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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT -• = ` COMMUNITY DEVELOPMENT Permit #: ELR2010 00263 G Rn 13125 SW Hall Blvd Tigard OR 97223 503.718.2439 Date Issued: 11/24/2010 .A RD , Parcel: 2S110DCO2400 Jurisdiction: Tigard Site address: 11565 SW DURHAM RD 110 Project: Dr. Tollenaar - Chiropractic Clinic Subdivision: Lot: 0 Project Description: Limited energy for (1) audio /stereo system and (1) security system. Contractor: QUADRANT SECURITY INC Owner: MOODY 2005 TRUST PO BOX 14833 BY PAUL W & LINDA L MOODY TRS PORTLAND, OR 97293 9811 NE 114TH CIR VANCOUVER, WA 98662 PHONE: 503 - 234 -5558 PHONE: FAX: 503 - 236 -2322 FEES Description Date Amount Specifics: Restricted Energy Permit 11/24/2010 $150.00 12% State Surcharge - Electrical 11/24/2010 $18.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 2 Audio & Stereo: Y Boiler Controls: N CCTV: N Clock Systems: N Data & Telecommunications: N Fire Alarm: N HVAC: N Instrumentation: N Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: Y Total $168.00 Other Desc: Required Items and Reports (Conditions) 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,, // Issued By: Sa„1410' �L__ Permittee Signature: (7/V / /����e v L 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 the next available inspection date. 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. �' ectricA Pe xa tt An Ple,. se.. City of Tigard n i i ` . 'r 13125 SW Ball Blvd,. Tigard, OR 97273 1' / , 0 Pemit Ne 0, rV r • .. y . i/ Y / t�� 1 wogep3 . I, Phone: $03.634,4171 Fax; 503:598.1960 _� / Plan Rcrfew ' Inspection Line: 503.639,4175 "t y 2 3 D iLlgtdl9v Other Permit T'1 :. ^. - DAidReady/fir Internet: www.tigard- or.gov Sel PAix 2 i w �. Not{Aedtmethoch . A 'I $V Illalllbli ttrtbrrg erica �. 1 Y: iI!1 Pp Twit OF WORK - rr u ► C . ill' - �►N'' REr r iV. - I _I New construet _V Addition / alterat ion/rep a,cement _ - Phase check e'11 ther apply (Fvbmlr 2 pets of plans w /ft i checked below): ID M p feeder 400 amps or more I7 Beildleg (flier three stories. ❑ Dcmoi iti0n ❑ Other: whera the available Ihn1r current 0 Marin and boatyardx. CA7 ROOY OF CON3tUCtl)N ezccede 10,000 arena nt 150 volN or 0 1- anc12•family dwelling 1! d 'Moving buildings, ommercial /indusn i ❑ Accessory building feF To ground nr ea 14 O Commercial Ant �grieultoml ❑ 1vlUItT f tail gi ps for all other installations, building, Y ❑ Master builder ❑ Other: pFire rump, 0 fnetRllntivn of 75 KVA .I0/3 ant INFORMATION AND LOCATION 0 Fmorgeacy system, Iatpe, Neptlnetcty derived Pygrm, 0 Addition doom motor food of 0 "A~ "E", "1 "1 Job no.: Job site Address: • i _6"' '"� a� 100!0 or mare, (� V! j C,rr+ (=money, City /State/Z1P; Y • I R "a �„ ID He lth.aorc fa ea i � l tl rf R °` Hovel vehicle per, �� Sllite/(11d 8 . nn, I C H'aaerdevt lemnica+a. ❑ Supply for more than �' / !! ® �rOjEC1', name: er nominal. ,Dr, Q re_ vlc © service or feeder 600 amps nr more. Crash street/directions to job sole: + -� F DULE New ralidcnti al single- or lrulti -.t u ally dwelling unitt, includes attached • - rage. Subdivision: Lot no.: 1,000 so. fl, or less 1 .11M11111111111 4 ax map/parcel no.: Ea. addi 500 to. ft. of portion 33.40 • t Limited en residential ■ i• -I r' i It ,r energy. 