Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00230
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/31/2008
PARCEL: 1 S136AD -06504
SITE ADDRESS: 11462 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: AMERICAS TIRE COMPANY LOT: 003 JURISDICTION: TIG
PROJECT: DISCOUNT TIRE COMPANY
Project Description: Installing (1) fire alarm 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: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
HALLE PROPERTIES LLC RFI COMMUNICATIONS & SECURITY
20225 N SCOTTSDALE RD 25977 SW CANYON CREEK RD. #E
SCOTTSDALE, AZ 85225 WILSONVILLE, OR 97070
Phone: Contact #: PRI 503- 682 -9900
FAX 503- 682 -9500
FEES Reg #: ELE 34- 174CLE
LIC 67147
Description Date Amount
[ELPRMT] ELR Permit 7/31/2008 $75.00
[TAX] 12% State Surch 7/31/2008 $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. - • 800.332.2344.
Issued By ' ' 0 � Permittee Signature:
tip
OWNER INSTALLATION ONL
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 ',
City of Tigard CEWE' Dateis �`��� �j PermitNo.: • "
City
13125 SW Hall Blvd., Tigard, OR 9''s Plan Review
Phone: 503.639.4171 Fax: 503.59:.1' Date/By: Other Permit. 6640/ `Gr .)c-fCr
I G A It D Inspection Line: 503.639 j1 `L 3 t 'Z008 Date Ready/By: Juris: ® See Page 2 for
Internet: ww'.tigard- or.gov JU Notified/Method: Supplemental Information
TYPE OF W Y OF ... _ ` ff AR® PLAN REVIEW
❑ New construction l� Addition alter ( 'VW Please check all that apply (submit 2 sets of plans w /items checked below):
{�� ��V �Qv ❑ 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 amps 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 El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A", "E", "I -2", "I -3 ",
Job no.: es(/le Job site address: 1/ t��oo2 s <<t� /ill 100HP or more. occupancy.
❑
/ 7 ❑ Six or more residential units. Recreational vehicle parks.
City /State /ZIP: Jt� ✓p( �� 9 7 ,Pa 3 / ❑ Health -care facilities. 0 Supply voltage for more than
/ ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt.no.: Project name: b;Stv>,n . / 4 l t,t eV lr,.,,,, ye_ ❑ Service or feeder 600 amps ormore.
FEE SCHEDULE
Cross street/directions to job site: 5(i.) ( / , _S— 7'' Description 1 Qty. I Fee. I Total I •
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'l 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
i °1/� ..5y /+1 Limited energy, multi-family 75.00 2
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: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: 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 I 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
Business name: (/"..";/ G / Fee branch b branch circuit
circuits
�'e /Toy?, C S /h e . - OrPriOYt B. Fee for branch circ
(J without service or feeder fee,
Contact name: 6✓ n �, S ` //5 first branch circuit 46.85 2
Address: ;Sy' / 7 7 sw Co- v. ro.,. f ), ce„/ Sk,'. rL' Each add'I branch circuit 6.65 2
/
Miscellaneous (service or feeder not included)
City/State /ZIP: �,'/SyJ,I vi //e 07O Each manufactured or modular / / dwelling, service and/or feeder 90.90 2
Phone: (5-03) ‘, ga- 9 ? O Fax: : (c ) 64,„1... 9S0.0 Reconnect only 66.85 2
E -mail: y` , xe, p y e V✓t e_ /2F/ 737 Cc4ye Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
/ C - �( Signal panel, alteration, or
circuit(s) or limited -
Business name: o /oar C $ A., r C . '- 0PPtac -t /� / extension. Describe: energy panel, ( -7 `�
Address: �, a, _ 'S' s 7, , � i f5 /a s" - 9 27 Sr,/ ✓ (c«�,o,. ( #7/ l Page 2 / 2
City/State /ZIP: 9 Z&,' / „ f/ Q/Z 5 7 20 Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: (56 ) 6,4; — 9 pop Fax: (9 3) 649 -S' f00 Investigation per hour (I hr min) 62.50
CCB Lic.: ‘7/e../ 7 Electrical Lic.: 3y - / Suprv. Lic.: g a [ L A- Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ,,,...T,7 Subtotal: G�
Print name: Date:
Plan review (25% of permit fee): ` '
State surcharge (12% of permit fee): Cf f CO
Authorized signature :�� -00-- TOTAL PERMIT FEE: n lI��
T his permit application expires if a permit is not obtained within 180
Print name: ��� S/� Date: 3j /p g' days after it has been accepted as complete.
• Number of inspections allowed per permit.
C\Building\Permits1ELC- PermitApp.doc 05/23/06 44046t5T(i /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information t , , a
LIMITED ENERGY PERMIT FEES:
•
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
1 Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
I:\Buildingwermits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #:F.AVMS.0023
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: -1 a%
Phone: (503) 639- 4171 j I l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: -1 , 31, O$ TIME: PAGE:
SITE ADDRESS: ‘1 S W 1 A c. i c i vuy CLASS OF WORK:
SUBDIVISION: JJ LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: k��1 $ C,O V M 1 a
1: A L.AI .
OWNER: PHONE #:
CONTRACTOR: � � Gb A * 6�� PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
mck
Corrections /Comments /Instructions:
II�
/
PA ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t 0 8 Date:11 3139 Phone #: (503) 718- 1-tilh