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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2012 -00071 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/18/2012 Parcel: 2S101AB00100 Jurisdiction: TIGARD Site address: 12005 SW 70TH AVE Project: Acupuncture Clinic Subdivision: Lot: Project Description: Audio, data telecommunications, security, and CCTV systems. Contractor: QUADRANT SECURITY INC Owner: RED ROCK BUSINESS ASSOCIATES LLC PO BOX 14833 23077 SW NEWLAND RD PORTLAND, OR 97293 WILSONVILLE, OR 97070 PHONE: 503 - 234 -5558 PHONE: FAX: 503 - 236 -2322 FEES Description Date Amount Specifics: Restricted Energy Permit 04 /18/2012 $300.00 12% State Surcharge - Electrical 04 /18/2012 $36.00 Type of Use: SF Class of Work: ALT Total Number of Systems: 4 Audio & Stereo: Y Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: Y Fire Alarm: N HVAC: N Instrumentation: N Intercom/Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: Y Other: Y Total $336.00 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 the rules or direct questions to OUNC by calling 503.232.1987 or 1,800.332.2344. Issued By: __-_-.- �� — 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. Electric Pk al _ Pe rmit 4pp lication &5e. rou. c)rrlr l• t'Sr 11111.1 City of Tigard �c x y ArirM ;t rho.: ' ' ab let — • ,6 7 13125 SW Hall Blvd., Tigard, OR 97223 P e ll Firm Firm Review Phone; 503.639,4171 Fax; 503.598.1960 „ osisinv: other Perhnk: A , i ,,, , Inspection Litre: 503.639,4175 TYPE OF WORK ;` �..� ? ' / rot hl 1ptenmatlaa Internet: WW►v.tigA}d- or ` y . L ,,u.1,,;lrt' r P } , .. ...: ; . ,,.�:. P3J►NVriSR ; .; •.; ; . ;•:; g New construction ❑ Addition/alteration/replacement A pR 17 1.131 Please cheek all that apply (submit 2 sets of plans w/ite not ehodlmd below): 0 © Service Or lhedor 100 cups nr room ❑Buildine t three goyim Demolition 0 other _ , . b where the available Stub cam* ❑ Marinas And boatyards. • . ' CATEGORY OF COmI'RI1CT'IoN C% . . II' . 7 g csoeeds 10.030 asps m 150 veleta ❑ hosting buuding . o 1 -an 2•fitmi]y dwelling pp�� CommereiaVindusWol 0 q ■ ,� V` 1 less a �° or exceeds 14,000 ❑ Cemnne2elal -hate ag;e�rltarnt e.d g l�s. 0 j g Imps for 211 (OCT installations. buildings, ' ❑ Multi - family Cl Master builder ❑ Other CD Fire per. C1 1nfha11ah1on Of 75 KVA CT ' JOB SITE • INFURNaTION AND LOCATION ❑ Fmcreency system, harper scow* derived system. Q Addition dam mow Toed of CI "n' - 'E•' "1-2' °1•3 ". Job no.: Job site address: �.{, 1 o0tiP a mere. oceopenty, i. • kil r Q Stir ermom residential mita, CI RmmKerial vehicle 2 0 Healtlworre Oldlitles. CI Supply v ltam for more that O Warmth= lna ticros, S Suite/bldg.lapt. no.: Po:gject Home: v 1I Service or We 600 mops or mote, G • V L . /. PEE SCHEDULE . Cron strect/directions to job site: AaspBllsa • I Oa I est. I t'as1 I - New madame' deg* or emlb - tylm fy dwelling unit. lneludes attached • rage. 1,000 Sq. R or k5S Subdivision: Lot no.: IN1111211r112 Tax map /parcel no.: Li m ier o oq. s ft o e tial n 75 .00 • DESCRIP ION OF WORK (with above anew. residential 75.00 -- Limited energy. multi-family TS.OD fi I . . 1 o I.,. ' _ Lk 1... I "a ' a residential with above a • . ft. strvloa or feedMjandla • , itavatio,;: attd1or relocation /, . A.P. I. . • - .. .ri. 200 amps or peso 6030 -HI PROPER'T'Y OWNER . main R 0 • 201 amps to 400 amps 106.85 r l Ju s J 401 amps,* 600 am • 160.60 MI 601 am • to 1.000 amps ME 240,60 © it Address: 0 se _ — tiro ,..... Over 1,000 amp or volt MBIKEZEI 2 City/State /ZIP: A ., , /. a y. ^ r Temporary services or feeders illation, eitcration, and/or 1 rk Phone: ( ) Pax: ( ) 200 amps or less I 66,85 if Owner installation: This Installation is being made on property that i own which is not 201 mops t° 400 amps 100.30 [© intended for sot ►c, lease, rent, or exchange, according to 401 ORS 447, 444, 670. and 701, as to 599 amps 133,75 if Owner signature: Date Relate circuits– , alteration, or elrttnelon A. Fee for branch circuits woh - •- 0 APPL11CANT I • ❑ CONTACT PERSON : •• ., above s e l or Re dat foe, 6.65 2 Business name: B. Fee far branch omits wldrmn service or feeder Re, Contact name: fro breach circuit 46.85 2 Address: Each add'lbranoh circuit 6.65 _ - 2 1 Miaceliaoeoas aavtet ar feeder not indod C1ty/State/fiP; Each manufactured or modular 90.90 � � dwellihhg,service otnd/or feeder Phone: ( ) Fax: : ( ) Reconnect on 66,85 E -mail: Pum- or irrigation circle - Mil 53.40 © DUN TRACTpA St . or outline lighting MI 53.40 EN + rt:nt� Signal cin �S 15. vit(s) or limited- Business name: (' - d 1 w r` r. s r." a , T enemy per, alteration, or //x� Address: 0 r3o2 f q s3 extension, Describe: . A . Page 2 75 City/State/ZfP: P. r }40.. -LQF Q , 1 7.E a 9 3 Each 11411111 mad 1 . 'new over allowable Ina • • of the above Per inspection = 62.50 - Phone: r O 3 . Y _ , r - Fax: ( )3) _ _ R4,1.. Investigation per hour (I er rtla 62,50 MI 9 b � S4 G, Electrical Lie.: a6 - �b6' s pr+. PCB Lie.: n r Lie.: q' q A industrial plant par hour r 73,75 • v Suprv.'Electrician signature. required: ELECTlRTCA1G Pl;'Jti 1 E3 (O h CIO . Subtotal: Date- flan review (fl% of permit fee): . �• ��_ State surcharge (In of oconit fee): 3 , , 00 Authorized sign ,��j�i�`� ...� _ :�.... TOTAL PERMIT Fa: , r D f e w ' I ion p rsorappgl tapist_v go Berta b oot ehlrr12Rd with% t''. � — r 1irw. L yj � i bate: N ill/ days sna is papa teem Helped as coatdeee. • NtanDet of Shgtec'ona allowed per permit. ivendireOPmalrAni..c- Rm,itApoow OfJJL06 cermet nil INNCnMrwTB • 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* ❑ Keating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* El Other: Fee for eac commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: Audio and Stereo Systems El Boiler Controls ❑ Clock Systems s tiZ Data Telecommunication Installation ❑ Fite Alarm Installation ❑ VAC ❑ Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n � / CI Other Y 1/ ktuvY , C,.l� 1 Total number of commercial systems: —1 *No licenses are required. Licenses are required for all other installations imulldittp Avg dee O112