Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00111
T I G AR. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/16/2009
Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16505_SW. _72ND.AVE - - --
Subdivision: PA CTRUST BUSINESS CENTER Lot: 0
Project: Safeco
Project Description: Install restricted energy for access control.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 04 /16/2009 $75.00
#300 12% State Surcharge - Restricted Energy 04 /16/2009 $9.00
PHONE:
Contractor:
ARONSON
8089 SW CIRRUS DR
BEAVERTON, OR 97008
PHONE: 503 - 639 -9988
FAX: 503 -684 -4357
Type of Use:
Class of Work:
Total Number of Systems:
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm:
HVAC: Instrumentation: Total $84.00
Intercom/Paging: Landscape /Irrigation:
Landscape Lighting: Medical: Required Items and Reports (Conditions)
Nurse Calls: Protective Signal:
Security Alarm: Other:
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 thro h AR -- 001- , 01 10 00. p You ay ob a copy of the rules or direct questions to OUNC by calling 5 6.6699 or 1.8.0.332.2344.
Issued By: C` �' 1'�l ' 1l ` ?C►^ Permittee Signature: ' • p 1
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'N Date:
LICENSE NO.
CaII 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 Applicatio FOR OFFICE USE ONLY
Rec eived
City of Tigard Date/B : • . • Permit No.: C• l K 4141" -
1 11111
a 13125 SW H Blvd., Ti ard, OR 97 2 4'
g Plan Review
. ° _ ' Phone: 503.639.4171 Fax: 503.598.196Q 1 1 DateB ' Other Permit:
• TIGARD Inspection Line: 503.639.4175 H 0 2009 Date Ready/By: Jur'' ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: of /CO- Supplemental Information
TYPE
CITY or D ®A o PLAN REVIEW
❑ New construction ®Addition/alte r e t pplaCeme nt 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 ❑ 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 ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2", "I -3 ",
Job no.: PDX -8298 Job site address: 16505 SW 72ND 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD OR 97224 -7761 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: SAFECO INSURANCE ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1 •
— New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family
INSTALL ACCESS CONTROL SYSTEM 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: SAFECO INSURANCE . 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 16505 SW_ 72ND. •. Over 1,000 amps or volts - - 454.65 • 2
City /State /ZIP: TIGARD OR 97224 Temporary services or feeders installation, alteration, and/or
relocation _
Phone: (978)253 -5030 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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
L ❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit _
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
' CONTRACTOR Sign or outline lighting 53.40 2
Signal panel, or limited -
Business name: ARONSON SECURITY GROUP
energy panel, alteration, or
Address: 8089 SW CIRRUS DR extension. Describe: 1 Page 2 75.00 2
City /State /ZIP: BEAVERTON OR 97008 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 639 - 9988 Fax: (503)_684 -4357 Investigation per hour (1 hr min) 62.50
CCB Lic.• 185024 ' Electrical Lic.: 6- 1u.� Suprv. Lic.: 0) CO Industrial plant per hour 73.75
S . ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 75.00
i
Print name: , allti -zC L -- Date: 6 n Plan review (25% of permit fee):
P� c 1-/ State surcharge (12% of permit fee): 9.00
Authorized signature: n/Lp iL - TOTAL PERMIT FEE: 84.00
t / &, This permit application expires if a permit is not obtained within 180
Print name: 1 ak Ike L ii_ ,(� Date: t {Q days after it has been accepted as complete.
* .Number of inspections allowed per permit.
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