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Permit CITY OF TIGARD ELECTRICAL PERMIT q Irh 0 COMMUNITY DEVELOPMENT Permit #: ELC2010 00414 I c A R Di 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/10/2010 • T Parcel: 2S110DCO2300 Jurisdiction: Tigard Site address: 11555 SW DURHAM RD A -4 Subdivision: Lot: 0 Project: Oregon Music Academy Project Description: Security alarm. Owner: FEES HIP WILLOWBROOK LLC Quantity Description Date Amount BY TAX DEPARTMENT, PO BOX 2708 PORTLAND, OR 97208 1 ea Signal circuit or Limited 08/10/2010 $75.00 Energy Panel PHONE: 1 ea 12% State Surcharge - 08/10/2010 $9.00 Electrical Contractor: PROTECTION ONE ALARM MONITORING 15500 SW 72ND AVE PORTLAND, OR 97224 PHONE: 503 - 624 -0244 FAX: Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Total $84.00 Required Items and Reports (Conditions) 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 through OM . - 001 -0100. You may obtain a copy of the rules direct questions to OUNC by calling 503.246.6699 or 1.800.332.23 . Issued By: " �iK -- --� Permittee Signature: . .)e.. . ilGi2i -e- 2-- 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' 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 untll completion of the project Approved plans are required on the Job site at the time of each inspection. Electrical Permit Application I IZ qfficE, ,us oN1 y CI of Ti and t, Received �j `.1 g AN i ` Date/By: j (0 /0 err Permit No.: F w � I l ,,�- k , ) 9 IL, q 13125 SW Hall Blvd., Tigard, OR 97223 Y v Plan Review C Phone: 503.639.4171 Fax: 503.598.1960 �� {� Date/By: Other Permit: ' H c ; AR]) Inspection Line: 503.639.4175 1 U Date Ready/By: Juris El See Page 2 for Internet: www.tigard- or.gov Al 1 3 0 (, Notified/Method: '76 Supplemental Information TYPE OF WORK l rTNI (� 7 1 ., c. PLAN REVIEW ❑ New construction ❑ Addition/alteration/re g 1� � DIN Please check all that apply (submit 2 sets of plans w /items checked below): i 1111JJJJ ` ❑ 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 [aCommercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ['Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job site address: r ^ ,, ]� I OOHP or more. occupancy. Job no.: /0Z7 f0 � 7-r // S S] 4J /J/���AN� /!!J , ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: ^ ❑ Health -care facilities. ❑ Supply voltage for more than t J �� ��� 7 �'7 ❑ Haaardous locations. 600 volts nominal. Suite/bldg. /apt. no.: S4;a.,e Az/ Project name: 6)16'40 /J riftiS J c 4614 E// ✓ ❑ Service or feeder 600 amps or more. 'FEE SCHEDULE Cross street/directions to job site: Nal z 9 9 Description 1 Qtr. 1 Fee. 1 Total 1 * New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential sq. 75.00 2 DESCRIPTION OF WORK ( with above q• ft. ) • Limited energy, multi - family ece,fet y /f /frig I,"1 -tiS 1`4 / /�qIi 4) residential (with above sq. ft.) 75.00 2 Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 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, per panel Owner signature: Date: A. Fee for branch circuits with • ❑ APPLICANT • ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: ed 6 , - /k 7/0 � C" B. Fee for branch circuits without `� "� service or feeder fee, first 56.18 2 Contact name: , E. s ` `/ 2)E0 ..c'E branch circuit Each add'I branch circuit 7.42 2 Address: /. 5-!4 �o2 & /lad - , Miscellaneous (service or feeder not included) / � Each manufactured or modular City /State /ZIP: /"d,e 4//J46 ,,e L p 9 ol• LI dwelling, service and/or feeder 67.84 2 Phone: Fax:: Reconnect only 67.84 2 ( ��) y�/3 - a e i3 v ( ) Pump or irrigation circle 67.84 2 E - mail: LUi /I tQ NA. OASC,r- - e <S6i• e,--bo.0 , r Cosy. dJ Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited energy Business name: s' / panel, alteration, or extension. - Page 2 75 2 CT e of C Q Each additional inspection over allowable in any of the above Address: Additional inspection (1 hr min) 66.25/ hr City /State /ZIP: Investigation (1 hr min) 66.25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr specifically listed (%2 hr min) CCB Lic.: / /6 315 Electrical Lic.: 3y- 4 /77 Lic.: 2s LeA ELECTRICAL :PERMIT FEES Suprv. Electrician signature, required: Subtotal: 7� Su p g q C� i4..) Plan review (25 % ofpermit fee): Print name: w://,' 04 b FUJ�ESr fate: D /fi /AO State surcharge (12% of permit fee): 2 / J /) / This permit PERMIT FEE: Authorized signature: 6 This ermit a Itcation expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: • Number of inspections allowed per permit. 1:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11/05/COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL: WORK ONLY: Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ©- Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: rCOMMERCIAL WORK,ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC • ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I: \ Building \Permits\ELC- PermitApp.doc 07/01/10