Permit ,e / / --- q 0 g
III q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2006 - 00270
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/9/2006
PARCEL: 2S 102AA - 00906
SITE ADDRESS: 12080 SW MAIN ST ZONING: CBD
SUBDIVISION: PAYLESS SHOPPING CENTER LOT: 002 JURISDICTION: TIG
Project Description: RITE AID. Security 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:
MONTCO ASSOCIATES VISION SECURITY SERVICE
BY THRIFTY /PAYLESS INC #5354 10874 SW ROLAND CT
PO BOX 8431 WILSONVILLE, OR 97070
HARRISBURG, PA 17105
Phone: Contact #: PRI 503- 682 -6713
FAX 503 -582 -1133
FEES Reg #: ELE CLE63
LIC 171552
Description Date Amount SUP 3899LEA
[ELPRMT] ELR Permit 11/9/2006 $75.00
[TAX] 8% State Surcha 11/9/2006 $6.00 REQUIRED ITEMS AND REPORTS
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 adopt • by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You ma o• : 'opies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. , /
Issued By: Q� v Permittee Signature: - ` A`,/
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.
, Electrical Permit Application FoR ()Frio: usl ()NI.)
City of Tigard E V D Received errttt o.
tY g Date/B . J/ a 11.. P i N Al.._ .. ,4 t, A/
13125 SW Hall Blvd. Tigard, OR 97223 Plan Review '
l e Phone: 503.639.4171 Fax: 503.598.196 Q U 9 2006 D . Other Permit:
r 1 G n I; r� Inspection Line: 503.639.4175 Date Ready/By: BI See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method Supplemental Information
BUILDING OIVISIOty PLAN REVIEW
TYPE OF WORK
❑ New constructionldition /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.
CARP OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
El I- and 2- family dwelling ommercial/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 deli ved system.
❑ Addition of new motor load of ❑ "A "E ", "I -2 ", "1 -3 ",
. Job no.: Job site address: ^� M 1 ; 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehide parks.
City /State/ZIP: , ) b1� �. al gaa.3 ❑ Health -care facilities. ❑ Supply voltage for more than
• ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
job site: Description FEE SCHEDULE
Cross street/directions to
J I O13.• I Pm 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
!
Q� – ^ Limited energy, multi - family 75.00 2
` - 1 i' Cj��1l residential (with above sq. R.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
• City /State/ZIP: Temporary services or feeders installation, alteration, and/or
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
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
x 1 f Si � 5 � each branch circuit 6.65 2
Business name: ( � � (' w B. Fee Fee branch for ch cir
}� ` „� � t� L ti � RP without service feeder fee,
Contact name: J) first branch circuit 46.85 2
Address: , 01') 4 SW T V-0 UP Or - Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
. City / State/ZIP: U \A ' O2 61101 b Each manufactured or modular 90.90 2
� O D. , (5? � ( 5 Fax: : .3 ��a.. - 33 Reconnect
dwelling, t only 66.85 2
and/or feeder
Phone:
( � ( Reconnect only
E -mail: ( 5 01■-) 5600/2A1 Satan e.. 0 C Gb*J Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: energy panel, alteration, or
4 Address: extension. Describe: I Page 2 2
City/ State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax:( )
Investigation per hour (I hr min) 62.50
C CCB Lic.: VI\ 5P- l Electrical Lic.:Cf-- - Su.rv. Lic.:3n�� Industrial plant per hour 73.75
Q rv. Electrician signature, required: �/� ELECTRICAL PERMIT FEES
P t 9 Subtotal:
� ,,
`` I�� y (� ' � Date: �y� Plan review (25% of permit fee):
s Print name :�W (, "'�'�i2" Date: l l , • :
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Pennit&atLC- PermitApp.doc 05/23/06 4104615T(11/05/COM/WPB
Electrical Permit Application - City of Tigard • •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: j
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:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(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
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
Protective Signaling
❑ Other
Total number of commercial systems: l
*No licenses are required. Licenses are required
for all other installations
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