Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00193
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/11/2011
Parcel: 1S136AD04000
Jurisdiction: Tigard
Site address: 11515 SW PACIFIC HWY
Project: Exclusive Salon Products Subdivision: VILLA RIDGE Lot: 7
Project Description: Low voltage for burglar alarm.
Contractor: PHILLIPS ELECTRONICS Owner: PACIFIC TERRACE COMMERCIAL LLC
3247 NW 29TH AVE BY SMITH, EDITA M
PORTLAND, OR 97210 833 NW 170TH DR
BEAVERTON, OR 97006
PHONE: 503 - 222 -5083 PHONE:
FAX: 503 - 227 -4992
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/11/2011 $75.00
12% State Surcharge - Electrical 08/11/2011 $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: Y
Security Alarm: N 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. ATTENTI • , . •re• • - law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0011 rough OAR 952-41 s. •0. o -y obtain a copy of the rules or direct questions to OUNC by callin! - c" • 2.1987 or 1.800.332.2344.
Issued ;y: ..��� �L .t i Perm ittee Signa .d.1 401
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.
08/11/2011 11:39 5032274992 9k PAGE 02
Electrical Permit Application REL9r..,, nti.'
FOR OFFIC'F, I:ISE•. ONLY
ipli City of Tigard RCGeivad
AUG 1 2011 Date/B $ n �i 1 Permit No.; EL/2 aCrt!- 604'93
r- ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
u ` Phone: 503.718.2439 Fax: 503.598.1960 pat�/}y; Other Permit:
eetion Line: 503.639.4175 CITY r
T l G A R : I? Ins p Ci 1 i OF ��''-'IAt t Date Read /B turn: !a gee Page - 2 for
Internet: www.tigard- or.gov t]l tit DING Mi i Notifted/Method: Supplemental information
TYPE OF WORK PLAN REVIEW
❑ New construction otAddition/alteration /replacement Please check alt that apply (submit 2 sets or plane wlitems 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 exceed& 10,000 amps at 150 volts or ❑ Floating building&.
�( less to ground, or exceeds 14,000 0 Commercial -use agricultural
• ❑ 1- and 2- family dwelling �1 Commercial industrial D Accessory building amps for all other installations. buildings.
[] Multi - family ❑ Master builder ❑ Other: O Pire pump ❑ tete: iatinn of 75 KVA or
JOB SITE INFORMATION AND LOCATION l Emergency System, larger separately derived System,
❑Addition ofncw motor tend of ❑ "A " 1 1 . " , " 1 - 2 " , " 1 - 3 " ,
1001.11' or more. occupancy.
Job no,: 1 ,iob site address: I 15 Ls-- Sa✓ p0.4.t t 14 No V ❑ Six or more residential units. C Recreational vchiele parks.
City /Statc/ZTP_ "� � 1 ' C�eetom ' a3 0 Health -cam (Widest. 0 Supply voltage for more than
U. II 14aaardenis locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: �*- !! `` ❑ Service or feeder 600 amps or more.
— 1
111 �1LG {JSit✓ei -"auto" Pree�alet9 FEE SCIIEDULE
Cross street/directions to job site: { pi >h /91t Dmartpltnn I Ow. I Pee. I Total 1 •
• - New residential single- or mold- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or lass 168.54 4
- - Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no -: Limited energy, residential
75.00 2
DESCRIPTION OF WOIWORK ( with above sq. R.)
_ -
' ' -' --"' Limited energy, multi - family
residential (with above sq. it) 75.00 2
• Services or feeders installation, alteration, and /or relocation
200 amps or lcsa 100.70 2
❑ PROPERTY OWNER L_ ❑ 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
- Temporary services or feeders installation, alteration, and /or
City /State /ZIP: _ relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 1
2
Owner installation: This installation is being made on property that I own which is not
201 amps to 400 amps 125.08
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 as to 599 as 16854 2
Branch circuits — new, alteration, or extension, et panel
Owner signature: _ Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON
above branch service or feeder fcc, 7 42 2
each branch circuit
Business name: B. Fee ibr branch circuits without
- service or feeder fee, first 56.18 2
Contact name: branch circuit •
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State/ZIP: Each tnanufacturcd or modular 67.84 2
dwelling, service and /or feeder
^ Phone: ( ) 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 limit i
r
pact, alteration, or extension. Page 2
Business name: Master Alarm LLC dba Phillips Electronics 2
__ Each additional Inspection over allowable In any of the above
Address: 3247 NW 29th Avenue Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 6625/ hr
City/State/ZIP: Portland OR 97210 _ Industrial plant (t hr min) 78.18/ hr
phone: (503) 222 - 5083 Fax: (503) 227 - 4992 inspections for which no fcc is 90.00/ hr
specifically listed (`h hr min)
CCT3 Lie.: 125364 E cetrical Lie.: 262I3CLE Suprv. Lie.: / ,3 E a . .. ELECTRICAL PERMIT FEES if7g °
Subtotal:
Suprv. Electrician si_ i , r� Plan review (25% of permit fee):
" p • (i r A « y State surcharge a (12" oC omit fee i
Print name:^ - r L(J Date: � ✓ 1 rg p ):
TOTAL PERMIT FEE:
Authorized signature: This permit application expires ►r a permit Is not obtained within 18a
days after it hot been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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08/11/2011 11:39 5032274992 PAGE 03
Electrical. Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a residential
systems ..... ................ .
RESIDENTIAL
combined........ $75.00
Check Type of Work Involved:
LI Audio and Stereo Systems*
Q Burglar Alarm
• Garage Door Opener*
[i Heating, Ventilation and Air Conditioning System*
O Vacuum Systems*
❑ Other;
. . ...........
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
Ell Audio and Stereo Systems
0 Boiler Controls
• Clock Systems
• Data Telecommunication Installation,
[] Fire Alarm Installation
IIVAC
O Instrumentation
❑ Intercom and Paging Systems
O Landscape Irrigation Control*
a Medical
• Nurse Calls
• Outdoor Landscape Lighting*
Protective signaling Tg „a-rilar P1ax m
Other
Total number, of commercial systems:
'KNo licenses arc required. Licenses are required
for all other installations
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