Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a • COMMUNITY DEVELOPMENT Permit #: ELR2010 -00254
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/12/2010
Parcel: 1 S127DD00100
Jurisdiction: Tigard
Site address: 9730 SW CASCADE AVE 100
Project: Shane Company Subdivision: Lot: 0
Project Description: Install card access system.
Contractor: ADT SECURITY SERVICES INC Owner: GM SHANE LLC &
2815 SW 153RD DR MAX R BROWN LLC ET AL
BEAVERTON, OR 97006 BY WESTERN STONE & METAL CORP.
9200 E MINERAL AVE STE #200
CENTENNIAL, CO 80112
PHONE: 503 - 469 -7212 PHONE:
FAX: 503 - 469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/12/2010 $75.00
12% State Surcharge - Electrical 11/12/2010 $9.00
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
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: Y Total $84.00
Other Desc: Required Items and Reports (Conditions)
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 -0090. Y•u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
,di _41 Issued By: Ata % _ 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 603.639.4175 by 7:00 a.m. for the next available inspection date.
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 RECEVE 1 Received FOR OFFICE USE ONLY
1,,, • City of Tigard D /7 /02 /d if Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 NOV 2 2010 plan Revie
C Phone: 503.639.4171 Fax: 503.598.1960 N L+ Date/By: Other Permit.
T I R 1 ) inspection Line: 503.639.4175 Date Ready /By: mrisyi /� . ® See Page 2 for
"Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: • / `ts Supplemental Information
TYPE OF WOtyhILDING DIVISION PLAN REVIEW •
❑ New construction gAddition/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 ❑ 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 al 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.
V — ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "I -3"
Job no.: //S 3a - 3 I Job site address: q73 ,5 1,) cAse,¢ i9v—e— 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: / ( 4 Q/ 97.ga 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.:/00 Project name: „ j(/C Co , ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
: DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
1 Limited energy, multi - family
S/2/1/ Q e�2t7 l eee-Cr Sy‘ 4'/)) 7v residential (with above sq. ft.)
75.00 2
/ Services or feeders installation, alteration, and/or relocation
,ee1 /�9Ce g- /STI>y 5 . 200 amps or less 100.70 2
• ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 .. 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 . 2
Address: Over 1,000 amps or volts 552.26 ; 2
City/State/ZIP: /State/ZIP: Temporary services or feeders installation, alteration, and/or
�' relocation
Phone: ( )
Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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 ex tension, per panel a
Owner signature: Date: A. Fee for branch circuits with •
❑ APPLICANT ' above service or feeder fee,
I ' " 0 CONTACT PERSON .. ., each branch circuit 7.42 2 is
Business name: B. Fee for branch circuits without
-- service or feeder fee, first
Contact name: t ���' id- A) branch circuit 56.18 2
� Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
ty dwelling, service and/or feeder
Phone: (5213 Sg r -790 Q Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy 7S"
panel, alteration, or extension. Page 2 2
Business name: D T S E e (/� / T �/ Each additional inspection over allowable in any of the above
Address: e2 8/.5 s u) /5,3 ad D g Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Be A v t � D Q 9700 6 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: a3 )'( 76 9 9 Fax: (03) 1/6€?- 7 / /e/ Inspections for which no fee is 90.00/ hr
. specifically listed (4 hr min)
CCB Lic.: $' q 41/ I Electrical Lic.:2(e• zol e r Suprv. Lic.: ( 3 r y ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: ke / k Date: // /Q —// State surcharge (12% of permit fee): 9 00
TOTAL PERMIT FEE: R .t` 0 0
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N umber of inspections allowed per pemtit.
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