Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELR2013-00243
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/08/2013
TIGARD Parcel: 2S102AC00100
Jurisdiction: Tigard
Site address: 9040 SW BURNHAM ST
Project: B and B Print Source Subdivision: BURNHAM TRACT Lot: 4
Project Description: Fire alarm.
Contractor: ACTION TECHNOLOGY SYSTEMS LLC Owner: STEVENSON, MICHAEL J&KAY L
835 SE 17TH AVE 16815 MAPLE CIR
PORTLAND, OR 97214 LAKE OSWEGO, OR 97034
PHONE: 503-231-1992 PHONE:
FAX: 503-231-1402
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/08/2013 $75.00
12%State Surcharge-Electrical 10/08/2013 $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: 1
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: 0 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 0 e' 952-'+ -00.0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �� 1 Permittee Signature: OA/ e��G I (f
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 503.639.4176 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.
Oct 02 2013 3: 1OPM HP LASE H p. 2
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Electrical Pe
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City of Tigard OCT 2 2013
13125 5 W Hall Blvd,.Tigard,O1 97223 [ / •' ��. Permit No,�C o20/�?�0�
i Phone $03,718.2439 Fax: 503.598.t /� "� Plan Revs.
Inspection Line: 503,639,4175 vl a G .M �dtylAt�� �°te/8y' Other ham!:
'r'IcAItp lhtteR t1d
Internet wwW ttgard-or,gov SUI Ofl{1q/. ° pjSGV a y/th "7--�i �e See Page 2 for
Y7�1� (n. QJ gild NouOad/Method: T
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n" j 'I W� Ietl�At ✓f ® Ii1 ';��tjNY1y"1' II T;f"1ptl f� V1 mClx;u
stall Fl • 7 vVt't')1?.s a+�rlt FEE,�a1 E4.1Lradt €7'r
E New construction V.I. -ddition/ateration/replacement Please shank all t apply(nt.mita aeu 0 p1,tsw items attacked below
❑Demolition Other: Service or feeder 400 amps or more ❑au1Idotg over three Stotler,
where the available Ault owrent DManilas and boatyards,Ijii qt ja° i k SEMI a. 0 y
meteeda 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ►:�.Oommorcia1/industrial ❑Accessory building la0e to around.or exceeds 14,000 ❑Commer iel-use amps 10 Multi-family 0 Master builder rrinpuorallodterineWledpns, Installation
rtiy r .� ;-.�; , ,r :}licit+.� Other. Orrin pump,
d rr+ ' �•'., f)����� q� �C+=E�"y IE.�1�•t 3r upF ,sv t, ❑InetalleNon of 170 KVn or
`"t'�'IwfG [•r u�A' '.t 1itaK �r-Q jY 1 F�'` t�c�a�I lit Wl ' td'4.Tip '! �� �� C �'��'�'r,m,"[� ❑ IlOrgertey ay6tem,
[s t d'w7�'afi'h�Lt, nw)I1 alt„•1 1;;° r1,th,.l�. .4:i t: °l,i.-4�; ' +' 3�? larger separately derived s r
�`a"'l1° '" "' ..'�'�l ❑Additio n of new captor load of ❑•A","6" `I-2•', r
Job no.;
( �. Job site address: /jl�(j �! + loam or mac, ocounaocy
, ❑Six or more rmideotiel units ❑Recreational vehicle puke
City/State/ZIP: T., t''')4, I_, - t)..; ❑Heal th-earetttel114es. 0 Supply voltege for more that
Suite/bldg./apt.no.: p DH ardouslocatlom, eC0 volt..oto;nel.
PI name:
.e or feeder 800 am., or more,
j� �t •�� { ps y
Cross street/directions t0 Job site;
iktti{I, p^I.SLd }Iry ieG�Iri;,io�l f e+n{�s:�,�",1� 1`[y�' 1! ;��„ kl:',.'r.,a)
•pad' 4th 're. Totgt
New residential single-or multifamily dwelling unit.
-- Includes attached garage.
Subdivision:
f Lot no.: 1,000s4 It or leas 16g•54
Tax map/parcel no.: Ee,add'!500 aq. onion 3392
}, t l j}4,f iii ),' ,i6 ,?t•r`a�`°� bTn+ o':1 7i''72;;; y Limited energy,residential
t fsr�a ilLi' 1r 11 1', y : v li `i� . , I iS!S I ' 75.00
3.g.. (with above sq,ft)t imtted energy,multl-t roily —
a resi•_.�� 4tbnva .1t. 75,00
l'i Vin"+!' - ;710.2ERE Sgiat a '3" '';r ,,a;,,,.
