A 10011P or more. occupancy'
Job no.: n / a Job site address: II illi , "1 C %AL, ► i!, 1 ❑ Six or more residential units.
❑ Recreational vehicle parks.
❑ Healtlt •care facilities. ❑ Supply voltage for more than
City/State/ZIP: ` cox ` U _ IJ Ha18rd0u3 10Ca110n3• 600 volts nominel-
❑ Service or feeder 600 amps or more.
Suite/bldg. /apt. no.: Project name: V ( C 10 / r ':', . ia^ "t>!E& Sf Iila DU1E.E:. • . ; "�'� Iota
Cross street/directions to job site: – New reg single - ar multi family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 168.54 I 4
Subdivision: Lot no.: l 33.92 1
Ea. ode l 500 sq. R. or portion
Limited energy, residential 67.84 2
Tax map /parcel no.; �, :: , ,.. r with above '... R
Old O ?WORK a rt 3 Limit energy, mult 2
` residential with above s.. R.
y +; ■L U ' ' I Services or feeders installation alteration, and/or relocation
- 200 amps or less 100,70 2
a�, 201 amps to Boo am
YRO 133.56
2
PER WNER .4..;_,..g.,,,;!..,;; . k: . 2
T O 401 amps to 600 amps 200.34
Name: � t g .
• 601 amps to 1,000 amps II 301.04 2
552.26 2
Over 1.000 amps or volts
Address: Temporary services or feeders installation, alteration, and /or
City/State /ZIP: _ relocation
---. 200 amps or lass 59,36 1
Phone: ( ) Fax: ( ) 201 amps to 400 amps _ 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits– new, alteration or extension ,er panel
Owner signature; , Date A. Fee for branch circuits with
$n above service or feeder fee, � 42 2
. AFrucA{!1'I' }YU \ :` ; �.. 1 ; - CONCAct�k ERSt '1 ea c hb reachcircuit
B. Fee for branch circuits wirhour
Business name. _ tt _ 11 • service or feeder fee, first 56.18 2
branch circuit
Contact name: Sara Patterson Each add'/ branch circuit 7.42 2
Address: 5411 SE McLau : lin Blvd . Miscellaneous (service or feeder not included
Each manufactured or modular 67,84 2
City/state /ZIP: putlan O$. 97202 dwelliryr service and/or feeder
Reconnect only 67.84 2
Phone: ( 1 ) – I I ' Fax: : ( I ) 1 1 ' ' Pump or irrigation circle 11 67.84 MI 2
E - mail: ,, if ,, , '" 1, o 1. i a • * • Sign or outline lighting 67.84 2
cC :p` - " b is r ``'' Signal circuits) or limited- energy ��
, : nel alteration or extension. 2
Business name: 4 tt : 1 - . c 11 - 1 Each additional inspection over allowable in an of the above
-- Additional inspection (1 hr min) IMI 66.25/ hr
Address: I / • e : • .25/ hr
investigation (1 hr rt in ) - 66
City /State ilF: Po tan • OR '720
Industrial plant (I hr min) - 78.18/ hr
Inspections for which no fee is II 90.00/ hr
Phone: ( 1 ) – I I Fes ( I ) I – t ' ' s. ificall listed ya lir min
CC13 Lic.: uprv. Lic.: ; E1I . . - #LA ' �t c u tl ;; ;:FEES.:::. , .
. t 1 i_ • i ' LB Subtotal;
Supry Electrician signature, required: ite� Plan review (25% of permit fee): Al q
Print name 1 _ r� �,1�p • ,� State surcharge (12% of permit fcc):
!. ie �
TOTAL PERMIT FEE: `
Authorized signature: T his permit application expires if a permit is riot obtained within 180
days after it has bete accepted as complete.
Print name: I Date: * Number of inspections allowed per permit.
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