Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
41..41.111 DEVELOPMENT r S O ERV SERVICES 639 -4171 DATE PET #: ELR2005
RMII ED: 2/7/2005 -00025
SITE ADDRESS: 06825 SW SANDBURG ST PARCEL: 2S101 DD -00400
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT: 001 JURISDICTION: TIG
Project Description: Adding video intercom 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: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
TOC MANAGEMENT SERVICES INC SONITROL (AKA SOUND SECURITY)
6825 SW SANDBERG ST 8220 N. INTERSTATE AVE.
TIGARD, OR 97223 PORTLAND, OR 97217
Phone: Phone: 503 223 - 5822
Reg #: LIC 53535
ELE 26- 370CLE
SUP 1812LEA
FEES Required Inspections
Description Date Amount Low voltage
[ELPRMT] ELR Permit 2/7/2005 $75.00 Electrical final
[TAX] 8% State Surchart 2/7/2005 $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 ,, r Permittee Signature ,e. or f_c
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
∎- \- 05
EIEttri tiI Permit A tteNV ED ' . FOR OFFICE USE ONLY
CI of Ti and Received �/ n �jj ' a Z �J g � DateBBy: I Jr✓3- Jl` Permit No.: � ' Cle. 2 a0�(,i is
v
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
��
Phone: 503.639.4171 Fax: 503.598.196 ; Date/By: Other Permit:
Inspection Line: 503.639.4175 �F T ` G A�....4 - 1411.- e'' I ' i\ Date Ready/By: Juris: FL See Page 2 for
Internet: www.ci.tigard.or.us ('�1'"( DAliS'ki Notified/Method: f
tfr
Supplemental Information
F ... RK _ .- .{:,,: ,%' ; _REVIEW. - ...c
❑ New construction 18,1 Addition/alteration /replacement Please check all that apply:
['Service over 225 amps, co'I ['Hazardous location
❑ Demolition ❑Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
--•� it ";,.,:h " ' -F„ of 1 - 2-family dwellings ,, >.., - '- . �'; < < : CriTEGORY,; OF •, - , :�:: :; - ' y s 4 or more new residential g
❑ 1 and 2' family dwelling X Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ['Feeders, 400 amps or more
❑ Multi - family 0 Master builder
❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
-; '- •' .JOB;,SE E 'INTORMAT1ON AND: LOCATION; I ❑Egress/lighting RV park
Job no.: %%404_
09 Job site address: 6p 8'aS S S(' - t � S\-. ❑Health -care facility ['Other: J Submit 2 sets of plans with any of the above.
City/State/ZIP: — r i r q, aa3 The above are not applicable to temporary construction service.
: r` " }:FEE. , :SCHEDULE, -,. .
G Vv ojrnC r` - ..CI � ' ' - -' ' - - r " - -- ` ..
Suite/bldg. /apt. no.: ( Project name:To
(� Description I Qty. I Fee. I T o t al I .
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
- 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
', `• _ ''t - `DESCRIP-TION-OF: WORK • - , 4 ' . , '_ :" :. Each manufactured or modular
•
C/ O\ t-Kk��C_U�,\ In dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
i ,� - -. , . - 201 amps to 400 amps 106.85 2
- l .PROPERTY�OWNER.. I - ❑ .. TEN A NT. " ='' r , 401 amps to 600 amps 160.60 2
Name: T3G YC \0,W‘a_ l(` x\"k" 601 amps to 1,000 amps 240.60 2
Address: 5000^& QS Over OR — • Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: (5p3) ( - 1. 1- 1 2000 0 amps 1 O Fax: ( )
relocation
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
:APPLICANT " r _ - r =
' ' - ' ❑ CONTACT ❑- CT 'PE A. Fee for branch circuits with
I service or feeder fee, each
Business name: branch circuit 6.65 2
. B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
-': " r . . - energy panel, alteration, or 6 b
. r - �
., .,, extension. Describe: I Page 2 1 5 f 2
Business name: St.n. SQLC.)
Address: C& aD_v (3 .'.-)� �L'A Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: 7 )0y - l — kG—ACk t 1 . e�1� Investigation per hour (1 hr min) 62.50
n Industrial plant per hour 73.75
Phone: (5 3) aa3 _ S a.a Fax: (5(i3) `\� 3— � l ., ` :ELECTRICAL PERMIT 'FEES *' . :. '
CCB Lit;.: 53 3 5 Electrical Lic.:a(o - 3 - 1 v Suprv. Lic. :Y Ze Subtotal i 5 t ez
Suprv. Electrician signature, required: ` . e l . Plan review (25% of permit fee)
' State surcharge (8% of permit fee) (o . CC
Print name: - MI
Date:,, _ TOTAL PERMIT FEE 8 k , pp
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
" Number of inspections per permit allowed.
is BuildinglPermiulELC- PermitApp.doc 12/03 340 -461ST(10 /02/COM/WEB
•
Electrical Permit Application - City of Tigard - d.
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
. �CO1VI�l �E• RCL. 4TI ,;WOI2�- �bl�ILI':"''';:- .�.._- _.,.. ,1
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
Et Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
rfki Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pemuts\ELC- PemtitApp.doc 04/03