Permit A CITY OF TI GARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2005 -01002
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/17/2005
PARCEL: 1 S 126BC -01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 480 ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Protective Signal.
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:
WYSE INVESTMENTS STANLEY SECURITY SOLUTIONS INC
111 SW 5TH AVE SUITE 1100 DBA BEST ACCESS SYSTEMS
PORTLAND, OR 97204 1804 EAST VALLEY HWY
KENT, WA 98032
Phone: 503- 294 -0400 Phone: 877 - 433 -4370
Reg #: LIC 89557
ELE 26- 1017CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 11/16/200: $75.00
[TAX] 8% State Surchart 11/16/200: $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 95 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699.
Issued By: Permittee Signature: c') a 2 2 1 e - 1 - 2 ,
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 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.
`- sari 1( --119-0> I
f I ` f _ :/2--- -,' '' ; // i - /l
"-.Electrical Permit App FOR OFFICE. 1 SFONI_v
City 'riga rd . 7 „i Re Iv • ' Past No.
L.! _ II.. — 00 n
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503 598 1960 °�- -- Other Permit:
Inspection Line: 503.639.4175 CI I Y �1 T I - L , I , .I ��
Internet: www.ci.tigard.or.us BUILDiNG DIVIS, ° " " obf d ®see
Supplements' Information
TYPE OF WORK PLAN REVIEW
❑ New construction A Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'I ['Hazardous location
❑ Demolition ❑Other:
OService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CAT .; r RY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
❑ I and 2 family dwelling 13 Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family • Master builder ❑Other;
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lightingplan RV park
Job no.: Job site address: 9070 s 1 fl.M i, s Q . n. .Health-care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: Pow I ( ft In 6 . A f� z 0 R 9-1-R,3 The above are not applicable to temporary construction service.
Suite/bldg. /apL no.: /20 Project name: IA . / A FEE* SCHEDULE
i 1∎1124 ` T gv a8A tlt New ream Qty. I Rte. I Total I .•
U L M.A[
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'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
4 e'er SS cv r 0 G S Y <, 6 , , dwelling, service and/or feeder 90.90 2
J Services or feedersinstallation, alteration, and/or relocation
,,,�111. 200 amps or less 80.30 2
❑ PROPERTY OWNER I TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: 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: ( ) Fax: ( ) relocation
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each
Business name: s 1 c ui _ Y S'v_ a, a' branch circuit 6 65 2
C • i _ `��VIAit _ ��_-��1, B. Fee for branch circuits
i without service or feeder fee, 46.85 2
• 111 '■-.1RWEEKIMALfi F each branch circuit
Cit iSs I EMILVI I Miscellaneous llan branch (service ice or feeder not included) 6.65 2
Miscellaneous (servi)
'hone: ( 0 3 sly - I ? 5 1 ax: ; ( Pump or irrigation cycle 53.40 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
�
CONTRACTOR energy panel, alteration, or
1 /J E SG cv 1 1 t S yST
extension. Descnbe: / Page 2 2
n
Business name: E �
Address: / eti0 ( VA L y, E y Hag, Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: j<E',J t f A 9 uQ 36)- Investigation per hour (I hr min) 62.50
Phone: (g - , .4 1./ � 3 1 - � 3 7 Fax: ( ) Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES•
CCB Lic.: 5-5 -7 Electrical Lic.: \ prv. Lic.: L 2 _ S 7 L,�n Subtotal '75
Suprv. Electrician signature, required: �' Plan review (25% of permit fee)
Print name: C L /- 0 6 7 ' `-ms Date: N—/‘---or State surcharge (8% of permit fee)
TOTAL PERMIT FEE O I —
Authorized signature: This permit application es Aires if a permit is not obtained within IBO
d seeb it has beat accepted u dumplete
Print name: G' C e:c ej , f Date ://— J ‘- Lj • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
1 \Buldmg\PermrulELC- PermrtApp doc 12/03 440-4615 T(10/02/COM/WEB
' 1,
Electrical Permit Application - City of Tigard ,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
ifigib tirr ORZ.ONLY :''. 7 Pis . :7
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*
El Other:
tCOMMtitt AL.WURK ONLY: `� ,, -- r : `i .
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 •
El HVAC -
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls .
❑ Outdoor Landscape Lighting*
X Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations -
I \Bwtdmg\Pcrmcs\ELC- PamitApp doc 04/03
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELR2005-01002
13125 SW Hall Blvd., Tigard, OR 97223'
DATE ISSUED: 11/17/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503)
INSPECTION WORKSHEET FOF1 DATE: 12/1/2005 TIME: 7 : 08 AM, PAGE: 55
SITE ADDRESS: 09020 "syv WASHINGTON SQUARE RD 480 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: UNITED HEALTH
DESCRIPTION: Protective Signal.
OWNER: WYSE INVESTMENTS, PHONE #: 503-294-0400
CONTRACTOR: STANLEY SECURITY SOLUTIONS INC PHONE #: 877-433-4370
Inspection Request Scheduled For: Date: 12/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 022701-01 503-849-6499 . N
Corrections/Comments/Instructions:
(
•
•
•
•
' PASS 0 PARTIAL APPROVAL 111 CANCEL LI NO ACCESS
0 FAIL , 0 CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718- 2 /(/
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2005.01002
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/17/2005
Phone: (503) 639 -4171 r , J�� � + �!���,�
Inspection Requests (24 Hrs.): (503) 639 -4175
J
INSPECTION WORKSHEET FOR DATE: 12/1/2005 TIME: 7 :08AM PAGE: 54
//
///
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 480 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:. , UNITED HEALTH
DESCRIPTION: Protective Signal.
OWNER: WY SE INVESTMENTS, PHONE #: 503.2.4 -0400
CONTRACTOR: STANLEY SECURITY SOLUTIONS INC PHONE #: 877 - 433-4370
Inspection Request Scheduled For: Date: 12/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 022701 -02 503849 -6499 N
Corrections /Comments /Instructions:
L
•
•
'PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: L- Date: / �/' / Phone #: (503) 718 -