Permit •
ELECTRICAL
C ITY OF TIGARD
RESTRICTED ENERGY
44:41
DEVELOPMENT BMENa Tigard, R R9 SERVICES 639 -4171 DATE ISSUED: 8/22 004 00245
SITE ADDRESS: 11565 SW DURHAM RD 100 PARCEL: 2S110DC 02400
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Proiect Description: Installation of new security system.
Job # 3318 -185.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
DOUGLAS FRY SON1TROL (AKA SOUND SECURITY)
2423 REMINGTON CT 8220 N. INTERSTATE AVE.
WEST LINN, OR 97068 PORTLAND, OR 97217
Phone: 503 348 - 2237 Phone: 503 223 - 5822
Reg #: LIC 53535
ELE 26- 370CLE
SUP 1812LEA
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 8/2/2004 $75.00 Elect'l Final
[TAX] 8% State Surchar€ 8/2/2004 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010
through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699.
Issued by Permittee Signature � fC �� w \f\c
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'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
f °' ,, 1' • F
; O R. 4 FFIC E;;'U SE ONL - , ,..
Ele Permit Application •
R ece i ve d ' � / Electrical l
Date/By: x Q `/ 04 Permit No.: U /s/ dO y avyy
E C E 1. E D Planning Ap royal Sign
City of Z'Igai' Date/By: Permit No.:
13125 SW Hall Blvd. c Plan Review Other
Tigard, Oregon 97223 AUG U 2 2004 Plan Re
Date/By: Permit No.:
Post - Review Land Use
Phone: 503- 639 -4171 CiR :ce..T' �0 k e� Date/By:
Post-Review Case Use
Internet: www.ci.tig LDING DIVISION ��'~e!�' Contact Juris ® See Page 2 for
a '- 'R
s " °« kr Information.
24 -hour Inspection Request: 503 - 639 -4175 Name/Method ) I Supplemental I
�,1
t ck all thaf a ° Ili -.
VIEW: � � l e ase'eli e. `P Y) '� <; :? ;:.`y�.:;.�'
..�r.�ti° �3x::r _ai.,�•, ,:;r.• - - ,.. - _. _ -.. ._ .. . ''PLAN' "RE... . ,.� P
��w �:�. � - • TY "PE�OF WORKs�'�;�= ..-', ...- .... ,..� ..-
❑ New construction ❑ Demolition 0 Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition/alteration/replacement ® Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
h izt':;a'= : i ",`) i,",c- TEGORY OF, CONSTRUCTIONn' ; ! '." :. '' : ;;.' , ° 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ® Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family 0 Occupant load over 99 persons ❑ Manufactured structures or RV park
• ❑ .Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
<t =-. ;:;.�.x :° °-;-<JOBSITE';.INEOR =LOCATION.; ''- "'"• Submit _ sets of plans with any of the above.
�t The above are not applicable to temporary construction service.
l� (i'� u'i'- , .";;`Z: _ .n f.' ', : LE « ,. : ;e - ................................................
Job site address: L � 5 �a 5 � 1., w.. ��., ... �.,,r�� . .,., .: � __ *�"��
Suite #: IOG BldgJApt. #: -- Number of inspections per permit allowed
Pro
j ect Name: � n 0y, an p _ \ �; -k- > (J Description Qty ' Fee (ea.) Total . 1
� -
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: - Limited energy, non residential 75.00 2
Tax map /parcel #: , ° Each manufactured home or modular dwelling
„5 ; +; s:<DESC- RIPTION :OF WORK: .._ ... .. -
service and/or feeder 90.90 2
Services or feeders - installation,
alteration or relocation:
�?\ �P1 ~ �� 200 amps or less 80.30 2
�SL f- ; ,r `. _j. $ \ S �-4 201 amps to 400 amps 160.60 2 106.85 2
J 401 amps to 600 amps
601 amps to 1000 amps 240.60 2
°❑ TENANT' >:.: ` ,:: : : : p p
PROP.ERTY:OWNER: '?` :^ = Over 1000 amps or volts 454.65 2
Name: tOu 11.3 "s. \ \ �10 Reconnect only 66.85 , 2
Address: 9,0 1 >X ¼. - ' -- 3}\ k (-Nck Temporary services or feeders - installation,
alteration, or relocation: 66.85 1
City /State /Zip: �,} \-2 - (� 2 �7 )-
200 amps or less
i 2 201 amps to 400 amps 100.30 2
Phone: 3 -53g- 13g0 Fax: 401 to 600 amps 100.70 2
AP.PLI,CANT: '::. = '.w:::' ❑ CONTACT •PERSON" <.: >'; s'. B ranc h c - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of 6.65 2
Address: service or feeder fee, each branch circuit .
City /State /Zip: B. Fee for branch circuits without purchase of 2
service or feeder fee, first branch circuit 46.85
Phone: Fax: Each additional branch circuit 6.65 2
Misc.(Service or feeder not included): 2
E-mail: -- Each pump or imaation circle 53.4
;; _ ? e _ ._ .CON:TRACTOR, =? , ";` Each sign or out lighting 53.40 2
Job No: 3 3 ` CS. 5 Signal circuit(s) or a limited energy panel, Page 2
/ /, — 2
alteration, or extension
Business Name: ( SQ_C.v Description:
Address: • AD:b tJ . _,TQ S-E-0 —
�p 1 Each additional inspection over the al lowable in any of the above:
City /State /Zip: Q�-l; Cs.. =✓\c Q v t f • 1 °_, l • Per inspection per hour (min. 1 hour) 62.50
ta
Phone: �3 - 5g Fax: Q' 13 - - 1 - 1` - ? 3 Investigation fee: Ir
-- '7 Other: _ -- _. - .-
Lic. #: 1O ' :itF=1 . 0 t_�'u� CtriC:il.'-:Wiiiifi 4 ` .,.:::•.....F.,4 r"'= ;rT: s>
CCB Lic. #: 35 L a� 3 = El "e. ees .
Supervising electrician , - Subtotal $ 'J .. signature required �
: /4(,( (. Plan Review (25% of Permit Fee) $
ryN ( c. #: ��J .1 " I7 State Surcharge (8% of Permit Fee) $ K O
Print Name: 'Ye ( t r� Li # O TOTAL PERMIT FEE $ A'
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it. has been accepted as complete.
*Fee methodology set. by Tri -County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Forms \ElcPerrrtitApp.doc 01/03 0 5
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information •
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: •
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm •
I 1 Garage Door Opener
Heating, Ventilation and Air Conditioning System
I I Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved: •
p J
Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
1 Fire Alarm Installation •
IIVAC
Instrumentation
n Intercom and Paging Systems
Landscape Irrigation Control
n Medical
n Nurse Calls
I I Outdoor Landscape Lighting
n Protective Signaling •
n Other - • - - — - .
•
Number of Systems
• * 'No licenses are required. Licenses are required for all
other installations -
•
i:\Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03