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Permit „, 6 ' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT • F ' Permit #: ELR2009 00165 ` COMMUNITY DEVELOPMENT 131 25 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/26/2009 ” GA Parcel: 2S112DD01600 f�war��i$tA:+:"fs�r Jurisdiction: Tigard Site address: 15495 SW SEQUOIA PKWY 150 Subdivision: Lot: 0 Project: Acceleration Chiropractor Project Description: Installation of security alarm system FEES Owner: PACIFIC REALTY ASSOCIATES Description Date Amount ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 06/26/2009 $75.00 #300 12% State Surcharge - Electrical 06/26/2009 $9.00 PHONE: Contractor: AMERICAN SECURITY ALARMS, INC. 5411 SE MCLOUGHLIN BLVD PORTLAND, OR 97202 PHONE: 503 - 231 -0303 FAX: 503- 230 -1044 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 $84.00 Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Required Items and Reports (Conditions) Nurse Calls: N Protective Signal: N Security Alarm: Y Other: N 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 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. i Issued By: 111 LL ` Permittee Signature: iA_C ( ti 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 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. a : g ar f � lIJC� L Electrical Per it A ��,r� li '- 1", PP � ,t�.f• �i�� & 4r�.��r" l �u 4;a� tir3!���.�±� ,t �� ?'.�tt � ' 4 a 1' l' ":!'d.0. City of 'Tigard f eived rennhNo.;ak„2009.- 07)145- ,,,•,,, .., : 13125 SW Hal Blvd., Tigard, OR 97223 JUN 2 2 2009 PlanRavtttiv ih Alm.. Phone_ 503,639.4171 Fax: S03.598.I960 Dyg ; OtherPcrmit; ,c4 7s Inspection Lino: 503.639.4173 Aar, R /By: juns. RI Eta Page 2 for ;!,'4!: 11, CITY OF TIGARD NolIAed/ 5upplealentel laraamanon &o.fiil�^xd lntemcC www- tignrd- or,gov T, o . t DING DIVISION . . — ,,,.,; , ❑ Ncw construction is Addltlon /alteration /replactmlent Fleaso cheek n11 that apply as mit A axe of pinta wfttoma checked bcIoW), ❑ Sar•iec or feeder 400 amps or more 0 Bbilding aver throe statics. 0 Demolition 0 Other: where site available fault current 13 Marinas and boatyards CATEbOaY OF cQt'IttRttc lO1V ' ' exceeds 10,000 amps at 130 volts or 1'] t' looting buildiogs. tam to ground, or exceeds 14,000 17 Cernmerciel•use agricultural ❑ 1- and 2 - family dwelling IN Commercial/industrial ❑ Accessory building amps for all ether inmslmone. troadings. • Multi -fomil ❑ Master builder ❑ Other: © sire ptunp. ❑ InitnlIntlob of 75 KVA or 0 rnergcnry system, larger sepormoly derived xyateel. 1 � En 119FO 1 ' X A • imam* ❑ Addition of new motor lead or LI "A" "E', "1 ", "1 -3" ,. �,, t00HP ov,nom. occupancy, Job no.: I ioh 91tC address' 1 5._e5 — , - l�.( ___S u0; , . , _ 11 f h . DSixnrmore residentinl units CI Recremlonal vehicle parka City tate/71h' M O Heahh {era [ac,litice, 0 Supply wlhge for more than �' \ 1 w CI Huerdvos loc.'ttions. 600 volts nominal. Suito/bidgia t. no.: r Project nam e: - • ttswioeor feeder 600 mops ormore. P 1 �iCCL'��Y -'•1,p 1 l ;,: wc,i:e Cross street/directions to job site: tlrsrlsttee , , . =7.7 .111 • New residential aingie- or mold- family dwelling pnt1, Includes attached swage. _ Subdivision: Lot n 1,0 sq. ft. or less I 14 4 Ea. add'I 500 sq. R or portion 33.40 i Tax map /parcel no.: _ Limited energy, residential D) RIPTI©19' We 75.00 2 , , (with above sq. ! t.) IS SWIM Limited energy, multi$ mlly 75.00 2 -J I MIR� S` t A _ . residential (with above $q,fL) Services or feeders Ins tinf L altt1 tlon, end /n relocatio ' 200 amps or less 80.30 2 .' C! FRt11PgR!Ft OWNER . - 111111111FAMS3111.1.11 201 amps to 400 am •s 106.85 2 401 amps 10 600 amps 160.60 2 Name: A ( ,, ii C ,,,b f 601 amps to 1 amps 240.60 _ 2 Address: Over 1,000 amp or volts 454.65 2 Temporary acrvkcs or Feeders inalnllalion, alteration, and/o relocation Phone: (1 f 14 1 Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation Is being medo on property that I own which is not 201 amps to 400 amps 10030 2 Intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and '701. 401 amps to 599 amps - 133.75 — 2 Date Broach circuits — new Alteration, or extension, per panel Owner signature: - _ A. Poo for branch circuits with .' APPLICANT .. . , ' COPPxAC1' MOON, above service or finder fee, 6.65 2 r each branch ciralil, Business nano: 1)ryi ` .) f' 1I L , 0, Fee for branch circuits tdif/tout service or feeder fat, 46.85 2 that branch circuit . Each add'I branch circuit 6.65 2 Miscellaneous (service or (ceder not included) City /State /ZIP; Baca manufactured or modular 90.90 2 dwelling, service and/or feeder Phone; ( ) pax:: ( ) Reconnect only 66.85 2 13-mail: .n... Pump or irrigation circle 53.40 2 , � .r 1 a.. 1/ • .� Sign or outline ligltin_ 53.40 2 '•,. circuit(a) or unite. Business name: `' , 4 • . kt %. ► h� l enetgy , a alien or Address: cxlenaton.Descrtbe: ` Page 2 2 r City /State /City/State/ZIP: ; i f . • , 4 "°', r ` �" 1 - f ^(1 Ra >l Inspection ddidonal Iion over allowable in tiny of the above � • Per inspection 62.50 Phone: ( D ) - M tf .= lmreatigat;on�er hour (1 hr min) 62,50 Ind 18•11 lr,it pot hew 73.75 --- �a � a 1 t L � );I ctr'cal Lic.:. 1-, a��fi� i '� '—�,- � .:.:.: .p 3uprv- Electrician signature, required: Subtetol:_ ' -.swot f Plan review (25% of permit fcc): 1 : 1 " Print name: s � t n � \ Date: lll' �J& State surcharge (12%efpermit fee); Authorized signature: TOTAL PERMIT FEE: ( N"t fate permit application aspires Ile permltio Nat obtained wattle 189 Print name: > day. after Ithea been aeeeptcd ae eemptete. • Nuinber ofhtpeelien.Mowed per permit, tanwinaWarr -a•te r- pem,ItA. .1-.. n41 RI6 4fl.•r615T(11/a51COM/WF0 L ' d S8N ' °N WdtiS Y E 600 2 zz , n r