Permit li e : .1 . CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00109
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/26/2007
PARCEL: 2 S 113A D - 01800
SITE ADDRESS: 16650 SW 72ND AVE B12 ZONING: I - L
SUBDIVISION: OREGON BUSINESS PARK I LOT: 011 JURISDICTION: TIG
PROJECT: JOHNSTONE SUPPLY
Project Description: Replace fire alarm panel
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: :
TOTAL # OF SYSTEMS: 1
Owner: Contractor: ,
PACIFIC REALTY ASSOCIATES ADVANCED SECURITY & FIRE
15350 SW SEQUOIA PKWY #300 -WMI 2218 NE SUNRISE LN
PORTLAND, OR 97224 HILLSBORO, OR 97124
Phone: Contact #: PRI 503 -519 -4550
FAX 503- 640 -8311
FEES Reg #: ELE CLE8
LIC 166176
Description Date Amount SUP 611 LEA
[ELPRMT] ELR Permit 4/26/2007 $75.00
[TAX] 8% State Surcha 4/26/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: C nt Permittee Signature:
C.
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:
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.
Ilik. 07 09:20a D i d r: ' ;i 503640831 1 to . 2
Electrical Permit Appl boa 16\ 1.0R . O r r l (1.1 ti t . ON I,\
City of Tigard Q� c r d .. Permit No.:.�Xa o o /o7
pp-��
1 &J
III 13125 SW Hall Blvd., Tigard, OR 9722) ` , i ew Other Permit;�u � O J
C Phone: 503.639.4171 Fax: 503.598. r , ' �`1, 1 Date/By:
y
T I G ;1 R n Ins Line: 503.639.4175 O ' K S ! >' - '� N�tfed/M od ham: ' ®See Page 2 for
: Supplemental Information
Internet: www.tigard- or.gov �`� '�
TYPE PLAN REVIEW
Please check all that apply (submit is sets of plans w /items checked below):
❑ New construction k^ ddition /alteration /replacement ❑ Service or feeder 40D amps or more ❑ Building over throe 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
CI 1 - and 2 - family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Fire pump. ❑ installation of 75 KVA or
❑ Multi family CI Master builder ❑ Other: ['Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ". "E . "1 "I ".
/` �� / / ❑ In or or more. occreaion.
Job no.: Job site address: Cp PL Six or mote residential units. ❑ Recreational vehicle parks.
/ /� p �7 ❑ Health -care facilities. ❑ Supply voltage for more than
City/State/ZIP: Q ry /a / 6/ � o K ! / 2 21 ❑ Hazardous locations. 600 volts nominal.
�
I ye /� _ _ / / / ❑ Service or feeder 600 amps or more. ,
Suite/bldg./apt. no.: Project name: A Fq f , j�jSQ�r FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fm I Tatar 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage. .
I Lot no.: 1,000 sq. ft. or less 145.15 _ 4
Subdivision: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Rio /�[ "FR e. Q 4 C/ 9 a/7e / residential (with above sq. R)
/' Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 1 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
F _ ( ) 200 amps or less 66.85 1
Phone: ( ) j I es
201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 133.75 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or ex tension, per panel -
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fec, 6.65 2
q� each branch circuit
Business name: xidfri. met ('e / ,If� . ,c � t' B. Fee for branch circuits
_ without service or feeder fee, 46.85 2
Contact name: 2 4 £/ //b '7OE, } , / ,' first branch circuit
Address: 22 / 6 /V G S�,v ,Uf , E ach add'' branch circuit 6.65 -
Miscellaneous (service or feeder not included) 2
City/State/ZIP: 775 //S �� CJ1e / ? 7 / Z/ Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (,...3 ) 5? 9 - i. I Fax.. (�3) a .52".0 - 5l3// Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
additional circuits) or limited
Business name: /96/, e!ed AI ' ' energy panel, alteration, or
/� , /C . extension. Describe: Page 2 2
A ddress: 2z�Tl /t'G �.//7� $ e el
City/State/ZIP: / /5befro / OR ! 7/ 2� Each h dditional inspection over allowable in any of the above
62.50
Phone: (5 ) 579 - evessd Fax: (.saj )o - 83// Investigation per hour (1 br min) 62.50 1
CCB Lic.: /44/7K, I Electrical Lic.: ' Suprv. Lic.: o,//Z6.79 Industrial plant per hour 73.75
• -
required: 5 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, req Subtotal: 7 CT
t Plan review (25% of pnit fec):
Print name: G ���j - L7� fie 2 0-7 e pennit
surcharge (8% of permit fee): 69, 0
Authorized signature Q e1/' ` 10-41.476 TOTAL PERMIT FEE: 9/,
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
CITY OF TIGARD _
BUILDING DIVISION PERMIT #: ELR2007-00109
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/26/2007
Phone: (503) 639- 4171�
Inspection Requests (24 Hrs.): (503) 639 -4175 s `__
INSPECTION WORKSHEET FOR DATE: 5/22/2007 TIME: 7 :01AM PAGE: 36
SITE ADDRESS: 16650 SW 72ND AVE B12 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 011 TYPE OF USE:
PROJECT NAME: JOHNSTONE SUPPLY
DESCRIPTION: Replace fire alarm panel
OWNER: PACIFIC REALTY ASSOCIATES. PHONE #:
CONTRACTOR: ADVANCED SECURITY & FIRE PHONE #: 503-519-4550
Inspection Request Scheduled For: Date: 5/22/2007 Pour Time:
Code # Inspection Description ;Confir # Contact # Message
135 Low voltage 048800 -01 5 518.4550 Y
Corrections /Comment Instructions:
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PASS !?:' RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C- 000 LI Date: 1O Phone #: (503) 718- yr l