Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I A il '' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00062
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/15/2011
Parcel: 2S112DC00500
Jurisdiction: TIGARD
Site address: 15887 SW 72ND AVE
Project: Knouf Investments Subdivision: OREGON BUSINESS PARK III Lot: 40
Project Description: Security system.
Contractor: AMERICAN SECURITY ALARMS, INC. Owner: PACIFIC REALTY ASSOCIATES
5411 SE MCLOUGHLIN BLVD 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97202 PORTLAND, OR 97224
PHONE: 503 - 231 -0303 PHONE: 503 - 624 -6300
FAX: 503 - 230 -1044
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/15/2011 $75.00
12% State Surcharge - Electrical 03/15/2011 $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: Y Other: N 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 • e ' ! 2- 001 -0090. You may ob -'. - • • •f the rules or direct questions to OUNC by calling 503,232.1987 or 1.800.332.2344.
Issued B ." Permittee Signature: >■ — . *� r Lt /i
f-01,7 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 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 • . . you OI' I i(E 15l: ()\I.1
City of Tigard Received
g Dete/B ® Permit c.: ` ,p
13125 SW Hall Blvd., Tigard, OR 97223 Plan Q Review �>l�d 0 LVd(„L
' C - Phone: 503.718.2439 Fax: 503.598.1960 Other i llii
ate/B 4
I 1 i; A R p Inspection Line: 503.639,4175 ]]ate Ready/By: fur s: g 1 ! See 'a t ge 2 for
Internet: www.tigard- or.gov Notified/Method: "7"....6ts Supplemented Information
„
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`g1 : :
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❑ New construction ® Addition/alteration /replacement Please check all that apply (submit 2 sets ofplans w /Items checked below):
❑ ❑ Service or fender 400 amps or more 0 Building over three stories.
0 Demolition Other: where the available fault current ❑ Marinas and boatyards,
l i 1 3 a t r s " py r •„ uW P rya ' : •11° sit o1 l l [ r. Amps at 150 volts or Floating
, r... ,a.. -� _..., f l� lr r i � t exceeds L p ❑ oa mg buildings.
......, , :,otta :.. _ ' .. ili iii, ,e . .sill. ..._,., -. . ._.e1 r i9
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial E] Accessory building amps for ell other installations. buildings,
❑ Multi - family 0 Master builder 0 Other: ❑ Fire pump. ❑ installation 01'75 KVA or
I , . .
, #, �, I� Jp it a�'ar F� ur ;75 e t r w e ::. ['Emergency system. 3 ; r' ' t i' h L• .5I i p ° ue' n,:: a it •. l ,,,, 8 Y Ys "A", separately r,"1- system.
a I 4.d' th tvt 1 Ylt... IA1 ! a1Klt�4�
. +. = °.n ..._...., : �.- �'1i$li ❑ Addition of new motor load of ❑ "A > "E" "I -2 ", "'1 -3 ",
Job no.: n/a Job site address: 15887 SW 72" Avenue iooHPormore. occupancy.
❑ Six or more residential units, ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR. 97224 ❑ Health -care facilities. 0 Supply voltage for more than
- • r ❑ Hazardous locations. 600 volts nominal,
Suite/bldg. /apt. no - n/a Project name; CCK Rest s�C. t ❑ Service or feeder 600 amps or more
i u i 8" o" 1 ' "�l �``s 1 `' 1 _ 1 s IIld t ;�"i ,
Cross street/directions to job site; . s ° '• ", 1�`(^ " ^ z ,n, 11 tS '
(w(jtf�w/r} Deecrsptlon Qty. see. Total •
New residential single -or multi - family dwelling unit.
_ includes attached garage.
