Permit CITY OF TIGAR® ELECTRICAL ENER -
RESTRICTED ENERGY
iy DEVELOPMENT SERVICES PERMIT #: ELR2001 -00230
M
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/17/01
SITE ADDRESS: 15995 SW 74TH AVE 200 PARCEL: 2S113A6 -00800
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Burglar alarm.
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: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
DUNCAN, JOHN A AND PROTECTION ONE ALARM MONITORIN
JANICE LEE 15500 SW 72ND AVE
7060 SW PALMER WAY PORTLAND, OR 97224
BEAVERTON, OR 97007
Phone: Phone: 624 -0244
Reg #: ELE 34- 428CCLE
LIC 116325
FEES Required Inspections
Type By Date Amount Receipt Low Voltage Inspection
PRMT CTR 9/17/01 $75.00 2720010000 Elect'I Final
5PCT CTR 9/17/01 $6.00 2720010000
Total $81.00
EXPIRED
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 rare set forth in OAR
952 - 001 -0010 through OAR 952 -001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246-1987. dL Q, •
Issued by 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'N: 2"7 i9-pfo -, 177 A i DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application
Date received: 9 /7 O/ Permit no.: EL/j Zoo J — 40 2..50
A y.Ylp 1,, ,,I L City of Tigard Project/appl. no.: Expire date:
CityofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: B �/� Receiptno.:
Phone: (503) 639 -4171 ���� p
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
• TYPE OF PERMIT '
❑ 1 & 2 family dwelling or accessory VCommercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
• JOB SITE INFORMATION
Job address: /5''qy,�s to 9r5'id"a ,cfG �ln- Bldg. no.: Suite no.:"v-e Tax map /tax lot/account no.:
Lot: I Block: 'Subdivision:
Project name:/, r 7Z4v_SPo27 /NG I Description and location of work on premises: 1,7 51 ( (r.rr , - i - , � ,rer� h , 4 f S
Estimated date of completion/inspection: •
• , A `- CONTRACTOR APPLICATION , • , FEE SCHEDULE • . .
Job no: /4, / .'-()/ Fee Max
Business name: C r7 Description Qty. (ea) Total no. insp
' e G o New residential - single or multi - family per
Address: /S'5 .5a) P ' /doe '{e:. /G;' v dwelling unit . Includes attached garage.
City: y-i 40 I State;O,e I ZIP: 97'-J' Service included:
•
Phone:,-5f-,4/.g2 I Fax:,�64.„ E -mail: 1000 sq. ft. or less 4
o I .Q -(* � ,G/= Each additional 500 sq. ft. or portion thereof
//
CCB n0.: 'Elec. bus. 11C. n0: Limited energy, residential 2
City /metro lie. no.: - Limitedenergy,non- residential 2
/ fs`1.-- - q ,,. / 2 -p / Each manufactured home or modular dwelling
Signattire ofsupery sing electrician (required) Date Service and/or feeder • 2
Sup. elect. name (print): ,1 ,ZR, f ?S License no:/ "G? --,c Services or Feeders — installation,
alteration or relocation:
- , .• ':,1 PROPERTY OWNER
200 amps or less 2
201 amps to 400 amps 2
Name / r - 04 g•, o - T/7 'v 401 amps to 600 amps 2
Mailing address: L.5" V-e c..)--e.) 601 amps to 1000 amps 2
City: p, -/- / s ,2, State: de I ZIP: 4. 72.... `--/ Over 1000 amps or volts 2
Phone: z!y' 3 "�3�7 I Fax: I E -mail: R econnectonl y i
Owner installation: The installation is being made on property I own Temporary services or feeders - . .
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
200 amps or less
20
ORS 447, 455, 479, 670, 701. 201 2
1 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: 'State: - I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc .(Serviceorfeedernotincluded):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
❑ Service over 320 amps- rating of 1 &2 0 Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, /� //
/5
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* { ) �6J' : 2
❑ Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection 1 1 1 i
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other �y
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $ (,' a
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ !J
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ ' '
Expires accepted as complete. TOTAL $ 7/ ‘
Name of cardholder as shown on credit card
Cardholder signature $ Amount EX 440 - 4615 (6/00 /COM)
Electrical Permit Fees: Limited Energy Fees: `
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 1, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional. 500 sq. ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less $80.30 2 n Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n Other
Over 1000 amps or volts $454.65 2 .
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918- 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, n
see "b" above. Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or n Clock Systems .
feeder fee. .
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85 • Each additional branch circuit $6.65 n HVAC
•
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above n Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: 1. Protective Signaling
Enter total of above fees $ n Other . .
8% State Surcharge $ Number of Systems
•
25% Plan Review Fee
See "Plan Review" section on $ ` No licenses are required. Licenses are required for all other installations
front of application.
Fees:
•
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
i:\dsts \forms \elc- fees.doc 10/09/00