Permit — CITY OF TIGARD [ ELECTRICAL RESTRICTED ENERGY PERMIT
`!1 COMMUNITY DEVELOPMENT f� Permit#: ELR2015 00087
OWN Date Issued: 03/24/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.24 Parcel: 2S114AA00100
Jurisdiction: Tigard
Site address: 9000 SW DURHAM RD
Project: Tigard Tualatin School District Subdivision: 1993-078 PARTITION PLAT Lot: 2
Project Description: CCTV system. 4/9/15,REPRINTED to correct address from 6960 SW Sandburg St to 9000 SW Durham Rd.
Contractor: A& E SECURITY&ELECTRONICS SOLUTIONS Owner: TIGARD-TUALATIN SCHOOL
PO BOX 179 DISTRICT 23J
MCMINNVILLE, OR 97128-0179 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-883-4139 PHONE:
FAX: 503-883-7664
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/24/2015 $75.00
12%State Surcharge-Electrical 03/24/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 1 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: 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: • =•• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 • .ugh OAR 95 101-0r••. You may obtain a copy of the rules or direct questions to OUNC by calling 50 .1324987 or 1.8332.2344.
Issued B • _ (P-.- Permittee Signature:
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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
EI
I ' COMMUNITY DEVELOPMENT Permit#: ELR2015-00087
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/24/2015
Parcel: 25101 DD00701
Jurisdiction: Tigard
Site address: 6960 SW SANDBURG ST
Project: Tigard Tualatin School District Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: CCTV system.
Contractor: A&E SECURITY&ELECTRONICS SOLUTIONS Owner: TIGARD-TUALATIN SCHOOL
PO BOX 179 DISTRICT 23J
MCMINNVILLE,OR 97128-0179 6960 SW SANDBURG ST
TIGARD,OR 97223
PHONE: 503-883-4139 PHONE:
FAX: 503-883-7664
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/24/2015 $75.00
12%State Surcharge-Electrical 03/24/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 1 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: 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 OAR 952-001-0090. You may obta - •• of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ifi = Permittee Signature:
i -
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.
Electrical Permit Application �( I OIi OI 11( I I �l ()\1 1
City of Tigard �i `Nyp Dammed ,'r �.� Permit No.: s•
• 13125 SW Hall Blvd.,Tigard,OR 9722E u 1 Plan Review
Phone: 503.718.2439 Fax: 503.598.1 Date/By: Other Permit:
1IGARI)
Inspection Line: 503.639.4175 015 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov AFAR 2 3 Notified/Method: o Supplemental Information
TYPE OF WORK t 11(MU.) PLAN REVIEW
❑New construction Addition/alteratiol i N Please check all that apply(submit 2 sets of plans w/items checked below):
i DIVISION ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: $1101 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 tgl Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑installation of 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E",'1-2","1-3".
Job no.: Job site address: IOOHP or more. occupancy.
�g 6,0 S W SQ h�bt.&vQ SI • ❑Six or more residential units. ❑Recreational vehicle parks.
J ❑Health-care facilities
. ❑Supply voltage a for
more than
City/State/ZIP: — Q 4 y p' t 0 IZ p 3 22 3 0 locations. 600 volts nominal.
Suite/bldg./apt.no.:
Project name: 'r 7-2.41,4,w ! Service or feeder 600 amps or more.
s ',g ""'�O1�w Sr"""i too FEE SCHEDULE
Cross street/directions to job site: V
Description I Qa• 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 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
L U w V o l';c.,q G 4v,_ t�7V 6p-cc U( d S ,� /t residential(with above sq.ft.)
'
enewable Ene ❑ See Pa e 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) I Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT I VI CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7.42
Business name: S{C bar each branch circuit
►��
B.Fee for branch circuits without
Contact name: IL I't S D y e,„ S service or feeder fee,first 56.18 2
branch circuit
Address: ¶j NI-, t.),,,, l g ' Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not included)
V1/�.r Kh U. 1.-e_ D K 9' 12 I Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Phone: (S 1 ) 4Y3 - 74 te ,' Fax: :(SO3) - 4'73 -Q6,4
Reconnect only 67.84 2
E-mail: k sirs.w S@ LI S40.4.r 14 y 0 rS Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: A4. & Slc t.r i 4_1 r E k c..4 '0,,,c,.. Ssa I uJF i o.v S Signal circuit(s)orlimited-energy See 1
panel,alteration,or extension. Page 2 2
Address: s;5 N Li Nw` 011 W Each additional inspection over allowable in any of the above
f Additional inspection(1 hr min) 66.25/hr
City/State/ZiP: i\/\c h'1irmv;11 L 1 O t2 9-' 1Z.S investigation(1 hr min) 66.25/hr
Phone:(Gje3 ) 4-117, —to 43 q' l Fax:(5,,,3) q 4 3 — 7 V e. y Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 00/hr
CCB Lic.: (e 5 1 c 4 I Electrical Lic. (o- .4 e l Suprv.Li specifically listed(/2 hr min) 90. _
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: st 1 5,6t)
Plan review(25%of permit fee):
Print name: M gr r N Date: 3 t-� its State surcharge(12%of permit fee): Al Authorized signature: 1 V, + TOTAL PERMIT FEE:
/''} This permit application expires if a permit is not obtained within 180
Print name: _ _ OA *Ate' 3/01/ days after it has been accepted as complete.
" Number of inspections allowed per permit.
I:\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 05/21/2013 440-46151(11/05/COM/WEB