Subdivision: I Lot no.; 1,000 sq. ft. or toss 168.54 4
• Tax map /parcel no
Ea. add'l 500 sq. ft. or portion 33.92 1
eft ,t, Limited energy, residential
n $ i t I "a _. ,11 O i 6 d (W S 1 t. 1 r #E (w
li +ilh 75.00 2
I, n , ....,. d I : ii .. ::.. ,1 , , „a' , , i;i4 , . art v ., .._., , ,1,}ilfiiiiii .. ' i l, hhd ...,.,.,.t. nr 4 rh •:. ith above sq. ft.)
r !1'4 Limited energy, multifamily
Installation of Security Al arm System tY Y residential (with above sq. ft.) 75,00 2
Services or feeders installation, alteration, and/or relocation
I 200 amps or less 1
� �1�{�,, � s "; c. . �. � ` .'1'!S amp 2
. .. ,n!. : i;, .. .1t a. s K _ i 1 1 !. ii 'a l a r s s.,j
" ss a:: : Y. .I i T... , dt r,:. ttsa "El ! F 201 amps o 400 amps 133,56 2
Name: CCK Restaurants, LLC. 401 amps to 600 amps 200.34 2
601 amps to 1.000 amps 301.04 2
T Address; _ Over 1,000 amps or vole 552.26 2
City /State/ZIP: '
relocation
Phone: (503)726 - 5951 J Fax: ( ) 200 amps OT ICES 59.36
201 amps to 400 amps r:
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. r . ' 2
Branch circuits — new alteration or ,
Owner signature: bate: A. Fee for branch circuits with
!, i t1 S{
,, , I . {1 u' 91 i , ; , ge: I + a -71 , , I r.1 ' ° r s l i; ' above
ach branch circuit
fee,
...... ft f .d ...._. � [(Il�� el: $`ca_.. �. .,f�,1�'v , l• •, 7,42 2
each branc circuit
Business name; American Security Alarms} B. Fee for branch circuits without
- service or feeder fee, first 56.18 2
Contact name: Sara Patterson branch circuit
Each add'l branch circuit 7.42 2
Address: 5411 SE McLoughlin Blvd. Miscellaneous (service or feeder not included)
City /State/Z1P; Portland, OR. 97202 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 231 -0303 Fax: (503).230-1044 Reconnect only _ 67.84 2
Pump or irrigation circle 67.84 2
E-mail: sara @asalarms.com
1 � °.ttrppt1rv�, { ^ ::, . 1 s , , w _, f f �r t. ,1 p Sign or outline lighting 67.84 2
";,,I,'74,i{A$llltll$liili i!:::.: 1iii+$�i�� iCi °> "_.:R. , ,'G1, 1 ''r lif ?� .:-' i'•sue•ti� , ,.S Si circuit(s) or limited-energy
Business name: American Security Alarms} panel, alteration, or extension. 1 Page 2 75 -00 2
. _ Each additional Inspection over allowable in any of the above
Address: 5411 SE McLoughlin Blvd. Additional inspection (1 hr min) 66.25/hr
City /State /ZIP: Portland, OR: 97202
Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 231 -0303 Fax: (503) 230 - 1044 Inspections for which no fee is
s.ceificall listed 'A hr min 90.00/ hr
CCB Lie.: 58640 Electrical Lic.: 26283cle Suprv. Lic.: 7841ea `. rf �` ,�1� � 11.i ?! t. 11 �?�?,,-, ' !,,, ..:
Suprv. Electrician signature, required: Subtotal: 75.00
Plan review (25% of permit fee): N/A
Print name: James D. Liston Date: 03 - - State surcharge (12% of permit fcc): 9
Authorized signature: TOTAL PERMIT FEE: 84.00
This permit application empires if a permit it not obtained within 150
days after HMIs been accepted as complete.
Print name: Sara Patterson Date: 03 -14 -11 • Number of inspections allowed per permit.
I: 1BuiidinplPennhela Lf'•P•^- ;.Appdo• nan.nn 440 - 46151(11 /05 /COMM1VEB
'd El9E ''N WdSii: l l lH 'tit 'a'M
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
�+; ' � .:..:. a +� � i �iiilS't iFl i� ' =s's�i ins��i;:;��:� ...... �ti,
� ..:.....:.......,•,..� �.:j .. S S r : , i_ . .- �E ;•I�F`iiriu,�aG n �. tliftl"`f`'� #.
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
d Garage Door Opener*
[] Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
fJ t i ` 6F1 "! �, ...��� `t t. S► a ji;' ;fir: j'i�uruL: ;:t i 11h t, a:�: �s;yaS
r.,rl 1, «K.�eF,�mLu. `- 'dliarwti�ly ^. oS: nni� ;a" yi::<t'i:'. II fi :fill 1tE�4
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
• HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
•
❑ Outdoor Landscape Lighting*
® Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
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