Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1.711 -
_ • COMMUNITY DEVELOPMENT Permit#: ELR2013-00247
Date Issued: 10/10/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 10/201 0100
Jurisdiction: Tigard
Site address: 15605 SW 72ND AVE
Project: Consumer Cellular Subdivision:HERN PACIFIC TIGARD INDUSTRIAL Lot: 1-2
Project Description: Burglar alarm.
Contractor: PHILLIPS ELECTRONICS Owner: UNION PACIFIC RAILROAD CO
3247 NW 29TH AVE 1700 FARNAM ST, 10TH FL SOUTH
PORTLAND, OR 97210 OMAHA, NE 68102
PHONE: 503-222-5083 PHONE:
FAX: 503-227-4992
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/10/2013 $75.00
12%State Surcharge-Electrical 10/10/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 1 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 OAR 952- 01- . You may obtain a copy of the rules or direct questions to OUNC by calling 5033.22332.19j88777oor 1.800.332.2344.
Issued By: Permittee Signature: �/'" /19/ ,z-/e e-77e'
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.
10/08/2013 12:39 Ph i I I ips Electronics (FAX)5032274992 P.003/004
rn
Electrical Permit A liCatiOil FoR OFFICE I ISE ON1,1'
City of Tigard . - V)0fi:—V ig gI:ii;31 /4//i)// g deir/ Penni'No.:EZA,92,0/3- 24/7
. .- u 13125 SW Hall Blvd...Heard.OR •_;'.0.1' .—•
ilh
Ptan Review Other Permit:
• I Phone: 503.718.2439 Fax: 503, •8.t '00 % r \ Dotailly: , . '
Inspection Lino: 503.639.4173 Date Rcarly/By: Sfe Page 2 far
FIGAKI) fiC1-\ iql I 14
Internet: www.tigard-or,gov „iiND Notified/Method: Supplemental Information
- ,::'','.;'':''-'‘'i": --. - - .:op"..*0 a,=N ? 0 .• .,. . _ . .. . . , ,01.4N'R YWC. 2V!!.'13
64;consruCto: ddition/aleatiol
Please check all that apply(submit 1,sets of plans w/ltems checked below):
0 Service or feeder 400 imps or more 0 Building over three stories.
0 Demolition 0 Other: where the available A wit current 0 Marinas and boatyards.
, i.....'...- ',:f. ---,i;:g'.:.4* 0(..-.OF?60..T.IsT14*.m.N:!. .z, ::.-....,,, :,i,,-...:!..i.Ict.,,..., ,., exceeds 10,000 amps at 150 volts or 0 Floating buildings.
Loss to grotmd,or exerted'14,000 a Cominmelai.use agricultural
1:3 l•and 2-family dwelling Iff Commercial/industrial 0 Accessory building amps lbr all other Installations. buildings.
12 Multi-family 0 Master builder 0 Other Ci Fire pump. 0 Installothut of 75 KVA or
0 Emersenoy system. larger separately derived system.
'1'-.t.:':-.:''.•;;f:f;'h '27,' t.git'i SRI 1;000041074;'4041160001).:11 .J.;44k'41'-! -;r:.:,`:'-.. 0 AddIttoa°film molar lond of 0"A",II","1.2", I-3",
Job no.: I Job site address:tregr.SA 72 11;01,..- 100HP or more. occupancy.
0 Set or morn residential units. 0 Remsaiional vehicle parka.
City/Statc/ZIP: 9J,19,Cf7.2-2(74 13 Health-care Within. 0 Supply voltage thr more than
ON azardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name:dvA.Iscato et/raw- °Service or Mader 600 amps or more.
'• '-'-;',-117:::?.••;•:0;:':'•-•:::;•;:t3=;/rEESCIIEDT.11 .:;.'7.::: :::::4,''.:;;:.".:‘:?,-..
Cross street/directions to job site: D01.411911 i_Qty. I Pic 1 Tom i •
-
New residential single-or multi-fonilly dwelling unit.
Includes attached garage.
,
Subdivision: I Lot no.: 1,000 eq.e.or iess 168.54 4
Ea.addl 500 sq.It or portion 33.92 I
Tax map/parcel no.: Limited=orgy.residential 75.00 2
-4;07..•t="ii:= 1.4.i' F'.0'.:,17',:,;:‘,.'.;:.DgS.CRigliAOttIJOr3V:0*'::::1A‘4'.i..7*:::'.;:,:•:-..&Vis4:.!'7:') ;10 With above all.ft.)
Limited enciiiy,multi-tinily 75.00 2-LOCO th2 fk-je... 2?Ctee,101.- iigar,107 itc-44-6145k4S
.....1 residential(with above sq II)
Services or feeders installationalteradon,and/or relocation....
