Permit ELECTRICAL RESTRICTED ENERGY PERMIT
' CITY OF TIGARD
F s ' COMMUNITY DEVELOPMENT Permit #: ELR2009-00275
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/20/2009
Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 120
Subdivision: Lot: 0
Project: Little Caesars Pizza
Project Description: Install (2) low voltage systems: data & CCTV
Owner: FEES
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Restricted Energy Permit 08/20/2009 $150.00
PORTLAND, OR 97205 12% State Surcharge - Electrical 08/20/2009 $18.00
PHONE:
Contractor:
SIMPLE SECURITY
4836 SW SCHOLLS FERRY RD. #226
PORTLAND, OR 97225
PHONE: 503 - 574 -2254
FAX: 503 - 245 -2998
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $168.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 acco an'P , ith 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. ATT ION: Oregon -w - • ' es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 0 through OAR 952 -' • 1 -010'. u may obtain a copy of � the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued k 0 10 /,. (J. � Permittee Signature: 42 1.--n----1.-- --
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 an inspection that business day.
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.
Electrical Permit Application FOR OFFICE; [SF ONLY
Received / n _ CL /J _ p _ dO .2 7
,
City of Tigard Received
: et'
mpg
Plan G Itn s ��
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I Phone: 503.639.4171 Fax: 503.598.19 Date/B Other Permit:
T I GA K D Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: �� Supplemental Information
; k TYPE OF WORK ?, PLAI1 R *'�W `,r. � .,
New construction ❑ Addition /alteration /replacement Please check all [hat apply (submit 2 sets of plans whtems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
e ` TE 6O R y OF : CONSTR U C T IO N exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
` less to ground, or exceeds 14,000 ❑ Commercial -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 of 75 KVA or
.;%e
n , ❑ Emergency system. larger separately derived system.
0014 +* 1a e�Le ,,-.,
'� 3 TI` x° ern..:^` o-
❑Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 1 Job site address:
1(-4'.1 (,?Jc Pa -F`‘ G ley Six or or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
Ci
n /State /ZIP: i �( i lS _0 ri.r) V K — ZD ❑ Health-care facilities. ❑ Supply voltage for more than
C... ❑ Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name: . t . C..46c /�-� -5 ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description l Qty. I Fee. Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
. DESCR LION oft W0� :; ` ',"Y '' (with above sq. R.) .
G L t Limited energy, multi - family 75.00 2
'?q 1 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
�"F. �t Y y'. n[ ? +c R sx" _ R4 ..i,
a � : : 40 .. , -k. . , ...... ,. � ;, _'' 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
. 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
f � A �� + above service or feeder fee
. ,. »E. �0, x�_.k.a mi l' 1 .� -41.. i .. 6.65 2
each branch circuit
Business name: 0 B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: h manufactured mar
dwelling Eacman , service fac re an or d /or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
y _ t Sign or outline lighting 53.40 2
Business name: I _ e u r
• t NC r Signal circuit(s) or limited -
�7 (mot n t y � L energ panel, alteration, or Ot C�
I �( extension. Desch e: , Page 2 / � 2
Address: Lice-4(Q 4, 4c t/ F-Pjivr . g zz CP `Do.- % ct
City/State /ZIP: f' j - IA C f2.--- _ l 7 Z 7.S Each additional inspection over allowable in any of the above
C( Per inspection 62.50
Phone: (O r - 7(i- 2.Z 4I Fax: (cC2) 7.ci — 29' I S Investigation per hour (1 hr min) 62.50
CCB Lic.: l 5 ( l Electrical Lic.: 3y -(,o3 GLC Suprv. Lic.: Wq I C4 Industrial plant per hour 7 3 75
>5�3hai.r:�;r � `s � i `�w�� 5111sJ '�.r�, a, ,
Suprv. Electrician signature, required: J Subtotal
.52 Print name: D a 4 A4 , e V Date: W Z
Plan review (25% of permit fee):
State surcharge (12% of permit fee): / S-, DO
Authorized signature: TOTAL PERMIT FEE: f _, roc)
This permit application expires if a permit is not ob within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee 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:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ A udio and Stereo Systems
❑ B oiler Controls
❑ C lock Systems
❑ D ata Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
H Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \ Building \Permits\ELC- PermitApp.doc 03/23/06