Permit .: CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
>s COMMUNITY DEVELOPMENT Permit #: ELR2010 00156
:ii G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/17/2010
Parcel: 1S134BC00800
Jurisdiction: Tigard
Site address: 12398 SW SCHOLLS FERRY RD
Subdivision: Lot: 0
Project: Oil Can Henry's
Project Description: Security alarm.
FEES
Owner:
DAVIDSON, WILLIAM G Description Date Amount
BY NORTHWEST DEVELOPMENT GROUP, Restricted Energy Permit 08/17/2010 $75.00
1200 NW NAITO PKWY STE 690 12% State Surcharge - Electrical 08/17/2010 $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 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 OA: 952- 001 -0100. You may obtain a copy o direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Li -- - Permittee Signature: - ' /` a - sf. .te
- --
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 until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Aug 12 2010 2.19PMe• •
r oxcation RECEIV No. 9767 • P. 1
City of Tigard Received
D ate/By: 131/ 2 10 e-7-7- Perrnit No.! 0.. L R k J_ (9 51,
. _.-- ., 13125 SW Hall Blvd., Tigard, OR 97223 A , ''' 1 0 ' • ' ',.. ; PIRgview
' Phone; 501.639.4171 Fax: 503,598.1960 i''' 1. 1 4d t - ' Ds
I N
Other Permit
1 0. ,Al n inspection Line: 503.639.4175 , - , - , thicr RD te Ready/By: hi Ed See Page 2 for
Internet: www.tigard-or.gov CITY. ° 1 1"I\ NNotified/Method: Supplemental Information
1 . 1 1 . N i . .
:" •••• , • •.... '. • •••'.' • ''... ; • : '' ' .• • :::: '''.•:.:•....•':::: 11iir bitVgaitt•Pfri' ?;••,i' %';3.:';'';;;,A'lifi•341: :•' .;) ' • .
D New construction DI Addition/alteration/replacement Please check all that apply (submit 1 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 13 Building over three stories.
0 Demolition l=I Other: where the available fault cumuli 0 Marinas and boatyards.
: ' . ' ' . ' ' ":...•,•; • ' ' ' ' • ''' I '.:0: : exceeds 10,000 amps at 150 volts or 0 Floating buildings.
• - ' ' ''' ' ' ' '' '' 4 " ' '' '. '' 's less 10 atound, OT exceeds 14,000 0 Commercial-use agricultural
ID 1- and 2-family dwelling Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family Master builder 0 Other: Prim pump, 0 Installation of 75 KVA or
. • •,• • • •• • • . , , ,,
.'.'' 0 Emergeney system. 0 la system.
• • • .. •• , • • . . L stMIN0 .00 . 0it . :''.."'..'...?.. 0 Addition of new motor load of
..
1-.... 100HP or more. occ.upancy
Job no.: il Job site address: fa - 598 sig s b „.,_,... . six v. mom residential units.
0 Recreational vehicle parks
-,
0 Health-care facilities. 0 Supply voite for more than
City/Statc/ZIP; 1 - Cgra (5 . C I iaa3
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: I Project name: (51 1 ( yi .10 ‘ •••••) 0 service or feeder 600 amps or more.
: :: ',..:•.,:].;'.::...'• ''•'..:••''!...i
... :, .. . .. , .. .. .
Cross street/directions to job site: Detelipllen 1 Qtr. I Pee. 1 Tote 1 •
New residential single- or multi-farnity dwelling unit.
Includes attached oarege.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
- Ea. addl 500 sq. ft or portion 33.92 1
Tax map/parcel no.: . Limited energy, residential
67.84 2
' . :... • , ,.. ... ' ,. :... ... ' ... , ,..• . :...bir4iclOtioir ,.,:•,11,, :4 (with above sq. A.)
Limited energy, multi-family
tt let e .
• ii LA I
.. • a ilAl residential (with above sq. ft.) 67.84 2
- . ilk
- Services or feeders installationalteration, and/or relocation
-- 7 a
200 amps or less 100.70 2
. .• . .'; 11 .• " opERry,ovint,.:., •,. ,...„, :.,...,. 201 amps to 400 amps 133.56 2
. -
401 amps to 600 amps 200.34 2
Name: CA\\Lcw#1.\ I r V y\x \I 1.
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/StateJZIP: relocation
Phone: (503) 590 . i s,? 5 , ,; 1 , 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 1 own which is not
ps
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 599 an 168.54 2
Branch circuits - new, alteration, or extension, . er panel
Owner signature: Date: .. A. Fee for branch circuits with
above service or feeder fee,
7A2 2
• ', ' . •'' ;., ''.. APPLicANT'.': ';'•' ' ''7':i:':?•; ...'''l ,:-., :,,•:'':''•••• ..•;:. 2 ' c - ' ''•': '
i
'''' ' ' ‘ each branch crcuit
Business name: B. Pee for branch circuits without
American Security Alarms, Itle service or feeder fee, first
56.18 2
Contact name: Sara Patterson branch circuit
Each add'I branch circuit 7.42 2
Address: 5411 SE MoLouglin Blvd. Miscellaneous (service or feeder not included)
ach f
manuacturer' or modluar
City/State/ZIP: . OR . E 67.84 2
a 1.. . 1 dwel service and/or feeder r .,
Reconnect only 67.84
Rime ( 5na ) 2.31 -nans Fax: : ( 5 03 ) 230-1044 - Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
•
'''..'.'...•.- ." .::••• : ;..''.......•;:-• ..'.'.:
, . * 4.=4',:: , ;;:w. , 1 , ,•:• , ! :,, • ,, ,.:L - :, ,, , 1 7 • . . • .
• . . • • , : . • • .„ • . • , ., ••., • • • . Signal circuit(s) or limited-energy 1
C (0
Business name: panel, alteration, or extension. 1 Page 2 1 .e. 2
American Secnrity_Al.arms, Inc. - Eacb additional inspection over allowable in anLof the above
Address: SE McLovglin Blvd. Additional inspection (1 hr min) 66.25/ hr
s4.11
Investigation (1 hr min) 66,25/ hr
City/State/ZIP: Portland. CLR, 97202 Industrial plant (1 hr min) 78,18/hr
Phone: ( 5 )
ua 231-03 3 Fax: ( 503 ) 230-11144 Inspections for which no fee is
90.00/ h
specifically listed (V. hr min) r
CCB Lic.: . Electrica _A,: , - . , . . S ',I 4 L. Lic.: ” 74LEA ••::•‘•••••,.....:.);' n't-FEES•;:.;: '1 • ••'''• • • .
. . I Il '• ' ' . Subtotal; - 15. lib
Suprv. Electrician signature, required. . 411)
Plan review (25% of permit fee); it) iq
,,
Print - • I
t name: 11.1, DateAlt; ... I J.. _ Suite surcharge (12% of permit fee):
: .. z I :.
Authorized signature:
OF _ TOTAL PERMIT FEB: 8 .00
Thls permit application expires if a permit is not obtained within 180
Print name:
days after it has been accepted as complete.
ate: D
" Number of inspections allowed per pemiit.
4404615T01/05/COMAVES
1:\BuiWingTermlisumc.permitApp,doc 10/0I/09