Permit 'te CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� ��;� DEVELOPMENT SERVICES PERMIT #: ELR2002 -00233
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/29/02
SITE ADDRESS: 11533 SW PACIFIC HY PARCEL: 1S136AD -04000
W
SUBDIVISION: VILLA RIDGE ZONING: C -G
BLOCK: LOT: 007 JURISDICTION: TIG
Project Description: Installation of protective signaling. Job No. 2432 -179
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:
SMITH, EDITA M SONITROL (AKA SOUND SECURITY)
833 NW 170TH DR 8220 N. INTERSTATE AVE.
BEAVERTON, OR 97006 PORTLAND, OR 97217
Phone: 503- 223 -5822 Phone: 503- 223 -5822
Reg #: LIC 53535
ELE 26- 370CEP
SUP 2260JLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 10/29/02 $75.00 Elect'I Final
[TAX] 8% State Tax 10/29/02 $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 throuc
Issu d by %,'1 • et � � jcso Permittee Signature C IV, (0,
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
Electrical Permit Application
Date received: lQ /0t- Permit no. :1G� y60A,
� )� ' l l l ' i ,, City of Tigard �- ^: _.. `J g + - ,_ ' Project/appl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd; d,. , +z,C,
't , Date issued: By: Receipt no.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type: .
Land use approval: OC 1 — 1 7f).1)2
TYPE OF PERMIT
0 1 & 2 family dwelling or accessory XConimerciaI/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Other: 0 Partial
JOB SITE INFORMATION
Job address: ‘t• 33 ? p igie C. 1 7h U 3- Bldg. no.: Suite no.: 1 Tax map /tax lot/account no.:
Lot: 'Block: I Subdivision:
Project name: -}pp 1' . I Description and location of work on premises: �O9 0 t 018)1,
Estimated date of completion/inspectio
..: `._ CONTR C OR APPL1(:ATION FEE SCIIEDULE j.
Job no: a k.‘ - 1 '19 Fee Ma
Business name: Sonitrol Security Description Qty. (ea.) Total no. insp
New residential - single or multi - family per
Address: 8220 N. Interstate Avenue dwelling mit. Includes attached garage.
City: Portland I State: OR IZIP: 97217 Service included:
Phone: 223 -5822 IFax973 -7773 1E-mail: L+ ¢_i) 1000 sq. ft. or less 4
CCB no.: 53535 IElec. bus. lic. no: 26 -370 Each additional 500sq.ft.orportionthereof
City/metro C �/ Limited energy, residential 2
/� Y' LLimitedenergy,non- residential 2
Each manufactured home or modular dwelling
Signature f supervising electricia (required) Date 7 7-0 Service and/or feeder 2
elect. Services or feeders — installation,
Sup. _Sec, 0^, Lice nse no: 22‘o it,
tf- alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: Fax: E-mail: 1 Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exchange according to Installation, alteration, or relocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
• 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am's 2 ,
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fce, each branch circuit 2
City: I State: • I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E -mail: of service or feeder fee, first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps - rating of 1&2 O Hazardous location Each sign or outline lighting 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, 1 ( )
O System over 600 volts nominal more residential units in one structure alteration, or extensions r 15 " 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
O Occupant load over 99 persons O Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan O Other.
Per inspection I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ r ■ (3
O Visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
• Credit card number: / / within 180 days alter it has been State surcharge (8 %) .... $ 6 r CSC
Expires accepted as complete. TOTAL $ I , 00 Name of cardholder as shown on credit card .
$
Cardholder signature Amount
440 (6/00/COM)
Electrical Permit Fees: 'Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS) .
Service included: Items Cost Total `I' Check Type of Work Involved:
Residential - per unit ' •
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular El Garage Door Opener*
Dwelling Service or Feeder $90.90 2
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less . $80.30 2 El amps to 400 amps $106.85 2 Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 ❑ Other
Over 1000 amps or volts $454.65 • 2
" Reconnect only $66.85 2
u I Temporary Services or Feeders . . TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts.
see "b" above. ❑ Audio and Stereo Systems
Branch Circuits ❑
• New, alteration or extension per panel Boiler Controls
a) The fee for branch circuits
with purchase of service or ❑ Clock Systems
feeder fee.
Each branch circuit $6.C3 2 ; , ' ❑ Data Telecommunication Installation
b) The fee for branch circuits .
l without purchase of service
or feeder fee. ❑ Fire Alarm Installation
4 First branch circuit $46.85
Each additional branch circuit $6.65 ❑ HVAC
i . Miscellaneous ❑ Instrumentation
(Service or feeder not Included)
Each pump or Irrigation circle $53.40 ❑
■ Each sign or outline lighting $53.40 Intercom and Paging Systems .
I Signal circuit(s) or a limited energy
panel, alteration or extension 1 _ $75.00 15 I ° = d ❑ Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional Inspection over ❑ Medical
the allowable In any of the above ❑
Per inspection $62.50 Nurse Calls
Per hour $62.50
In Plant $73.75 ❑ Cutdoor Landscape Lighting'
Fees: ® Protective Signaling
00
Enter total of above fees $ �s . ❑ Other
1
8% State Surcharge $ ___(g_l_Ui t Number of Systems
25% Plan Review w' section on $ Fee
See "Plan Review" * No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $ IN , CSa
Enter total of above fees $ I-1 5 , Co El Trust Account # Surcharge $ t , en
Total Balance Due $ Et ‘ • Cn
i:\dsts \forms\elc- fees.doc 10/09/00
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECT ON DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested /4 / -) AM PM BUP
Location )1 X 3, Sue 4 C ( C' Suite MEC
Contact Person Ph ( ) 7,a) 53T2 PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR 2U1/2--0 .233
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Water he v
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PART FAIL
r Service
Rough -In
ow Vol a 1 �C
Fire A larm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
jv PART FAIL
SI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA O ))/9 m
Approach/Sidewalk Date Inspector 'j Ext
Other: c/
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL