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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1111 7 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00101 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/05/2011 Parcel: 2S 101 AA00101 Jurisdiction: Tigard Site address: 12150 SW 68TH PKWY Project: Landmark Subdivision: RAILROAD YARD Lot: 17 Project Description: Upgrade alarm panel & keypad in Used Car Building. Contractor: PHILLIPS ELECTRONICS Owner: CORLISS, JAMES L & CORA K 3247 NW 29TH AVE LEASE TO: FORD LEASING PORTLAND, OR 97210 DEVELOPMENT COMPANY TIGARD, OR 97281 PHONE: 503 - 222 -5083 PHONE: FAX: 503 - 227 -4992 FEES Description Date Amount Specifics: Restricted Energy Permit 05/05/2011 $75.00 12% State Surcharge - Electrical 05/05/2011 $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 - • . s • - • o the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done '• accordance with app .•ved 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. • TENTION: Oregon law r. free o to follow the rules adopted by the Oregon - • - ... Those rules are set 1prth in OAR 952 -0' -0010 throw • h OAR 952-11: -019 . ou ay obtain a copy of the rules or direct questions t. • UNC by callin•....s f•c_ or 1.800.332.234 . / • /�1 Iss d By: � / Permitte _ I. re: �� .1P1& lfLd 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 4)1S) FOR OFFICE USE ONLY y g Received ���� N. Cit of Tai n Permit No.: / / DateB � � l[ � r 114 13125 SW Hall Bl a vd. d , Tigard, O' O�� Plan Review • Phone: 503.639.4171 Fax: 503. ' .0 G Other Permit: Date /By: TIGARD Inspection Line: 503.639.4175 Date Ready /By: luris: ® See Page 2 for Internet: www.tigard- or.gov v., © 4SNG1 S1o� Notified/Method: Supplemental Information TYPE', OF WUR)o, `; PLAN REVIEW ❑ New construction ddition/alterati \Cement Please check all that apply (subm 2 sets of plans w / checked below): ID Service or feeder 400 amps or more ❑ Building over three stories. I: 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 .11.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 El Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", Job site address: 1 / Q IOOHP or more. occupancy. Job no.: I Q W t(/ t 1 ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: Q n /� n 9 7 ❑ Health -care facilities. El Supply voltage for more than I / hCX U 2 / 7 1 El Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: I Project name: L Q r k — /,/S-,P� l Q e J� ❑ Service or feeder 600 amps or more. " " FEE SCHEDULE Cross street/directions to job site: / Description I Qty. I Fee. I Total 1 New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 67.8,4 2 l Limited energy, multi - family 67.84 2 f '(J (& 2L U . Q T � PaAd yt- pQ residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less I 100.70 I 2 ❑ PROPERTY' OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: " Over 1,000 amps or volts 552.26 2 City /State /ZIP: l.r Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 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 extension, per panel Owner signature: Date: A. Fee for branch circuits with 0 APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 56.18 2 first branch circuit Address: Each add'l branch circuit 7.42 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and/or feeder 67.84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 Business name: Master Alarm LLC dba Phillips Electronics Signal circuit(s) or limited - energy panel, alteration, or Address: 3247 NW 29th Avenue extension. Describe: I Page 2 2 City/State /ZIP: Portland OR 97210 Each additional inspection over allowable in any of the above Per inspection 66.25 Phone: (503) 222 -5083 I Fax: (503) 227 -4992 Investigation per hour (I hr min) 66.25 CCB Lic.: 125364 1 Electrical Lic.: 26213CLE I Suprv. Lic.: ( LE p. Industrial plant per hour 78.18 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Subtotal: Zs 00 Print name: J e _ L! Sc 0 Date: q_ 1 I Plan review (25% of permit fee): State surcharge (12% of permit fee): i. 00 Authorized signature: TOTAL PERMIT FEE: gilt O This permit application expires if a permit is not obtained within 180 Print name: Date: days after it has been accepted as complete. * Number of inspections allowed per permit. 1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 46t5T(I1/05 /COM /WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems n Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations IABuilding'Permits\ELC- PermitApp.doc 07/01/10