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Permit 17 P CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2009 -00065 T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/10/2009 Parcel: 2S104CD07200 Jurisdiction: Tigard Site address: 13533 SW BRIM PL Subdivision: HILLSHIRE ESTATES Lot: 72 Project: Steele Project Description: All Encompassing Low Voltage - Security, Audio Data, Phone , TV FEES Owner: PITTS, JEREMY D & Description Date Amount STEELE, TANYA L, 13533 SW BRIM PL Restricted Energy Permit 07/10/2009 $75.00 PORTLAND, OR 97223 12% State Surcharge - Electrical 07/10/2009 $9.00 PHONE: Contractor: QUADRANT SECURITY INC PO BOX 14833 PORTLAND, OR 97293 PHONE: 503 - 234 -5558 FAX: 503 - 236 -2322 Type of Use: SF Class of Work: ALT Total Number of Systems: Audio & Stereo: N Security Alarm: N Garage Door Opener: N HVAC: N Total $84.00 Vacuum System: N Required Items and Reports (Conditions) Other: N Other Desc: 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 OA 9 1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1.800.332.2344. Issued By: Permittee Signature: 0'YL- 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 an inspection that business day. 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. EI etrical E,;ermit Applicatiion P I IQ JNIQ ..- _ , ti �VJI,L30 rOit {)rlrF> c;;r r�n1,, City of Tigard n Rceefved 4S , ,�J / Il l 13125 � r 11 I bait : ; Permit No.: L F - �� -� '�.:a CO 13125 SW Han B1vd., Tigard, OR A7 ?23 an Review : Phon 503.634,417) Pax: 503,$98.1460 DatcBv Other Y 1 ;, t , ingneetic,n Lind 503.6394175 — ., . lurks: s � I M; Pa roe d ibr interne;, ww�v.tigartl- pp,�pv ,, 8n 'lamented hrtartrintlop ..--_ TYPE OF WORK : . , ;; :: PLAN. REVIEW :,:•:'; • ... -; : , • New construction ❑ , Addition /alteration /replacement Please check all that apply (submit; gets of plans Whams checked below): ❑ Demolition CD Service or feeder 400 amps or morn ©HoIldinp over three ileac ❑ Other: wltare the psreileble NIP carnet (] Mnrinna and 1,optvor8a, CAT OR OF CONSTRUCTION exceeds 10,000 attire Ott 150 volts or ❑ Meeting belldInga, leas To ground, nr exceeds 14,000 ❑ Commetcisl -me rip 1- and 2- familydwelling ❑ Commercial /industrial ❑ Accessory building amps Porailothcr inataliations. buildiags, © Multi- family ❑ Master builder 0 Other: CI pump, U insta11:t1icm vf'y$ KVA m Ton SATE INFORMATION AND LOV TION ❑ F ma,xattey eyatenl. larger sttperptaly derived yAtern, ❑ Addition of new motor load of ❑ "A'' "t3" "l.2 ", "1 -3' Job no.: Job site address: 1 37,, 5 I R 100HP or more, occupancy. . < J a- "' . = � O Six Or more rtoidcntiat only :. ❑'Rearm: etall vehleie trerkn. Cit'/State/7TP; p I M r G1 - 0 i4eeltli�tnc I Belting, ❑ Supply voltage for morn than 7 a Har9rdous lncaticros, 600 Krlh nominal Suite/bitlgdept, no Project n, me: P; >Ae rt+ } rr In service or reader 600 amp %nrmere. - FEE SCHEDULE Cross septet /directions t0 job Sits: n tattriptirro — 'I Q4. 1 ate. Teal r--.— - ' Nen (residential single. or molt; -family drrellirig unit. IncIedes Attaabed 1parsge. Subdivision; Lot no.: 1,000 sq. •R, or less - 145.15 4 Tax map/Parcel no,; — Ea. add'( 500 sq. ft, or portion 33.40 _ 1 • Limited energy. residential 75.00 2 AESCRPT'ION OF WORK Limited . above aq, fl) s. r mte energy, rnultf- fttmmlly V� - ^ - -R-, 4 t , residential (with abo`94 A) 75.00 2 -1 }� /� —Ty'" Services or ketfcrs Installation tio n, Aind/or reiocatia �' ` ) M' d 1� J 200 amps or Ices ,30 80 2 Q PR,OPERTX OWNER O TENANT • _ 201 amps to 400 =tat 10615 2 Name: 401 =is to 600 amps 160.60 2 —' J — 6 m s o 0) a 1,000 amps 240,60 2 Address; over 1,000 amps or volts 454.65 2 City/State/ZIP: Temporary service, or feeders inetallation situation, and/or relocation) Phone: ( ) 200 amps or Mess 66,85 ' _ t Owner installation: This installation is being made on property that 1 own which is oat 201 ecope to 400 amps 100,30 2 intended for sale, leis, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 a s to 549 amps 133,75 2 Owner signature: _ Date: Winch drones. new sliertltio or ex ta teaslon per pe) E.) APJfLiICA1VT PERSON A, Fee for branch' circuits tote ❑ CON . above service or feeder fee; 6.65 2. Business name each branch circuit B. Fee for bra.nth circuity Contact name: t+ service Or fegdes the, find bnttach circuit 46.85 2 Address: _ Each Oil branch circuit 6.65 2 1Ktseeltlatie wcr i ec or reader iiot 1H Clode City /State/ZIP: Poch manufactured or modular dlvellin gcrvict ;Ind /or feeder 90.90 2 Phone: ( ) Fax:: ( ) - . , Reconnect only 66.85 2 , E -mail: Pump or irrigation circle _ 53,4D 12 • • CONTRACTOR Sign or outline lighting 5,3.40 2 Business mime: . 5igmal circuits) ar limited- - i energy parcel. alteration, or Address: i <) , /30 / £ 83 • extension, Describe: P age 7. 2 City/State/ZIP: / 0., L �. 0, c' 7a 9 3 . Etreb additional IntiV over allowable Ina of the above - Phone: ; jn 3),g2' 4,/ _ Fax: (57J3 )', . Per inspection r ' °� Invest i per hour(l 62.50 CCB Lie.: ' 6 g Electrical T,ic.: „,r,, - ;' I Saprv, Lac,: LI 3159 LEA tndvatrinl plant per hour 73,75 5u rv. Electrician si " c i ' r. A r • t 1 �i . ' . ELECTR>I'C P ER, „ ' p gel fie. >�e(�uired: Subtotal 1 6-c Print name: . 3"E ri alim rt' Date: 7. i 0 • Plan review (25%of permit fee); ` Authorial d signature: State surcharge p2 "rh nfpt$7nit fbe): T I _, �� >u TOTAL PERMIT FEE; od Print name: ` _ ; a a s Date: .. a'Ade pestle apptlpepva axing if w pelt to not nhHdned within 1 6., ate, Q daps altar it hoe been aeeepted sa eninplett, " Number or ms al towed par permit. ImuildinutrermtrOFX Permits tint to /z7rp5 d4O-4415'rt11/ /COMM1VISB