Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00126
T I GA RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2012
Parcel: 1S136DB00501
Jurisdiction: Tigard
Site address: 11611 SW PACIFIC HWY
Project: Union Gospel Thrift Store Subdivision: 2000 -025 PARTITION PLAT Lot: 2
Project Description: (1) Signal circuit low voltage fire panel swap out and add 1 keypad
Contractor: PROTECTION ONE ALARM MONITORING Owner: KBF III LLC
15500 SW 72ND AVE JGF III LLC
PORTLAND, OR 97224 602 THIRD ST STE 94107
SAN FRANCISCO, CA 94107
PHONE: 503 -624 -0244 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/19/2012 $75.00
12% State Surcharge - Electrical 06/19/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: Y
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
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 OA 9 - 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: /eA
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 603.639.4175 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.
•
Electrical Permit Application RT FOR OFFICi USE ONLY
o
City of Tigard Received c �� S i `1�� Permit N /� r
I� �- �
Date /B L ���' _
° 13125 SW Hall Blvd., Tigard, OR 97223 •
M Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 JUN N 1 9 2 Q 2 Date/B : Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready /By: EI See Page 2 for
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: Supplemental Information
TYPE OF W jr :1DIA G3 DIVISION PLAN REVIEW
❑ New construction ® Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- 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
JOB SITE. INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: 120608255 Job site address: 11611 SW Pacific Hwy 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /Stale /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Union Gospel Thrift Store ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description ,
P I Q r• I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
low voltage fire panel swap out + add of 1 keypad residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ® CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: Protection One B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Emily Lehr branch circuit
Each add'I branch circuit 7.42 _ 2
Address: 7312 SW Durham Road Miscellaneous (service or feeder not included)
City /State /ZIP: Tigard, OR 97224 Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: (503) 443 -2904 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: emilylehr @protectionone.com Sign or outline lighting 67.84 2
• CONTRACTOR Signal circuit(s) or limited energy
Business name: Protection One panel, alteration, or extension. 1 Page 2 2
Each additional inspection over allowable in any of the above
Address: 7312 SW Durham Road Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State /ZIP: Tigard, OR 97224 Industrial plant (I hr min) 78.18 / hr
Phone: (503) 443 -2904 Fax: (,tOkl. 100k Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lie.: 116325 /I g� Electrical Lie.: 34 -428CL Suprv. Lie.: 4124LEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7 Subtotal: 75.00
Plan review (25% of permit fee):
Print name: Phillip Wolfe Date: 6/18/12 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
' Print name: Emily Lehr Date: 6/18/12 • Number of inspections allowed per permit.
1: \BuildingTermits\ELC- PermitApp.doc 07/01/10 440- 46t5T(II /05 /COM/WEB
Electrical Pgrmit Application - City.of Tigard
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Page 2 - Supplemental Information •
LIMITED ENERGY PERMIT FEES:
"i RESIDENTIAL WORK ONLY: ?.
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n 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:
❑ Audio and Stereo Systems
❑ Boiler Controls •
•
❑ Clock Systems
❑ Data Telecommunication Installation
a Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
• Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
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