Permit • 1
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
li 5 • • COMMUNITY DEVELOPMENT Permit #: ELR2009 -00153
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/04/2009
Parcel: 1 S 1260000300
Jurisdiction: TIGARD
Site address: 9724 SW WASHINGTON SQUARE DR F06
Subdivision: Lot: 0
Project: Gap
Project Description: Install burglar alarm system.
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, Restricted Energy Permit 06/04/2009 $75.00
2235 FARADAY AVE STE #0 12% State Surcharge - Restricted Energy 06/04/2009 $9.00
PHONE:
Contractor:
ACS ELECTRIC LLC
16559 SW SHANE CT
SHERWOOD, OR 97140
PHONE: 503 - 442 -3938
FAX: 503- 625 -1862
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: N
HVAC: N Instrumentation: N Total $84.00
Intercom/Paging N Landscape /Irrigation: N Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
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 r ante wi . pproved 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 A NTION• Oregon . w requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 -00 -0010 th • gh OAR 952-11 r 00 ou may obtain a copy of the rules or direct questions to OUNC by calling 503 2 . • : •' • I 1 :00 . 2344
Is ued By: – _ � ,..1 & — L . ' Permittee Signature: 1ilj�i:��,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.
J - " I.
Electrical Permit Application FOR OFFICE USE ONI.V
° iv
City of Tigard Receed
O - Permit No �� /t
/C ��
a.l �0/5 r
13125 SW Hall Blvd ,Tigard, OR 97223 Plan Review
Phone 503 639 4171 Fax Date /B 503 598 1960 Date/B . Other Permit
T I G A It D w Inspection Line 503.639 4175 Date Ready/By � ®see Page 2 for
Internet www tigard -or gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
New construction TX ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /Items checked below)
12 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
❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "I -3 ",
Job no. Job site address: c �, r I IOO or more Recreational p
7 i,�./ ward,, w�i'o^.+ S l ❑ Six or more residential units ❑Recreational vehicle parks.
4 ❑ Health -care facilities ❑ Supply voltage for more than
City /State /ZIP
r Ok 1 7 22A ❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt no.: Project name: Q, ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty 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 145 15 4
Ea add'I 500 sq ft or portion 33 40 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft ) 75 00 2
Limited energy, multi - family
eil � y cJ 1€1A C ssc`2.IL ��, 777 ) residential (with above sq ft ) 75 00 2
`� Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
❑ PROPERTY OWNER TENANT , 201 amps to 400 amps 106 85 2
Name. �--z!' ,n 401 amps to 600 amps 160 60 2
NA_ 601 amps to 1,000 amps 240 60 2
Address: 1 7� Arx....) l_ `` fs� 5Q Over 1,000 amps or volts 454 65 2
City /State /ZIP: r � Temporary services or feeders installation, alteration, and /or
C relocation
Phone ( ) 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
%APPLICANT ❑ CONTACT PERSON , above service or feeder fee,
/ each branch circuit 6 65 2
Business name' S C l � Q B Fee for branch circuits
Contact name: be 1 J - ` , i(J ) --tt � _ 4 without service or feeder fee, 46 85 2
Y ( first branch circuit
Address: 4/ b 5-7s—? i , iizelJ e_ (--/--- Each add'l branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City/State /ZIP. j j d ., U-�e ` O Z cc 7/ f f Each manufactured or modular 90 90 2
dwelling, service and /or feeder
Phone: (0,3) `i c Z 5 � 3 l� 2! Fax' (p3) 6Z / Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53 40 2
CONT CTOR Sign or outline lighting 53 40 2
�{ ( � Signal circuit(s) or limited -
Business name: L� L
• r • C L.1�- energy panel, alteration, or r
Address: extension Describe I Page 2 75 -----
City /State /ZIP: / Each additional inspection over allowable in any of the above
,7/i Per inspection 62 50
N., Phone: ( ) CI Lf, 2 , Fax:
( ) /0/1 (II Investigation per hour (1 hr mm) 62 50
\ CCB Lic : «57? Electrical Lic .2,5 co Suprv. Lic.: .--6 / LE-A_ Industrial plant per hour 73 75
4- Suprv. Electrician signature, required: A i ■ ; ELECTRICAL PERMIT FEES
• ��,_ �i 1 GIr i i, . SubI T total. *7--- Print name: ' ` ' ai
Plan review (25% of permit fee)
` ! - State surcharge (12% 12% of permit fee). q
Authorized si nature: ,���� r TOTAL PERMIT FEE
g / ice ° � ` = �J— 'c
This permit application expires if a permit is not obtaine wi to 180
Print name �� Date
r days after it has been accepted as complete.
• Number of inspections allowed per permit
I \Buddmg\Permns\ELC- PermitApp doc 05/23/06 440 -461 ST(11 /05 /COM/WEB
4 , — , 4.
Electrical Permit Application - City of Tigard 0 Other
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES: *No licenses are required. Licenses are requir
for all other installations
:'ittkE•EisitiAL*Qiuc:oNtyi, ,: ' f '',,, ‘,.:-;','•::'.'':
- K - :■.
Fee for all residential systems $75.00 -
combined
Check Type of Work Involved:
III Audio and Stereo Systems
,i'l:' tf.,,I,, --., :.,,,:',.', :gi \'
111 Burglar Alarm c
-:
-,,
n Garage Door Opener* c ,- .,+_'■ '
r ' -- - , -
n Heating, Ventilation and Air Conditioning
System*
O Vacuum Systems
O Other:
,,,
' , v i ,) ---, ....I )`-....' .1 .('-i i '''. • • cl„ 7 -:, ,,,,_.
commtitoAt wo,,mc, - 0 - sii,Y ; ' : ', - .77;,,,:`,:2,, ,-,,,‘,,',' ,.. .:
Fee for each commercial $75.00
system \-,;•(-:\, '
i
(SEE OAR 918-309-0000) , . , . ., , ,
2 4 1 ; 22 ) __,..+ ', , .A—. '.. ',. — • — ,'
--
. .-
Check Type of Work Involved: :)
O Audio and Stereo Systems
O Boiler Controls
0 Clock Systems
._„.•....1..-,:', _; :- - ., .. ,, , - '._,7: 1
i . . _I,
111 Data Telecommunication Installation - k,_-' ''.. , . - - ., : t..■ -„
`,.' %) 2 .,4.t.... ..',', \,,--'
0 Fire Alarm Installation
_
III HVAC ''') :,: ',, ' (2, )-
O Instrumentation
r
' ". - - --1 ' • - F, - -?'- 1. ,
n 'Intercom and Paging Systems _ 1
7',
O Landscape Irrigation Control* / z
t —.....-
O Medical
LI Nurse Calls •
, , \
D Outdoor Landscape Lighting*
1 '. ' '
protective Signaling 1 1 .
t.e-,-P 5/5 ' .
N . k
I \13101clingWermits\ELC-PermitApp doc 03/23/06