200 amps or less 100.70 2
0 yipititt.y.,0*00/7,;.:....,.0...i,;41i.,:;:t...f.,::::-; 4;:i.,?:.:0F.01044.Ky,,‘:::::::: ii,tily:•••,: 201 amps to 400 ants 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation,alteration,and/or
City/State/ZIP; relocation
Phone:( ) Fax:( ) 200 amps or lea • 59.361. 1
Owner installatton:This installation Is being made on property that I own which is not 201 amps to 400 amps 125.08
22
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54
Brunch circuits-nakalteration,or extension,per panel
Owner signature: Date: A.Fee for branch thrum with
,
07.411).&IP4N7.1!t7c,:::':::!:::`,,.17111'..::::';:1":::DTPPIITA0t1100$1'6'n::: :;: „thyterfcteacierwr leder fee' 742 2
Business name: B.Pee for luaneh circuits without
service or feeder fee,first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7A2 2
Address: Miscellaneous(service or feedi not Included)
City/State/ZIP: —Bach manufbetured or modular
dwellingservice and/or feeder 67.84 2
Phone:( ) I Pim:( ) Reconnect only 67.84 2
Pump or inisation circle 67.84 2
E-mail:
. Sign or outline lighting 67.84 • 2
'..,::. .;:41..::::1'::. ..-.‘;-:::°,*-,,.:<=;oicraxeroa-. ":,':.: :::; !::,:::11E..'.-. :.::,j'..^)q.:;;',' 4. mina circuit(s)or limitetknergy
Business name:Master Alarm LLC dba Phillips Electronics canel,alteration,or extension. f % ZP e 2 c 2•
_ • Each additional vable In any of the above
Address:3247 NW 29th Avenue Additional inspection(1 hr nun) 66.25/hr
.
City/State/ZIP:Portland OR 97210 Investigation(I hr min) 66.25/hr
Industrial plant Cl hr min) 78.18/lir
P one:(503)222-5083
on (503) Fax (503)227-4992
CCH tic.: 125364 10 li I lectrieni Lie: 2 2)3CLE .Suprv.tic.: hupections fbr which nu the is
specifically listod Oh hr min) 90.00/hr
:1-1-: 1-:-:-.;:-.■':',1:!':-.'",.fELECTRICA.1.;"•FERMIT,'FEES:',,,..ti214,.,1:,:•;:-7.i.;;A:
Suprv.Electrician signature,required: • Subtotal: 7.5-;496
Plan review(25%of permit fee):
Print name: j to.94 5,4hL _Date: t lq, 7 slaw surcharge(12%ofpennit fee): q,Ixo
I..., ._
TOTAL PERMIT FEE: 54#1,,f0
Authorized signature:
This permit application expires lie permit Is net obtained*thin 180
Print name: Date: days after It has been accepted as complete.
__. . - • Number of litspecilons allowed par permit.
1MluiolLn5Warmi5ELC•PenailApp.doe 07101110 440.48137(11/05/12014Avan
i IA in6 Pr
10/08/2013 12:40 Ph illi ps Electronics (FAX)5032274992 P.004/004
Electrical Permit Application- City of Tigard •
• Page 2-Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for 1111 residential systems combined........ $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
El Burglar Alarm
ElGarage Door Opener*
0•Heating,Ventilation and Air Conditioning System*
0 Vacuum Systems*
El Other:
EZ,Ola-RERCIAL;WRVONLYga;. ...iW;;."117:44.4Z471
Pee for.each commercial $75.00
system
(SEE OAR 918-3090000)
Check Type of Work Involved:
O Audio and Stereo Systems
O Boiler Controls
El Clock Systems
O Data Telecommunication Installation
0 Fire Alarm Installation
El HVAC
O Instrumentation
O Intercom and Paging Systems
ID Landscape Irrigation Control*
O Medical
O Nurse Calls
O Outdoor Landscape Lighting*
2/Protective Signaling
O Other •
Total number of commercial systems:
No licenses are required. Licenses are required
for all other installations
lAliddingVemilliABLC.PermttApp.doe 07101110
//44,61)40
10/08/2013 12:36 Ph i I I ips Electronics (FAX)5032274992 P.001/004
3247 NW 29th Avenue
Portland Oregon 97210 Philii s Electronics
voice 503-222-5083
Phillips
503-227-4992
Fax
To: r • From:
Fax: I VIk16 Pages:
Phone: Date: lb- H3
Re: CC:
If you do not receive ell pages, please call the sender at the above number.
Li /
0 , , 1 •
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The information contained In this fax is intended for the sole confidential use of the designated recipients and may
contain confidential information.If you have received this information in error,any review,dissemination,distribution
or copying of this information Is strictly prohibited.If you have received this communication In error,please notify us
Immediately by telephone and return the original message to us by mail or if electronic,reroute back to the sender.
Thank you.
•