Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
7 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00182
• 1 Date Issued: 08/02/2011
TIGA D 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15115 SW SEQUOIA PKWY 110
Project: Integrated Services Subdivision: Lot:
Project Description: Security system.
Contractor: WILLAMETTE VALLEY SECURITY Owner: PACIFIC REALTY ASSOCIATES
28101 SW LADD HILL RD ! ATTN: N PIVEN
SHERWOOD, OR 97140 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
•
•
PHONE: 503 - 244 -5273 PHONE:
FAX: 503 - 625 -6144
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/02/2011 $75.00
12% State Surcharge - Electrical 08/02/2011 $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 OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B i Permittee Signature: ._ . Q e— P + /�
OWNER INSTALLATION ONLY 7
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.
Aug 01 11 12:49p p.2
Electrical Permit Applicati c'
FOR OFFICE USE ONLY
City of Tigard 4U G 0 1 2011 Received �,���
Date/B . i
IP %
p 13t2SS1>r` Hall Blvd, Tigard. OR 97223 P lan Review ��� �� �ti ��
Phone: 503.718.2439 Fax: 503.598.1960 Date/B . Other Permit: -
Line: 503. 639.4175 CITY OF T rli Date Read .
T fGAI�Q Inspection CI t 1 �iff r i TIGMD Y'' EI See Page 2for
Internet: www.tigard or.gov DIVISION Nod ted&Method: FM Supplemental Information
TYPE OF WORK PLAN REVIEW
•
❑ New construction .ddition/alteration /replacement Please check all that apply (submit 2 sets orphans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition : ❑Other
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ I - and 2-family dwelling Commercial /industrial less to ground or exceeds 14,000 ❑ Commercial -use agricultural
❑ 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
o Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ °q', E ."1 -2 °I -3
Job no.: Job site address: 15 1' y Q lni . 100HP or more- occupancy.
x✓ r ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: P ,.-}) a r,(\ n e . --7 r a l + 1 0 ` , /E,, ❑ Health -care facilities. ❑ Supply voltage for more than
T ❑ Hazardous locations. 600 volts nominal.
Suite/bldglapt..no.: 1 I t) Project name; ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Toter I
New residential single or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R, or less 168.54 l 4
Ea. add'l 500 sq. R. or portion 33.92 1
Tax trap /parcel no.: Limited energy, residential
I DESCRIPTION OF WORK (with above sq, ft.) 75.00 2 •
.Limited energy, multi - family
L V 1 + a. 9 Pr . '3 �r L ). 1 1 ; '' residential (with above sq. ft.) 75.00 2
_ _ Services or feeders installation and/or relocation
S `` 1 eyy-1 200 amps or less 100.70 2
PROPERTY OWNER Cl TENANT 201 amps to 400 amps 13356 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
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: . relocation
Phone: ( ) 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. � a01 amps 10 599 amps 16854 2 •
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
❑ APPLICANT ❑ CONTACT PERSON each branch circuit
2
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 2
Each add'l branch circuit 7.42 • 2
Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular f 67.84 2
dwelling, service and/or feeder
Phone: { ). Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 ' 2
E Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy '
Business name: CO I r �� Yl 7 � - {!n , , . 7 r panel, alteration, or extension. I Page 2 "75, 2
`�, VVV l `tc.L 1 (� Each additional inspection over allowable in any of the above
Address: a %I c i S Lo L c ci d I l ) IZ `J Additional inspection (1 hr min) 66.25/ br
investigation (I hr min) 66.25/ fir
City /StatelZlP :S 0 n2 ql I ti 0 Industrial plant (I hr min) 78.181 hr
•
Phone: 5'0'A ) 141_,\ • 5,2,-1_5 111 I Fax ) („ , I ) + Inspections for which no fee is
90.00/ hr
' I � specifically listed (t hr min)
CCB Lic.:q t Electrical Lic.: 3 cL Suprv. Lie.:
i
•vi - ,/t II/ ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician Si ft tequIred: Plan review (25% of etmit fee): p ) I 5 00
Print name: i _ + Date: 2 ._ i ._ ( 1 1 State surcharge (12% of permit fee):
t TOTAL PERMIT FEE: $ QC,
Authorized St 31 di � } -
•
e 1Y-• � This permit application expires if ape rink is not obtained within 180
Print name Q - a c o 10 yl Date:--J . 1 1 . Number of lowed per pe rm h� azcomplete
f:' .ELC- PennitA0p,doc 57,01/10 440 - 46157 {I 1415 COM,'WEB
Aug 01 11 12:49p p.3
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*
Q Burglar Alarm
❑ Garage Door Opener*
n 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
❑ Boiler Controls
❑ C lock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
[7 L andscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ P rotective Signaling
Q otherSC (? r � j S s' e y,
Total number of commercial systems: f
*No licenses are required. Licenses are required
for all other installations
I.'J ildi ng\Permit ELC- PCrmitApp. 07;01,10