Permit l
a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN $ COMMUNITY DEVELOPMENT Permit #: ELR2010 00042
T { G AR 1D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/10/2010
Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16505 SW 72ND AVE
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Liberty Mutual
Project Description: Extend (1) existing limited energy panel to include (2) doors to access control.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 03/10/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 03/10/2010 $8.14
PHONE: 503 - 624 -6300
Contractor:
ARONSON SECURITY GROUP
8089 SW CIRRUS DR
BEAVERTON, OR 97008
PHONE: 503 - 639 -9988
FAX: 503 - 684 -4357
Type of Use: COM
Class of Work: ALT
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 Total $75.98
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: Y
Other Desc:
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 thro gh 0 R 952 - -0 0001,0 , Q 1100. You may obtain a ccoppy / of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: C\ _l�lU 1 (_i �� ' . " 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' AV P
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 OFFICE USE ONLY
City of Tigard RDa1eiBea / Permit No.: C� r ?ii , �� 2
r
'� 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1p D Date /B : Other Permit:
TIGARD Inspection Line: 503.639.4175 MAR 4 201 Date Ready /By: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK ' ' PLAN REVIEW
❑ New construction ® Addition /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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A "E "I -2 ". "I -3
Job no.: 9063 Job site address: 16505 SW 72 nd Ave 100HP or more. occupancy.
❑ Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Liberty Mutual ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 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'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
nd Limited energy, multi - family
Add Network Room door and 2 floor Telecom Room door to access control residential (with above sq. ft.) 67.84 2
system Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER Z TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Liberty Mutual 601 amps to 1,000 amps 301.04 2
Address: 16505 SW 72n Ave Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /Z1P: Portland, OR 97224 relocation
200 amps or less 59.36 I
Phone: ( ) Fax: ( ) 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 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 circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee, 7 42 2
❑ APPLICANT ❑ CONTACT PERSON each branch circuit
B. Fee for branch circuits without
Business name:
service or feeder fee, first 56.18 2
branch circuit
Contact name:
Each add' I branch circuit 7.42 I 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Reconnect only 67.84 2
Phone: ( ) Fax: : ( ) Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
panel, alteration, or extension. 1 Page 2 67.84 2
Business name: Aronson Security Group Each additional inspection over allowable in any of the above
Address: 8089 SW Cirrus Dr Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State /ZIP: Beaverton, OR 97008 Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 639 - 9988 Fax: (503) 684 - 4357 Ins for which no fee is 90.00/ hr
specifically listed (YZ hr min)
CCB Lic.: 185024 Electrical Lic.: 26497CLE Suprv. Lic.: 3161 LEA ELECTRICAL PERMIT FEES
Subtotal: 67.84
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: JAMES WHITE - :USE Date: 3/3/10 State surcharge (12% of permit fee): 8.14
■ TOTAL PERMIT FEE: 75.98
Authorized signature: el f This permit application expires if a permit is not obtained within 180
�.✓ days after it has been accepted as complete.
Print name: / Date: • Number of inspections allowed per permit.
1: \ Building \ Permits \ELC- PermitApp.doc 10/01/09 440- 4615T( 1I /05 /COM /WEB