Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 00227
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
Parcel: 2S115AB01800
Jurisdiction: Tigard
Site address: 11354 SW DURHAM RD
Subdivision: Lot: 0
Project: Chase Bank
Project Description: Security system.
Owner: FEES
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Restricted Energy Permit 10/26/2010 $75.00
PORTLAND, OR 97205 12% State Surcharge - Electrical 10/26/2010 $9.00
PHONE:
Contractor:
ADT SECURITY SERVICES INC
2815 SW 153RD DR
BEAVERTON, OR 97006
PHONE: 503 - 469 -7212
FAX: 503 - 469 -7114
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 0 - 952- 001 -0100. You may obtain a - . - . - s or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B P te_. ". Permittee Signature:
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.
> C/i Electrical ermit Application 1 OFFICE USE ONLY
City of Tigard , 9' -,t Received P e r m it No.:
tY g Date/By: 1(91 I0 Elk b (t) )O )- - 7
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1 G Date/By: Other Permit:
T I G A Ii D Inspection Line: 503.639.4175 [ v Date Ready/By: lam . See Page 2 for
•Internet: www.tigard or.gov v c � q 10�o Notified/Method: "rIK ® Supplemental Information
TYPE OF WORK _ v v r.QO ,n�`` PLAN REVIEW
❑ New construction [�Addition/alteration/ 1 `� ` ` ' W t+0\v Please check all that apply (submit 2 sets of plans w /items checked below):
G 0 ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ Other: ��````\\` C)° where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRU@tION exceeds 10,000 apps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling 14 Commercial /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 no.: p 336 2 - st/ S id 1 jU,€y g /r� �./i t Six or or more. occupancy.
I Job site address: 3 �� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: / / � t 9) c , 7 ❑ Health -care facilities. ❑ Supply voltage for more than
"/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 67/4154 F/9N/C. ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: feGrE ✓` rAN IJ /n/ 4" ' / Description 1 Qty. 1 Fee. 1 Total I •
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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
p �� , Limited energy, multi - family 75.00 2
Q , , �/ ` -- D/2/, aric, L residential (with above sq. ft.)
- Services or feeders installation, alteration, and/or relocation
/-f? e L - . / ,.' i /]� 200 amps or less 100.70 2
❑ PROPERTY OWNER 4 ' ❑ TENA r • V, — ,,,J 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: ID 9f, /l a 601 amps to 1,000 amps 301.04 2
Address: T 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
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 ' 13,20NTACT PERSON above service or feeder fee, 7.42 2
d each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: ,.4.) z2AU S branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included) s
Ci City/State/ZIP: Each manufactured or modular
tY dwelling, service and/or feeder 67.84 2
523 ) / !� -761/L ( ) Reconnect only 67.84 2
Phone: ( v!/ ( Fax:
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal crrcuit(s)orlimited-energy °�
Business name: b T S E d ole i t panel, alteration, or extension. 1 Page 2 /'' 2 •
Y /� Each additional inspection over allowable in any of the above
Address: e>2 e/ .S a) 1$3 ad b Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Be A V CA. TbN Q 9,00 Investigation (1 hr min) 66.25/hr
Industrial plant (1 hr min) 78.18/ hr
I P, : ne: a3 )4.41 - 76 gel I Fax: (i3 ) lie 9- 7// y Inspections for which no fee is
specifically listed (Y hr min) 90.00/ hr
( CCB Lic.: 59 g ve Electrical Lic.: 26. ZO9eze Suprv. Lic.: LEI 3r y ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: "<e,),...., t Subtotal:
Plan review (25% of permit fee):
Print name: KkJgVs Date: / c v .6 • / State surcharge (12 %ofpermit g
TOTAL PERMIT FEE: R 4, p O
Authorized signature: This permit application expires Ira permit B 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 07/01/10 440.461 ST(11'05ICOM/WEB