,
• utilises or feed
ers instgladon,aIteraden,and/or relocation RA L c n E '` �' E�dE� t t t 00 s tripe Ur esa 100.70
Name: 201 amps to 400 amps 133,56
401 amps to 600 amps 200.34
Address: 601 amps to 1,000 amps 301.04
City/State/ZIP; Over 1,000 amps orvolts 55226 7-
Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
Owner Installation:This installation is being made on property that I own which is not amps or Ices 59.36
201 intended for sale,lease,rent,or exchange, according to ORS 447,449,670,and 701. 401 amps to 400 amps 125.08
Owner signature; 401 amps to 5
(;nature; P 99 amps 168,54
t.yp[y r�{ .rt Dale:�u' '."��:t5;�, ;+�:`i ist l.7t•esY rtk�4`+1 ttt.'.I..or, I '1 It 1 1 .' nor �• T vn+rtu '' A Pee r run tq-npw,alteration,or extension,!!r panel
_-
h ortiZie1 sJ t i •'4 ,''• ''..:6°fi of t.' l' " 1144 z e-"'i �;!r A.Poe for branch of feei a with
Business name: above service or feeder Ica,
—
_ each branch circuit
7.42
Contact name' 13.Fee far branch circuits wrrbewr
acrvice or feeder foe,first
Address; — branch circuit 56.18 2
Each add'I branch circuit — L 7.42 2
City/State/ZIP: Miscalls 1ua(service or feeder not Included)
•
Phurtc: ( ) ' Fax; :( ) dawehling,service and/or l testier 67.04 2
Reconnect only 67.84
2 Pump or irrigation circle 67.84 2 i:i, ';r. '.`*..P,i.,P tt 14: .?Y -'..p ' �' nnm "r;`. 7:.`r;... . u e
Sign or outline lighting 67.84 2
Business name: Action Technolo• S sterns LLC ySignalcavet- (s—jorl�mited-energy A See i]
penal emtto�t Or exampion, 1 Pale 2 I -- 2
Address: 835 SE17th Ave Each additional ins ttectlo i over allowable in any of the abode
L,ty/Staldr,JP; Portland, OR 97214
Additional inspection(1hrtmin) 66.25/hr
_lnvastlgadon(t hr min) 66.251 hr
Phone:( ) 503-231-1992 Pax:( ) 503-231 -1402 Industrial plant(I hr min)
78,18/hr
CCf3 Lic•:157630 P.lectrital Lic.: — Inspections or cI mores Is
26-775c sup Lic.:� OOLEA °' 1 • lgt-t Vs rmin 90.0C/hr
Suprv.Electrician signature,requircd:.4 / •' -� 1; y't}! �h�!1 :call-bt :!,, .a'v�k l l o.f 1�(...11,11,0v •,',r a!',e;:
i Cn.ti u•uc
C_. ., -- Subtotal: .76...,c,
_Kirkl-nd . Date: `,, �Planreview(239r•ofrennitfee
Print name: James A
State surcharge(12%of permit fee): c3)---
Authorized signature: / /'
TOTAI,PERMIT PEE: Pi Chi
Printname:Rena Kirkland Dato: /t / rnlsptrmltappNcatton expires lrapertntrls nor obtained within Igo
nays aver Jr has been accepted se complete.
I.u3ullding Pcrmitrl!LC_vr l„illpy_51 R liRti.deu Are On uto 13 ' Ntnnber or inspections allowed pct permit.
d40-4615'R I INSrCOMAOS
Oct 02 2013 3: 10PM HP LASERJET FAX p. 3
Electrical Permit Application--City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable.Energy Permit Fees:
;s _ "9✓1'8 lr(��1t +�' r Fl`fl` 't) �.i',F, ° 734,`' .;1, 7 y„�¢�,►►'ray it=;l dd��r'i!?{f y;e r..;�,
t �r f �vta,f�{t y r �p}(1�un11 r „f 1 +�[
!�Ir•5'f' 1•..�i', SPIR ) 4YE'l{+L{So u,11t�1`�NEir�ERI,1t h:Lll
Fee for C.I
jj residential systems combined ... $75,00 poacrlpalea •(9. 5x .rota,
Renewable ctechical energy systems;
Check Type of Work Involved: S kva or lest j ' 100,70
❑ Audio and Stereo Systems* 3.0l to 15 kva _ 133.56
15.01 to 25 kva 200,34
ElAlarm Wind generation a inn in exam)of z5 kva;
25,01 to 50 kve 301.04
❑ Garage Door Opener* 50,01 to 100 kva 352.26
>100 kva(fee in accordance with 552,21
❑ Heating,Ventilation and Air Conditioning OAR 919.309-0040)
System Solar generation systems In excess of 25 kvaJ
Each additional kva over 25 7.42
❑ Vacuum Systems* b.I00 kva—no additional charge 0.0
Each additional Inspection over aid 0,w ble in any of the sin
❑ Other: Each Additional lnapcution is
charged at an hourly(1 hr min) � Itr
ry1e �,� j r�'/+ t'' , Intpeoalona For which no fee is Ir 90,00/Fr
`In•1. ' r,�„�J,F,.�: . tt;+l tl b 1 �f ,�„`1', ry r '�'�� ;tT'�� u:n�Jt1 1 •�:. ii109 is
Fee for each commercial system �rSh��4R r 1 d a� ,i�1 ��o0.Ut Subtotal: a t
(SEE OAR 918-309-0000) Plan review,if required(25%ofpenn (be)Y
State surcharge(12%of permit fee)
Check Type of Work Involved: _ TOTAL PEglvliT 1 flE.
( Audio and Stereo Systems This permit application espirca If a permit Is not obtained within I
day*atler It Imo been-ceoptad es complete.
Number ot'utspections allowed pot petntii.
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication installation
I] 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: I
*No licenses are required. Licenses are required
for all other installations
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