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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT e . COMMUNITY DEVELOPMENT Permit #: ELR2010 00218 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/14/2010 Parcel: 1 S 136CA01600 Jurisdiction: Tigard Site address: 11655 SW PACIFIC HWY Subdivision: Lot: 0 Project: RAZ TRANSPORTATION Project Description: Security alarm system. FEES Owner: AMAN, WALTER S CREDIT SHELTER TR Description Date Amount AMAN, WALTER S MARITAL TRUST ET AL, BY Restricted Energy Permit 10/14/2010 $75.00 STEPHEN D AMAN TR, 19217 SW 119TH AVE 12% State Surcharge - Electrical 10/14/2010 $9.00 PHONE: Contractor: A & E SAFE & ALARM CO PO BOX 179 MCMINNVILLE, OR 97128 PHONE: 503 -472 -6439 FAX: 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 Required Items and Reports (Conditions) Landscape Lighting: N Medical: N 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 R 952- 001 -0100. Ypu may obtain a cop rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By. — i ce Permittee Signature: o 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. 5034723570 p.1 Oct 12 2010 4:O1PM A e) Electrical Permit Applicati r E 5 M'` �?� 7 � hO12 O! FILE 1;11'. (l: \L)' City of Tigard Received (� a � 7111 13125 SW Hall Blvd., Tigard, OR 9722`3 T O llate/By: 'dm a7-7- No.: €L �� _ ()oat/ i s Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit 1.16 ry tt D Inspection Line: 503.639.4175 �x1' : C.. � �, ! , ` „ 6, - t"r Date Ready/By: Internet: www.tigard or.gov � i t Notrfied/ethd: Judy See Pane 2 for e x . e ilB ( t - { I ,. � r I PP mental information r t:i LP;, .- .. - PLAN REVIEW • ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets tat wfitcros checked below): ' ❑ Demolition Other; ❑ Service or feeder 400 atnps or more ❑ Building over three stories. 1 ❑ where the availabk fault current CI Marinas and boatyards. . ,. s_ ; ( t0 / ) t+!1`P rt, , S? .i4T ?hta! 1'' 1 1 " � . n`, .t!. _ exceeds 10,000 amps at 150 volts or ID Floating buildings. El 1 - and 2 - family dwelling ommercial /industrial Accessory building less to ground, or exceeds 14.000 ❑ Commercial -use arieultural ❑ Y g amps for all other instaliaboru. buildings. ❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation _ }�� r: ,u N n^, �, -F � Installation of 75 KVA or h1hy !?" � " it ❑ 3m. tor load of larger separately derived v . '-"= "' u� -- - , , r 7. . :.l( . , f ❑Addit ency ofnew ❑ 4 6 s, u_m. Job no.: Job site address: l' 6 Sr `) I/.J i ct 2AC, Ctk \ "r^'v 100 HP or mre o. occupancy ❑ S tx of more residential units. ❑ Recreational vehicle parks. City /State/ZIP: o c c v �p (31� (�'q� ❑ Health -care facilities. ❑ Supply voltage Fut more than r Lvl l ,J ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: tZrj1/4. C t � 3( kY \. ❑ Service or feeder 600 amps or more. l ls; i. -•+,, :`;. - :'FEE`SCHEDULE Cross street/directions to job site: aiserinrlou 1 Qty. 1 Fee. 1 Total 1 New residential single- or multi- family dwelli rig unit. includes attached garage. Subdivision: 1,000 s Lot no.: q. ft. or less 168.54 4 Tax map /parcel no.: Ea. add'I 500 sq. ft or portico 33.92 1 _ +•- A.:....,...., ._ t Limited energy, residential • �u Z :. +,,',+ p ',,,1•.. 0 '*g.I }a , � Yt .:... -`, f4 'k,': r (v.ith above sq. ft.) ;5.00 2 ' I � ^ � Limited energy, ith a b ove i 1 q . U l residential (with a bove q. ft.) '50(1 2 Services or feeders installation, alteration, and /or relocation amps or Tess ©..p'x....•,.s . „5i*w” "6°,. t'rt¢ 1 1 : a> .*NJ 5z!'0 r `` •5... 20 amps to 400 amPs 133 2 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 7 City /Stale /ZIP: Temporary services or feeders installation, alteration. aud/or relocation Phone: ( ) .1 Fax: ( ) 200 amps or less 59 36 ` Owner installation: This installation is being made on property that I own which is not 201 amps to aoo amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 1 68.54 1 Owner signature: Branch circuits- new, alteration, or extension, per panel . a . 0 . e: ..;- '..r �:• • i - — Ste' A. Fee for branch circuits with :'r41 0 , t ; , „t } . V,V6 $' t , fit; ; ?• 4" above service or feeder fee, 6 "' t'`' ` each branch circuit 7.42 Business name: B. Fee for branch circuits without — L service or feeder fee, first Contact name: branch circuit 56 18 2 Address: Each add': branch circuit 7 2 Miscellaneous (service or feeder not included) City /StatelZiP: Each manufactured or modular 67 84 1 2 dwelling, service and/or feeder Phone: ( ) I Fax:: ( ) Reconnect only 67 1 2 - mail: Pump er irrigation circle 67 2 ,Y j `, ,.; ;. er •;' <. �, - :.: �; i,.: ,. ...x;, U Sign or outline lighting 67.84 2 . },.. +<l y't f {} :. ' �Cli" r .., .': f ., . . Signal circuit(s) or limited energy p Ilbn•'� � twt C. IR .T(Grl , Business name t1--I_ 1t__ ' I C- so! r panel alteration or extension Page 2 '72 ULlf ll I g Each additional inspection over allowable in any of the aboveAddress: 2 - `J s- E q Additional inspection (I hr min) _ 66.25/ hr v -1 � � t City /State /ZiP: C �M + � 4 I �/ 1 Investigation (1 hr min) 66.25/ hr � l _ Industrial plant (] hr min) 78.18/ hr Phone: (( J3 Q Q `O 7 - L ( Elcctric 110 Fax: (S/x^7lJJ , Qn ) _ 7 / 0 ( / Q inspections for which no fee is ' l 9000/ CCB Lie.: al Lic.: c 0 - rv. Lie.: .1? p 41Li9 . u - : ELECTRICAL PERMIT FEES ' � Suprv. Electrician 14, required: 4 Subtotal Plan review (25% of permit fee): Print name: M G �1_ _ , D I 0 j i � f io State surcharge(12 %ofpermittee): - 8 — . C. 17RX / 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. I leuileingTeimitrE LC -PermitApp.doe 07 /01;10 4 4CA615T(I Itt15 /COM"w5B Oct 12 2010 4:08PM R & E Security 5034723570 p.1 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL'WORK ; ON?Y:. -,:.. , r ...........t= . Fee for all residential systems combined $75.00 Check Type of Work Involved: [] _Audio and Stereo Systems* LI Burglar Alarm 0 Garage Door Opener* 0 Heating, Ventilation and Air Conditioning System* E l Vacuum Systems* Ei Other: . COMMERCIALWORK OMSO ,. -.h W ,. h<: r -_, i Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: O Audio and Stereo Systems ❑ Boiler Controls 0 Clock Systems ❑ Data Telecommunication Installation Fire Alarm Installation El I -IVAC LI instrumentation [I Intercom and Paging Systems O Landscape Irrigation Control* El Medical D Nurse Calls , Ei] Outdoor Landscape Lighting* r j C� El Protective Signaling / _ _ 'then 6M el-l r i Total number of commercial systems: *No licenses are required. Licenses are required for all other installations Mi luildilsl resmi'5\ELC- pumitApp.doe TN I!10