Permit CITY OF TI GARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
lk DEVELOPMENT Tigard, � 639 -4171 DATE ISSUED: 03 -00298
13125 ED: 9/30/0
SITE ADDRESS: 10220 SW GREENBURG RD 501 PARCEL: 1S135AB -01004
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
Project Description: Installation of (3) limited energy systems. Other systems are access & CCTV.
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: ACCESS/CU. X
TOTAL # OF SYSTEMS: 3
Owner: Contractor:
EOP LINCOLN, LLC COOK SECURITY GROUP
10260 SW GREENBURG RD 4252 SE INTERNATIONAL WAY SE
SUITE 100 MILWAUKIER, OR 97222
PORTLAND, OR 97223
Phone: Phone: 503 786 - 5173
Reg #: LIC 151552
ELE 3 5 41 C EP
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/30/03 $225.00 Elect'I Final
[TAX] 8% State Tax 9/30/03 $18.00
Total $243.00
•
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. AA ENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules ar- i`.rth in OAR 952 - 001 -0010 throuc
Iss ed by : �!IA �/ / '-�'�% Permittee Signature I/ —,
V V
OWNER INSTALLATION ONLY I
The installation is being made on property I own which is not intended for sale, ease, 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
v ,`
Electrical Permit Application FOR OFFICE USE ONLY
Received
By: 7 O zz Permit N o.:
Date/By: < O 5
atBy: � � J Perm N C-L�
Cit of Ti and Planning Approval Sign
Y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
// N : � Date/B Case No.:
�� G n
Internet: www.ci.tigard.or.us v _ ( Contact t
Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 W Name/Method: Supplemental Information.
' .;_ WATI ... ' N E-MKO 2K -4 Mlit4ita MtnOVrOIW »_ W l a e all t aM V
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
111 Addition /alteration/replacemen ❑ _ Other: commercial ❑ Building over er 10,000
� � N ,�, �, � �, Mai El Service over 320 amps - rating of ❑ Building over 10,000 square feet,
#= 3 .'"' = t M:00: ®. G® S ei '' „ . ,WV2 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
El Accessory Building El Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
£ i.. Y ,? 6 *X SYT + NaIld" t OPg Submit sets of plans with any of the above.
r LI1IQ' RlV1A . O r IC / �� ;� _, „ The above are not applicable to temporary construction service.
Job site add,ress. Ozz b v-.1 6- , e_eC� Q " ) T01 � T gi� rIVJ ac'` : "t Rt `a tO iF._" $,O . °DUIiar; ',rr_rR k. .r: g R
Suite #: (� "� I �> Bldg. /Apt. #: , ' Number of inspections per permit allowed
Project NaiI1e.`/ W P'(,(-S F sIg -(rd HO^-t `"ae-EoVe.-"€ - Description Qty Fee (ea.) Total
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
i. ` x D:ESCRIPT Mini `WQRI{ '.4- s g `l" service and/or feeder 90.90 2
Services or feeders - installation, •
/*C C et S C(a%.Tfyid L.--- alteration or relocation:
r 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
GL7li 401 amps to 600 amps 160.60 2
112 P :Majni,.O.V l' : 1G, • N `100,.. ITT .K ; - IA ;,&,,, :. 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Naive: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City/ State/Zip: alteration, or relocation:
y p 200 amps or less • 66.85 • 1
Phone: Fax: 201 amps to 400 amps 100.30 2
..„ 401 to 600 amps 133.75 2
a:ma ttotC1; a'-. .n. a ® atexe wP .,K_::�
Branch circuits -new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
53.40 2
tg raY relax,: . N,-c.R ' to <0 m :,, : "pa Each s or
sign orontlineti le
lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel, nr Q9
Business Name: C�� 5t�c,2t G.C.)✓,>D alteration, or extension Page 2 ��� 2
Description:
Address: -1 -5 s tesCe renelii — �,Pr - �# E OCnI 41404, ACC TL- -
i Each additional inspection over the allowable in any of the above:
q. City /State /Zip: r^Ic (.tjekv a ,--- n e-- 7 ?--1-2-- Per inspection per hour (min. 1 hour) 62.50
Phone: SC -7 -8(73 Fax: Investigation fee:
CCB Lic. #: I5cj , Lic. #: 3— 5- other: rem
1 .��` ���; ��� . =wElectneal "I?ermrtiFees:.,... �°'.`�- . ��
Supervising electrician l / I V /05 Subtotal $ a 2.5 , GU
signature required: Plan Review (25% of Permit Fee) $
Print Name: - f c- Lic. #: 3 N5 txP State Surch arge (8% of Permit Fee) $ / S . 6 " /
1 TOTAL PERMIT FEE $ 8.4 ,
Authorized N otice: This permit application expires if a permit is not obtained within fr
Signature: _ A , . Date: 27 0 3 180 days after it has been accepted as complete.
qv
/ \� *Fee methodology set.by Tri -County Building Industry Service Board.
, (hl� . ) Cu
'lease print name)
i:\Dsts\Permit Forms\ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm
ri Garage Door Opener
Heating, Ventilation and Air Conditioning System
n Vacuum Systems
El Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
El Landscape Irrigation Control
n Medical
n Nurse Calls
n Outdoor Landscape Lighting
9 3 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i: \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03