Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.', COMMUNITY DEVELOPMENT Permit #: ELR2011 -00218
T[GARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439
Date Issued: 10/11/2011
Parcel: 2S110DCO2200
Jurisdiction: Tigard
Site address: 15570 SW PACIFIC HWY
Project: Safeway Subdivision: 1997 -016 PARTITION PLAT Lot: 2
Project Description: Fire alarm
Contractor: STONER ELECTRIC Owner: TRC MM LLC
1904 SE OCHOCO 5973 AVENIDA ENCINAS STE 300
MILWAUKIE, OR 97222 CARLSBAD, CA 92008
PHONE 503 - 462 -6500 PHONE
FAX: 503 - 659 -4968
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/11/2011 $75 00
12% State Surcharge - Electrical 10/11/2011 $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 Y
HVAC: N Instrumentation: N
Intercom /Paging N Landscape /Irrigation N
Landscape Lighting N Medical' N
Nurse Calls N Protective Signal. N
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 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 th- - _ •r direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued Permittee Signature:
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.
Oct.10. 2011 2:56PM Stoner Electric Group No. 9947 P. 1/3
i NI ',. 11
Electrical Permit Application Pit.. C C O Fp it OFFTCF -Jtir
City of Tigard O 1 113 24 'ecerved IMEMEMEM
97223 W Hall Blvd„ Tigard, OR Date/13 : / l) / 0 i/ yfi
iI e u 13125 $ ' ' —
Phone: 503 639.4171 Fax: 503598.1960 i-N OF TIG , g Other Permit;
Inspection Line: 503.639.4175 C Dl�l t +Tn 60 See rage 2 for
Internet: www.tigard or.gov WIWI Supplemental Inform atm.
TYPE OF 'WORK ' : „." . , .
s .' .. , r wr .` L,l N REVIEW ,
❑ New construction gAddition /alteration/replacelnent Please check all that apply (submit j seta of plansw/iitems checked below);
9 Service or feeder400 amps or more ❑ Building over three stories,
❑ Demolition ❑ Other: *hero the available fault current ❑ Marinas and boatyards.
.Q � ` , t li - j � ' _ "= �,. yp exceeds 10,000 amps at 150 yeas or ❑ Floating buildings.
m� c�IZ�r Q �3 5n �- _-_ E�ad1l_� .
:- -^ " ' • ' ' • ' " c --" - � ' `� - "�� less to ground, or exceeds 14,000 ❑ Cormnereial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
t , ; r, - • { w x- s w x- r n - - ❑ Emergency syvem larger separatelydenred system.
•- r "" r� <�'a J OtkgktiO�N' -6i� 6T , Addition of
-. ax::- k=fli =sr -S: � Y - - 9 0 ❑ 2 ,. ,.l _3„
Job no,: 1$95f3 v" Job site address: IS 7D Sw) Pic, Fin 60wA `r , Si, o P or more, Re ctio ❑ ,c or more reaideni2a] units. ❑ Recre a reation al vetucle parka.
City�State/ZIP ��� P� 97 d. d Health•caro facilities. ❑ Supply voltage for more than
❑ Hazardous locations, 600 volts nominal
Suite/bldg./apt. no.: Project "ecname: Service 60smpsormo
0ro,
3 A F /�y$ 9 ,
' ^
Cross street/directions to job site: oestrlpdon I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq, ft or less 168,54 4
• Lea. add'l 500 sq. ft or portion 33 92 1
Tax map/parcel no.:
Limited energy. residential
`; t t y � ` y:- == 1 gC. 1'�. Qi11. OF., 'O11IC (with above sq. R.) 75.00 2
Limited energy, multi-family 75.116 2
RELOtAT r I -E6f2N t ok3e F o ! 2 AM-Ri cy Ex/la/Ai-mod residential (with above sq ft)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
f= _;.: P,IO� t,WA t.gt a'-;s= � ❑ '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 55226 2
City/State/ZIP: Temporary services or feeders lnstallallon, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59,36 1
201 amps,o 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
" `gL, t'r,`,(: aQ T 1, 7 " ? ' :- .I 4 ' . - j ggIgKE g. rf above service or feeder fee,
tip x - IZ$ON 7.42 2
a'" �•� � ° - - -� �� - each brancbcncuit
Business name: B. Fee for branch circuits without
service or feeder fee. first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
City /Stale/ZIP: Each manufactured or modular 67 84 2
dwelling(, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
P amp or irrigation circle 67.84 2
B -mail: Sign or outline lighting 67.84 2
��' e: " r - :p a i't 1 ' , Signal circuit(s) or limited-energy �_ ° : ty;:_ - °' . ": ': -- C OIVTRe1CT0R -':
Business name: STONER ELECTRIC, INC, panel. alteration, or extension, / Page 2 7$ 2
— Each additional inspection over allowable in any of the abov
Address: 1904 SE OCHOCO Addilional inspection (1 hr rain) 66,25/ hr
Investigation (I hr min) 66.25/ hr
City /Smte/ZIP: MILWAUKIE, OR 97222 Industrial plant(] hr min) 78.18/hr
Phone: ( 503) Prix: ( 503) 659 -4968 Inspections for which no fee is 90.00/ hr
specifically listed (Y: hr min)
CCB Lic.: 44823 Electrical Lie.: 26 -122C Suprv. Lio ": 3496S i v:5 _=`R__is Ri(0 EEE$:
Subtotal. 'Z'$'.
Supry . Electrician signature,required: p 4 A" Plan review (25% ofpemutfee), ler
Print name: MICHAEL FALCONER Date: ( % State surcharge (12% of permit fee)' 900 0
TOTAL PERMIT FEE: e.4-. op
Authorized signature; This permit apatite lion expires if a permit is not obtained within 180
Print name: Dale: d53 a after it has been accepted as compleie.
Number of inspections allowed per pcnnil.
L\Boildmg\Per dtslELC- PennilAppdos 07/01 /10 440- 46151(11/O3/COhI/WED
Oct. 10. 2011 2:56PM Stoner Electric Group No. 9947 P. 2/3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Pee for all residential systems combined..,.,,,. $75,00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
[;'ItCIAL 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
❑ Clock Systems
❑ Data Telecommunication Installation
0, 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
1;u5Uldn2\ fl tstEI.C- PenmtAoo dot 07101110