Permit CITY OF TIGARD
V ELECTRICAL RESTRICTED ENERGY PERMIT
• 13 COMMUNITY DEVELOPMENT Permit #: ELR2009-00187
TIGARD.. 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2009
D
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 430
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Reference Capital
Project Description: Install (1) restriced energy for fire alarms.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 07/14/2009 $75.00
#300 12% State Surcharge - Electrical 07/14/2009 $9.00
PHONE:
Contractor:
STANLEY SECURITY
15495 SW SEQUOIA PKWY #100
PORTLAND, OR 97224
PHONE: 503 - 968 -3353
FAX: 503- 968 -3398
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: y
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: 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 =nter. Those rules are set forth in OAR
952- 001 -0010 th ug AR 952- 001 -0100. You ma obtain a By: VJ �,Or copy of the rules or direct questions to OUNC by calling 503.•699 or 1.800.3 .2344. I �n
Issued B A � /`� Permittee Signature: `� \ OUu ''2
� , � M-" 9
OWNER INSTALLATION ONLY
The installation is being made on property { 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.
Electrical Permit Application R ECEIVED Hoi OFFICE USE ONLY
City of Tigard Received re Permit No.: ? g ?004 e7
11 2 Y g JUL 14 2009 Date/By:
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review - �,�+ � (�.�
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: GC .0103(02..
TIGARD
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Jurist 63 See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: ‘ Supplemental Information
YPE OF WORK PLAN REVIEW '
❑ New construction ►rJ, 'Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition A • ther: where the available fault current ❑ Marinas and boatyards.
CATE ORY 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 ommercial /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 ", "I -3 ",
Job no.: Job site address: (� 1 o spi 1001-11 or more. occupancy.
❑ � �� �j O`• , ❑Six or more residential units. Recreational vehicle parks.
Clty /State /ZIP: � ❑ Health -care facilities. ❑ Supply voltage for more than
���(� Oil- 223 ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: e f ❑ Service or feeder 600 amps or more -
� T . FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Q ,, e Limited energy, multi- family
Ab f1 1N c oks '� _ os .; .. xe S fort residential (with above sq. ft.) 75.00 2
if I ` Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT . , " , 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT - I ❑ CONTACT PERSON . . above service or feeder fee, 6.65 2
each branch circuit
Business name: G- A � 1 f P (4 �`T'v B. Fee for branch circuits
Contact name: a JI s�m without t bra service or feeder fee, 46.85 2
first branch circuit
Address: 15 6 25 SA-) �K¢ Qt oo Each add'I branch circuit 6.65 2
�! / Miscellaneous (service or feeder not included)
2
City /State /ZIP: j (2-7--- R- 7 2 - 24 Each manufactured or modular 90.90 2
+ dwelling, service and /or feeder
Phone:.() ci 6, 83 Fax:: (5C ) 33 J Reconnect only 66.85 • 2
E - mail: Iv Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
c n , (� Signal circuit(s) or limited- ✓
Business name:
�4 c, 1 SL (4 LI ffl' energy panel, alteration, or
Address: / 541 c S ki Y Ce0 k cm- extension. Describe: Paget 2
1 "
City /State /ZIP: p o it. 9 .1-- Each additional inspection over a lowable in any of the above
Per inspection 62.50
Phone: ( � b
g
r 3 &oa Fax: (�� 496 3 Investigation per hour (1 hr min) 62.50
CCB Lic.: 1 b` 5 7 Electrical Lic.: gsyC(eSuprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name:p / �/) `� Date: 7,1 {,� � Plan review (25% of permit fee):
` 1► W Q + t t�+� a� Si Q i 7 State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: &Lf, CO
/ This permit application expires if a permit is not obtained within 180
Print name: t� ►� Date: 14/a days after it has been accepted as complete.
Number of inspections allowed per permit.
I:\ Building \Permits \ELC- PermitApp.doc 05/23/06 440 - 4615TH I /05 /COM /WEB