9ndential 7S.OD with above . , ft, .r .. .r Limited energy, multi- famiry •n^- d a residential with nAovep•.ft 75.00 P 0 • 1),.. Services or feed s inatallndon aiteratto audfor relocation . �. all. - r" r.r • 1 0;tmps or less 1R PROPER OWNER g� TENANT 80.30 �� 201 amps to 400 traps 11111�� Name: T. !� &--Alf amps to 600 amps ' 160.60 Address: �y /� 601 am • • s to 1,800 amps 240 60 J��= �ifiLe i l �`C /Vr/� Over 1,000 am • or volts r 454.65 11111 City/State/ZIP: Temporary cervices or Feeders intttatl „firm, alteration, and/or relacctk in Phone: ( ) Fax: ( ) 200 amps or less 6b,$S 1 Owner installation This installation is being made on property that 1 own which is not 201 amps to 4 00 amps 100.30 intended for sole,1e se. rent. or exchange, according to ORS 447, 449. 670, and 701, 401. a rapt to 599 em � 2 amps 1 . 33,75 2 Owner signature: Date: Branch irCritfdt - nest' alteration or extension taxi . AfTLIICANT A. Fbe branch circuits with CANT' 7UN above e s service or #blrcdet fee, Business n eg . ,� ' , r r . r 0971 /9c 3 ' ( 1 8. pee egeh ib b h Cinc circuit uita Contact name, t^ "� rv,thaur service or feeder fee, l!• .;? - ` ' 1 /L[ / first brarlclr circuit 46.5 Addrms: 1 t ” i % 1 t 5 E'gch add'lbranch circuit 11.I 6,65 i City /State /ZIP: 't i. l ; t r feeder not indade • Each manufactured or modular III Ph ^ne• ( ) dweilin., ocrvicc and /or feeder 90.40 a p o r on e E -mail; it' -' Pump or irrigation circle 53.40 CONTRACTOR St -.0 or outline Ii& ir: EMMEN Business near: r w ./7'1._$ Si gttgl circuit(I) or litnitnd- Address; I . Q (30 energy panel, alteration, ,, j t r 0 . / 0 f >� �� extension, Describe: ••` Page 2 2 2 City/State /ZIP: Pe r^ ,,,,,,,_La 0 , q 7 9 3 Each additimut in. , ectton over allowable In an Perin 011 the above P • roe: co 3 )� `{ - � " spectien 62.50 � IMIMIEEMS investigation rer hour (I hr min) Ell 62,50 CCB Lic.: Electrical Lk,: a,.5 ;. Sup rv, Lie.: Industrial plant � • '�38 Rl. p per hour 73,75 5ttprv. Electrician signature, required; 4 Print name: ,.3. � EFp �i fzr �„T TZ72. Date: r ! Pratt review (x51/ of. permit ke); p . Authorized signature: �, State surcharge (12n% ofpermit fee): �,(• TOTAL PERMIT FEE: \ AI sr L r3 ate: 1114 e perm t o:piretif • tit ba � permit oat nMalned within x'R • da tiKkar Ft lI Re been accepted se r! lad t.� I 1PulldlreFtFermlrrtbr .C- IkrmieA� . a OM /Od Number of inapeetiona arlowed per pemril, �y / 4 oan45I ItelICCPW +SET l 6L av + erd V- Id�Ly� /a L9 .1z.mci.r1caA rermit Application - City of Tigard Page 2 - Supplemental !phonation LIMITED ENERGY PERMIT FEES: Fee for a remdernisi $75.00 iI5ER r t ktY , t'bitr6NtVFI'T':::"T:T'' """ Check Type of Work Involved: 0 Audio and Ster eo Sy El Burglar Alarm Garage Door Opener* Heating, Ventilation and Air Conditioning System* Vacuum Systems* n other; • Fee. fo tub Co menial $75,00 syste , • (SEE O.Alk 918-309-0000) lAgek Type of Work Involved: uclio and Stereo Systems E Boiler ControIS 0 Clock Systems E Data Telecommunication Installation D Fire.Alarm Installation • T-3 • inettimett,tion. E Intercom and Paging Systems • Landscape Trzigation Control* o /vtedical El Nurse CR1JS 0 Outdoor Landscape Lighting* ( ,..-g \ I;rotective Signaling epther otat number of commercial systems; f<0 r e; t y 7 s; eye) — *No licenses are required, Licenses Afe for all other installations mnoiditIormmumcqtrmha con3,n5