Permit "
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
* DEVELOPMENT SERVICES PERMIT #: ELR2004 -00049
- '' ' IJ- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/26/04
SITE ADDRESS: 15570 SW PACIFIC HWY PARCEL: 2S110DC -02200
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 JURISDICTION: TIG
Project Description: Low voltage for fire sprinkler monitoring system.
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:
INSTRUMENTATION: OTHER: SEE ABOVE X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TIGARD, CENTER LP STONER ELECTRIC
9777 WILSHIRE B LVD #609 1904 SE OCHOCO STREET
BEVERLY HILL, CA 90212 MILWAUKIE, OR 97222
Phone: Phone: 503 659 - 4968
Reg #: LK/3- 46244 3
SUP 4025S
ELE 26 -122C
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 2/26/04 $75.00 Elect'I Final
[TAX] 8% State 2/26/04 $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 c7>i
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: `tida5 's
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
02/25/2004 WED 10:44 FAX 5036592824 STONER SERVICE 21002
El c'drical Permit Ayplication Ftor. or 1:1( E 1 SE ()1:1
City of Tigard ECEIVEL' Received .'j, 0 %' ■ �N
P, �l
_ . t
13125 SW Hall Blvd., Tigard, OR 97 2. Plan Pewit • abar permit:
111 Phone: 503.639.4171 Fax .503.598.1960 ''.''`�}' {,.i's Datr/BY --
inspection Line: 503.639.4175 t „ M.. .`l f„ Dam Re dyBy_ 0 Sea P 2 for
Internet www.ci.tigatdor.us FEo 2 2004 Notifiedimethod: I supplemental Information
. t v'i� ART PLAN REVIEW
❑ Ncw construction construction • t Please check all that apply:
' � INC ❑service over 225 amps, coming ❑Ifa¢audousloodian
❑ Demolition LI Other 0 Service over 320 turps - rating ❑ Buildng over 10,000 sq. IL,
CATEGORY. OF CONSTRUCTION - of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling Commer ial/industrial CI Acccssory building of
over 600 oohs nominal units in one structure
CI Multi-family Master builder 0 Other. over three stories ❑Foedaa, 400 amps 01" more
Y 130ceeFem load over 99 persons ❑Mnmufacturcd atmetur s or
. JOB SITE IN oRMATIoN . i* OCAT1O 1 J ❑ ES�,q�gPlan • RV park
Job no.: ,,)-.--/ 3 . I Job site address: 1 cg. 70 S 03 i A i 1'f-/•(' / 2sets ofpl with any of the ahoy&
City /Stater: i 14 , a e.. ei 7 d--e- 3 _ The above are not applicable to temporary construction service.
SuitelbldgJapt no.: 1 Project name: 5 /41) i4- t/ / 4 .7i FEE >
w Destatvaxc I Qtr. E Pm. I ra,d I
Cross street /directions to job site New residual single- or malts- fiumlj dwelSng unit.
Includes attached garage. _
1.000 sq_ ft. or leas 145.15 4
Subdivision: I Lot no.: Ea. add'1 500 sq. a or portion 33.40 i
Tax map/parcel d no.: - Limited energy. residemial 75.00 2
lintited energy, non-residential 75.00 2
•
, � , i' /.• : .. _ DESC*I»TON:CF WORK . ' Eetfi mmmficQaed of modular
Ir 1 �2� #4k ( .e.--- OAI rare �6 dwelling, service and/or instal feeder 90.90 2
Service' or feeders ImlaRatiols, alteration, and/or eeiocafioa
5 V J *E/j _ 200 amps or bras 8030 2
. . 201 amps to 400 amps 106.85 2
[j= PBOPER :tOSNNER . `-0 • • . • 401 amps to 600 amps 160.60 2
Name: 601 amps to L.000 amps 240.60 2 1
Address: Over 1,000 amps or volts 454.65 2
Rammed only 66.83 2
City/Statel/IP: Temporary mr*ae or feeders alters Lion, mmd/or
Phone. ( ) I Fax ( ) 'relocation
200 amps or Ins 66.85 t
Owner ikon: This installation is being made on paapaty that I Owls which is not 201 mar to 400 amps _ 10030 2
intended for sale, lease, rmt, or eacdlange, et o drbag to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Oanef sigaamre: Date: Ikon& dradts —Dew, alteration. or extension, per panel
:•., -% :: Ii z _ ''`i JC &1t}T: :' : j] r&VT •FEDSO Q' :: 'Z''' A Fee for branch circuits with
t = service or feeder fee, each • 6.65 2
Business name: circuit branch circuit
B. Fee for branch circuits
Contact nix= withoar service or feeder foe,
each branch circuit 46.85 2
Addr s:
Each edd'1 branch circuit 6.65 2
City/State/ZIP: MisceIbmeatn (service or feeder not included)
Phone ( ) I FaX : ( ) Pump or irrigation circle 5140 2
5140
or outline rigid ng 53.40 2
E - mail: Signal circuit(s) or limited -
coNTRACPOR energy Feel, alteration, or
_ extension. Describe; ' 75.00 l c r 2
Business name: Sin N ER E t-Ec.. i C - • W
Address: 1 Each additional inspection over alowahle in any of the above
904- S E oc _koro
Per inspection 62.50 _
City /State/ZIP: f r ` p4 ,, /C i e O R 9 72 2 Z Investigation per hour (1 hr ow,) _ 62.50
. plant per hour 73.75
Phone: ( ) 4l0 2 - X050 t� I Fax (5 ) Co 59- L�9lo g m EcnucA[. Pl.Rwar FEEse
CCB Lie.: 44$23 I Electrical Lic.:2(o - j 22 c I Supty. Lic.:3 -9( Subtotal 361,0D
Suprv. Electrician signature, required: ptae K 4..a1 Plan review (25% of permit fee)
Print name: '1/1 I iL>= refs h_ co 1�t' e R Datc: , b Y _ State surcharge (8% of permit fee) • 0�
TOT* 1.. PERMIT FEE i 1, ao
Authorized signature: • This permit application expires Ifs permit is not obtained within 180
- - "^ dry
s Idler it has been accepted AS complete
Print name: -- II) • Fire methodology sir by Tn.Co,atty building industry Serv,cc tidatd