Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s , COMMUNITY DEVELOPMENT Permit #: ELR2012 -00280
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/24/2012
Parcel: 2S113BA00200
Jurisdiction: Tigard
Site address: 7800 SW DURHAM RD 500
Project: The KOR Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: (1) low voltage for alarm system
Contractor: MASTER ALARM LLC DBA PHILLIPS ELECTRONICS Owner: METZGER VENTURES, LLC
3247 NW 29TH AVE PO BOX 400
PORTLAND, OR 97210 SHERWOOD, OR 97140
PHONE: 503 - 222 -5083 PHONE:
FAX: 503 - 227 -4992
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/24/2012 $75.00
12% State Surcharge - Electrical 12/24/2012 $9.00
Type of Use: COM
Class of Work: DEM
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
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
•
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 0001- 000900.. You may obtain a copy of the rules or direct questions to OUNC by calling 503. or 1.800.332.2344. ,1
Issued By: 7 � A L� 1 Oh Permittee Signature: Of`-r A P PL (C4 -r /O CL
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 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.
12/21/2012 @S:36 5032274992 PAGE 02
Electrical Permit Application RECEIVED
FOR OFFICE USE ()NIX
City of Tigard 1 2 4 2012 Re i '` 1 '
Daiefily: Permit No6Le. a Dix _ D0)- g D
125 5W Hall Blvd,. Tigard. OR 97223
: w i 3
11 Nan Retrfcw
• 11 . • Phone; 503.718.2439 Fax: 503.598.1r/Ty OF T Darel8Y;
IGARD /8 Other Postale
Ti CA RE) Inspection Line: 503.639.4175 Date Ready _y: 63 See Pner 11 2 for
Internet; www.tigard-or.gov 9uppkmentt Information
BUILDING DIVISION Nat'''''''''14_'
'':''' ..' l'
El New construction V Addition/alteration/replacement Please check all that apply (submit a sets of plans whtems checked below):
0 Service or feeder 400 amps or more 0 Building over three stories,
El Demolition 0 Other: where the available fault current [1 Marinas and boatyards.
1 ltO• I'... , i'' ' *.'!6#;',0001401401ettbiV1:1!.9'j::•17ii.S4C,l-4.2.::::::■.i."•:.:P•I'' exceeds 10000 amps At 150 volts or 0 Floating buildings.
loss to ground, or exceeds 14.000 ['Commercial-use agrimilturn1
El 1- and 2-filmily dwelling 1/4 Commercial/industrial 0 Accessory building amps for all other instillations, buildings
ID Multi-family 0 Master builder 0 Other: 0 Fire Pump. 0 installation of 75 KVA or
'.: • ' ...; ..•;.‘,-,,m,.• " " --- - — '', --;.;;;;•.:'..,.0:......::.:- El Elm VE larger scperatcly derived system.
' • .
.i_ .. •4, IV .-,r fl...5 [I Addition of new motor load of
Job no.: I Job site address: 7800 Su p A «S0 100HP ar more.
aloe' I:1 Six nr more residential units. occupancy.
0 Recreational vehicle parks.
- City/State/ZIP. 0 Hcalth-care fecilitics. 0 Supply voltage for more than
' s . ... ... 0 122 4" 0 Hazardous locations. 600 volts nominal.
Suite/bldg/apt. no.: s Project name: - , K op, .N, -1‘..,.... 9 , ,scry, , , °T ked .:
cr 6 °° rl" "w're
, .. , ;'.'1,:.;'1•J,, , A,;.■''. , iiii , ,;;;*EUA lti:
Cross street/directions to job site: s 791 A, Av, DetcrIpdno i cm. i" Pet. I Teed I • ‘,
New residential single- or multi-family dwelling unit,
includes attached garage. •
Subdivision: tot no.: 1,000 sq, It or less i 68.54 4
Ea. addl 500 sq. ft. or portion 33 92 1
Tax map/parcel no Limited energY, residential 75,00 2
. ..c....,.. T : AtititifradttlfitWbRic (with above sq. ,I
. i.....Tst.... , ' ' (with ,
'''. Limited energy, multi-family
75.00 1 2
1 00 V- t- . - At . „ s .64e.., residential (with above sq, ft.)
Services or feeders installation, alteration, and/or relocation _
200 amps or lest 100.70 2
:1■'!..:44nillittiiilltretiViittit ... . . D TEN-A., .:...' 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 j
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP! relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59,36 1
201 amps to 400 amps 125.08 2
Owner instatietiont 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 to
- new, altCration, or extension, pr panel
Owner signature: Date; A. Fee for breach circuits with
1■110i1 IR: ..,', XOtri :.;,,:,,:,, , above service or feeder fee,
7,42 : 2
,, each branch circuit ,.■
II. Fee for branch circuits without
Business name: i
. ,
service or feeder (be, first
56.18 l 2
Contact name: branch circuit
Each add'I branch circuit 7.42 I _ 2.
Address: Miscellaneous (service or feeder not included) ..
Each manullictured or modular
C ity/Statc/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E ... Sign or outline lighting 67.84 I 2
i. . CO , ...' A
1 .....F1''ii , ..c.. , ?::::..!■ ! ; ) :' , Xi;::: : : F"....,"' sig circuit(s) or limited-energy i 75-.t.
panel, alteration, or extension, Page 2 2
Business name: Master Alarm LLC dba Phillips Electronics
Each additional inspection over allowable in ally of the above
Address: 3247 NW 29th Avenue Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66,25/ hr
City/State/ZIP: Portland OR 97210
_
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 222-5083 9( 9.1 3 _s" ax: (503) 2274992 Esspections for which no fee ia
90,00/ hr
CCB Lic.: 125364
K specifically tisted (55 hr min)
• ' ‘.1 ' "' .'..;
1 Electrical Lic.: LE 1 ry L .: t # .1,k ji i i i:,,,.:,,,,,,,„.,,„.....,•„,. , ..,00,,„„,,..,... •.•.,
Suprv. Electrician signature. required: Plan review (25% of permit fcc):
# ....
Print name: _ .1 c c-0 50-1.. Date:
_..... State surcharge (12% of permit fee): 1
TOTAL PlUvTIT FEE: 4 Sti '
Authorind signature: .•
This permit applicatien expires Ifs permit is not obtained within 180 ".
days after it has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit. _
t:liulldlog1PermietTLC-PermitApp.ene aVnino 440-4S I ITO I /6SiCOMAIJES
12/21/2012 09:36 5032274992 PAGE 03
Electrical Permit Application - City of Tigard
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*
❑ Ideating, Ventilation and Air Conditioning System*
❑ Vacuum Systems
❑ Other:
i
11 I i.,
�.,..... .... .... I i• ', ,..,1.i:::;.:�::��11��llili� "1.1,.,1 )L, I ,� ..
Fee for g commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑
Boiler Controls
El Clock Systems
❑ Data Telecom nunicat.ion Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation. Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
VI Protective Signaling
❑ Other
Total number of commercial systems: J_
*No licenses are required. licenses are required
for all other installations
1:\13tal kig1PemltoiELGPmnitApp.dx 07/01110