Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
a '
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00074
TiGnKD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/1/2008
PARCEL: 2S101AD - 03200
SITE ADDRESS: 12909 SW 68TH PKWY 340 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE CENTER LOT: JURISDICTION: TIG
PROJECT: MERIDIAN TECH GROUP
Project Description: Installing (1) low voltage security system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES SONITROL PACIFIC
15350 SW SEQUOIA PKWY #300 -WMI 8220 N. INTERSTATE AVE.
PORTLAND, OR 97224 PORTLAND, OR 97217
Phone: Contact #: PRI 503- 223 -5822
FAX 503- 973 -7773
Reg #: ELE 26- 370CLE
FEES LIC 53535
Description Date Amount SUP 3567LEA
[ELPRMT] ELR Permit 4/1/2008 $75.00
[TAX] 12% State Surch 4/1/2008 $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow 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 copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By:/ _ �_� _ -� 'ermittee Signature:
ii
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'N: 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
r City of Ti 81 d �� /\ Received 5 /.... 4 � � 0
Permit No.:
g C ' Date /By: o V
° 13125 SW Hall Blvd., Tigard, OR 923 Plan Review /
Phone: 503.639.4171 Fax: 503.598.1960 l '„
Gate /By: Other Permit: T L42 (1i-.. ,j (e
TIGARD Inspection Line: 503.639.4175 '' a Mlle Ready /By: turis• Ei See Page 2 for
Internet: www.tigard - or.gov t ' ; ' � ,.,-)�' Notified/Method: Supplemental Information
�i
TYPE OF WOR t , ti PLAN REVIEW
❑ New construction ® A ddition /alteration placement 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 atnps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- 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 ", "1 -2 ", "I -3
Job no.: P080096 Job site address: 12909 SW 68 Parkway 1001-IP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, Oregon 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 340 Project name: Meridian Technology Group ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Description 1 Qtv. I F. 1 Total 1 .
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. it.) 75.00 2
Limited energy, multi - family 75.00 2
Installation of Security System residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: PO C t '� f f �/ S� . 401 amps to 600 amps 160.60 2
I ( 601 amps to 1,000 amps 240.60 2
Address: e, S lit) Eq_ Acri, t "i / V
, , Over 1,000 amps or volts 454.65 2
'
City /State /ZIP: p ` VI`' a ° R l "ix /1,—V, Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
C Contact name: first branch circuit
Address: Each add'I branch circuit 6.65 1 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Sonitrol Pacific Signal panel, or limited -
energy panel, alteration, or
extension. Describe: 1 Page 2 2
Address: 8220 North Interstate Avenue
City /State /ZIP: Portland, Oregon 97217 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 223 -5822 Fax: (503) 973 -7773 Investigation per hour (1 hr min) 62.50
CCB Lic.: 53535 Electrical Lic.: 26 -370 -C Suprv. Lic.: '36 (o 7 Z 'A industrial plant per hour 73.75
t lik ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: C ik� Subtotal: 75
(,,,,,,,..\ �C /- Date: Plan review (25% of permit fee):
Print name: "` 'J1 —
State surcharge (12% of permit fee): 9
Authorized signature: TOTAL PERMIT FEE: 84
■ This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
♦ Number of inspections allowed per permit.
1: \ Building \ Permits \ELC- PermitApp.doc 05/23/06 440- 4615T( I I /05 /COM /WEB