Permit CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
A DEVELOPMENT SERVICES PERMIT #: ELR2000 -00285
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/1/00
SITE ADDRESS: 16316 SW 72ND AVE B -03 PARCEL: 2S113AA -00300
SUBDIVISION: ZONING: I -L
BLOCK: LOT: OOA JURISDICTION: TIG
Proiect Description: Burgler Alarm
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:
Owner: Contractor:
. PACIFIC REALTY ASSOCIATES PHILLIPS ELECTRONICS
15350 SW SEQUOIA PKWY #300 -WMI (DBA FOR MASTER ALARM L.L.C.)
PORTLAND, OR 97224 1110 NW FLANDERS
PORTLAND, OR 97209
Phone: Phone: 222 -5083
Reg #: LIC 00125364
SUP 329JLE
ELE 26- 213CLE
FEES Required Inspections
Type By Date Amount Receipt Elect'I Final
PRMT CTR 12/1/00 $75.00 2720000000
5PCT CTR 12/1/00 $6.00 2720000000
Total $81.00 EXPIRED
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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -1987.
Issued by Permittee Signature Q�
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
r
Electrical Permit App , t,', OAP
• Datereceived: Permitno.: ;,_ - 0 -,, i 1
l o t ,,,,,, •• City of Tigard r , - • . f • r $roje no Expire date:
City i Address: 13125 SW Hall Blvd, Tigard, OR 9'7223
rY f Tigard Phone: (503) 639 -4171 ^�g 11011 DEN t l 0', `�'ssued: By: Receipt no.:
Fax: (503) 598 -1960 t Case file no.: Payment type:
' • 'Land use approval. • . •.
TYPE OF PERMIT •
❑ 1 & 2 family dwelling or accessory 5if Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement 0 Other: 0 Partial
3011 SITE INFORMATION
Job address: /0/4 sli 9 72 _ Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: I Block: Subdivision:
Project name:1304E 4o4 Di- bi oh I Description and location of work on premises: ,et4y / >0 a
Estimated date of completion/inspection:
, ..a:.r (,'04y): ,4 “.A 01::1 11 = .�x ; ... -a .•ti- :;_..,t .1113 SCHLI)ULL - _ •
-
Job no: Fee
Business name: ,l �j ,, ,.�,, _ Description Qty. (ea) Total
r $ , v New residential - single or mull- family per
Address: ) 1,1O NW C6.44.(4.24 dwelling mit. Includes attached garage.
City: f - .Gk. I State: De. I ZIP: g7u7q Service btduded:
Phone:503-a4,) 50$3 I Fax: 5 I E -mail: 1000 sq. ft. or less 4
/ S 3 (ii I : a 2 &- a� nl 3 ^ Each additional 500 sq. ft. or portion thereof
CCB no.: Elec. bus. lic. no l `Limtedenergy,residential 2
City /metro lic. no.: j (,O3 _ Limited energy, non- residential 2
l j J3400 Each manufactured home or modular dwelling •
Signature o supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): Ro p • t t 11 A_ License no: Services or feeders — installation,
alteration or relocation:
-•• PROPERTY OWNER 200 amps or less 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: I State: I ZIP: Over 1000 amps or volts 2
Phone: I Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders - --
which is not intended for sale, lease, rent, or exchange according to llatioa , alteration, orrelocation:
200 amps or less 2
ORS 447, 455, 479, 670, 701.
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 am .s 2
ENGINEER Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E -mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
O Service over 225 amps - commercial 0 Health -care facility Each pump or irrigation circle 2
O Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) ora limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* I 7
! 2
O Building over three stories 0 Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection I I 1 I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other r
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ ?S-- eo
❑Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ 6 9 •
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires accepted as complete. TOTAL $ e t —
Name of cardholder as shown on credit card I �r 1)
Cardholder signature $ Amount n'z + 1 � F 440 -4615 (6100/COM)
Electrical Permit Fees: Limited Energy Fees:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
p Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost . Total y Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 ❑ Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Opener*
Dwelling Service or Feeder $90.90 2 .
Services or Feeders ❑ Heating, Ventilation and Air Conditioning System'
Installation, alteration, or relocation
200 amps or less . $80.30 2 111 •
201 amps to 400 amps $106.85 2 Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2 •
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation
200 amps or less $66.85 2 Fee for each system $75.00
201 amps to 400 amps $100.30 2 (SEE OAR 918 - 260 -260)
401 amps to 600 amps $133.75 2
Over 600 amps to 1000 volts, Check Type of Work Involved:
see "b" above.
Branch Circuits ❑ Audio and Stereo Systems
New, alteration or extension per panel ❑
a) The fee for branch circuits Boiler Controls
with purchase of service or
feeder fee. n Clock Systems
Each branch circuit $6.65 2
b) The fee for branch circuits ❑ Data Telecommunication Installation
without purchase of service .
or feeder fee. n Fire Alarm Installation •
First branch circuit $46.85
Each additional branch circuit $6.65 ❑
HVAC
Miscellaneous
(Service or feeder not included) ❑ Instrumentation
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 ❑
Signal circuit(s) or a limited energy Intercom and Paging Systems
panel, alteration or extension $75.00
Minor Labels (10) $125.00 ❑ Landscape Irrigation Control
Each additional inspection over ❑ Medical
the allowable in any of the above
Per inspection $62.50 ❑ -
Per hour - $62.50 _ _ _ _ • Nurse Calls
In Plant $73.75 ❑
Outdoor Landscape Lighting
Fees:
14 Protective Signaling
Enter total of above fees $
8% State Surcharge $
n Other
25% Plan Review Fee Number of Systems
See "Plan Review" section on $
front of application. * No licenses are required. Licenses are required for all other installations
Total Balance Due $ Fees:
c0 ❑ Trust Account # Enter total of above fees ' $
^7
00
8% State Surcharge $ Co
• Ri
T otal Balance Due $
°- -
i:\dsts \forms \elc- fees.doc 10/09/00 •
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