Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II I CI .* COMMUNITY DEVELOPMENT Permit#: ELR2010 -00193
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/22/2010
Parcel: 2S102CB00302
Jurisdiction: Tigard
Site address: 13185 SW PACIFIC HWY B1
Subdivision: Lot: 0
Project: Salvador's Bakery
Project Description: Limited energy for (2) CCTV systems
FEES
Owner:
CJ GLOBAL LLC Description Date Amount
PO BOX 5668 Restricted Energy Permit 09/22/2010 $150.00
ALOHA, OR 97006 12% State Surcharge - Electrical 09/22/2010 $18.00
PHONE:
Contractor:
GLOBAL SECURITY & COMMUNICATION
3212 MAIN ST
VANCOUVER, WA 98663
PHONE: 360 -693 -1900
FAX: 360 - 906 -9692
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: Y Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $168.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N 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.
Issued By: ������ -� ' "mi Permittee Signature: 4P �/ t- /C'T
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 603.639.4176 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.
09/21/2010 TUE 16:10 FAx 3609069692 Global Security 121002/003
Electrical Permit A licatio CEIVED FOR OFFICE USE ONLY
City of Tigard Received
Date/By: a62 /o ft• PennitNo.: � p�� -
I - u 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
EP O
Phone: 503.639.4171 Fax: 503.598.19 L 1 2 1 ( ' , '' t 0 Date/By: Other Permit:
Itts eetion Line: 503.639.4175 Date Ready /13y: iu • BJ Sc e Page 2 for
TIGARD infant[: www.tigard or.gov
CITY OF TIGARD NoNotified/Method: �� It Supplemental Information
c . PLAN_: REVIEW {
. TY. PE OF u � c ., . .... ,. .
.. � �?I�VG D�l'Sl��' ...... _
""' ` t Please check all that apply (submit 2 sets of plain w /itenns checked below):
❑ New construction Addittotr /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
p CATGORY OF CONS7 R UCTION j, exceeds 10 000
or exceeds 14,000 ❑ Commerc000 amps at 150 volts or ❑ I'lonting ial -us
building. gricultural
less to groue a
El 1- and 2- family dwelling [ E Commercial /industrial ❑ Accessory building amps for all other installations. building.
❑ Multi - family ❑ Master builder ❑ Other: ❑ File pump. ❑ Installation ot'75 KVA or
::. ;; JOB SITE INFORMATION AND � LOCATION „ ' . ; new motor Toad of ❑
larger C pa "1-2", derived
system ❑ Bnrcrbcncy syswnn. st
0 of t•wi
` ? � 1-16,1 10011P or more. occupancy.
Job no.: Job site address: 31 �S SW 4/ GCt�� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: (&�� q7 2.. ❑ Health-care facilities. 0 Supply voltage for more than
W ( Vx 0 ❑ hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: ei Project name: -Si. rz,"- .6 0 6,9 72.1 0 �rvkc or fader 600 a mps or nrc ,
f FEE S
Cross street /directions to job site: Description I Qty. 1 Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 1
Ea. add'1500 sq. R. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential 75.00
D
; ESCRIPTIO OF WORK
(with above sq. n.)
Limited energy, multi- family 75.00 2
3(t kr`t I' •• 14A ILt1( C( T V S SWl() residential (with above sq. III
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
r
;❑. PROPERTY OWNER ❑, TENANT : 201 anr to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Nance: 601 amps to 1,000 apps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City / State/ZIP: relocation
Phone: ( ) ( ) 200 amps or less 59.36 I
Fax:
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168. 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, er panel
Owner signature: Date: _ A. Fee for branch circuits with
about service or feeder 1'ec, 7 42 2
❑;APPLICANT , i.,` ` .,;❑ CO NTACT PERSON each branch circuit
B. Fce for branch circuits without
Business name: service or feeder lcc, first
56.18 2
branch circuit
Contact name:
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67 84 2
City /State/ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E t , Q ,ccl @ (jlbol'k'f, AAA Sign or outline lighting 67.84 2
.CONTRACTOR .. Signal circuit(s) or limited - energy r
(� panel, alteration, or extension. Page 2 I 2
Business name: JeC1.4 1 Each additional inspection over allowable in any of the above
Address: % 2 (1. , .AAAAA &t. Additional inspection (I hr min) 66.25/ hr
`e Investigation (1 hr min) 66.25/ hr
City / State/ZIP: U $ \A) j et S'6�3
Industrial plant (t hr min) 78.18/ hr
6 !
Phone: ( 360 ) / • Fax: ( ) 7P? -- ?6c2 Inspections for which no fee is 90.00 / hr
/r specifically listed (% hr min)
i(/ CCB Lie.: 4 i705 . Electrical Lic.:26 /C1` uprv. Lie.: . 905 . 44 - .,ELECTRICAGPERMIT FEES;'
Subtotal: )S 0, CO
Suprv. Electrician signature, required: Plan review (25% of permit lee):
Print naive: / ' 9_ 2/.,/ State surcharge(12 %ofpermitfee): JF,W �� ' TOTAL PERMIT FEE: I 6i,(,o t/
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: 4ckt- .Ait. Date: et _If- f!l • Number of inspections allowed per permit.
I9ltui lding /Pcrmiu PermiiApp.doc 07/01/10 440.4615'I'(11i05/CO 'WOOB
09/21/2010 TUE 16:11 FAX 3609069692 Gloaecury
bl S it 0003/003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
Audio and Stereo Systems*
0 Burglar Alarm
0 Garage Door Opener*
0 Heating, Ventilation and Air Conditioning System"
O Vacuum Systems"
0 Other:
COMMERCIAL WORK ONLY
Fee for each commercial $75.00
system
(SEE OAR 918
Check Type of Work Involved:
0 Audio and Stereo Systems
0 Boiler Controls
0 Clock Systems
n Data Telecommunication Installation
0 Fire Alarm Installation
LJ HVAC
0 Instrumentation
O Intercom and Paging Systems
O Landscape Irrigation Control"
O Medical
0 Nurse Calls
Outdoor Landscape Lighting*
O Protective Signaling
" Other CC T as-rttc--
Total number of commercial systems: 2._
"No licenses are required. Licenses are required
for all other installations
1:q1uildineentlits‘111.C.PumitApp.doc 07,01110