Permit CITY O F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2008 -00028
TIGARD DATE ISSUED: 2/5/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S102CB - 02300
SITE ADDRESS: 13240 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 008 JURISDICTION: TIG
PROJECT: WESTSIDE SURGERY
Project Description: security alarm system installation
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:
INSTRUMENTATION: OTHER: SECURITY X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC PROPERTIES AMERICAN SECURITY ALARMS
BY MARTIN JOHNSON 5411 SE MCLOUGHLIN BLVD
13200 SW PACIFIC HWY PORTLAND, OR 97202
TIGARD, OR 97223
Phone: Contact #: PRI 503 -231 -0303
FAX 503- 230 -1044
FEES Reg #: ELE 26- 283CLE
LIC 58640
Description Date Amount
[ELPRMT] ELR Permit 2/5/2008 $75.00
[TAX] 12% State Surchai 2/5/2008 $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
503.246.6.! or .x00.332 344.
Issued , y: — /i Permittee Signatu
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 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.
C. •
l P ermit A ti 14 E/ ill; ctrl Ih I I ..r, cl
City of Tigard e .Ci.
ti is Da r•/By:
d (( o f ParmitNo.: E Luc at
Ili .S
---- 13125 SW WI Blvd.,Tigard,OR 97223 `AN 3 1 Plan Review i py 1er p erm i L
Phone: 503.639.4171 Fax: 503.598.1960' ;' 1�{D Dat�Y
Inspection Line: 503.639.4175 � Or , 'Dote Ru lob; s s; 21 See Page 2 for
1' 14: F' i) ix G 1�Y M N oriredm4abod; Supplemental information
Internet: www.tigOrd•or.gov , U `
' TYPE OF W .7t _
pleas check GU that apply (subnlit3 seta of plans w/itam s checked below):
❑ New construction F.,Addltlon/alteratlonheplaccmem OSar„ice or feeder400ampsormore ❑ Bull dingovRUnocstories.
ID Demolition . 0 Other: where the avail MR currant p Halms and boaryaM4.
CATEGORY 'ON. contaticnoii. rereads 10.100 amps at 150 volts or ❑ nothing buildings.
law to ground or woods 14,000 ❑ Commeratsl -ue agricultural
❑ 1- and 2- family dwelling • ommercial /industrial El Accessory building amps for all other insrolluione. buildings.
CI Multi-family 0 Master builder ❑ Other: One pump. tn,asIln of 75 VA or
Q Emagoaq open. largo sepenuely 4aivcd p.tem.
.101 SITE INFORMATION AND LOCATION DAddition of now molar load of ❑ ' 1 A ", "E". -1.2 ", "1 -3 ^.
la w In wPA 1002P ormote. nee o
Job no.: n
�M lob site address: ['Recreational v ahiale
❑Sbaorroor•ce.idontialbnits. ❑ parks.
.------ n ❑Raab case facilities. [1 Supply voltage for more than
City /Stare/ZIP: ( d 1 `0 a ❑Ha avdeusImams. 000 volts QOMiO,.I.
Suite/bldg./apt no.: °_ W .e� ., li �k, L3 Unto Project name: Unto or too* 600 amps m Tore.
FEZ SCHEDULE
Cross street/directions to job Airs: Damao f qq. I P.6 _ I MN I • ,
New residential single- or multi - faintly dwelling unit.
Includes attached garage
Subdivision: Lot no.: 1,000 sq. ft. or Ices ' 145.15 4
Ea. add'I 500 sq. It or portion 33.40 1
Tax map /parcel no.:�ted energy, residential 75,00 2
DESCRIPTION OF WORK (with obeys sq. B.)
lig Limited energy, multi - family 75.00 2
�0 i 1 ASIMMIIIIMI residential with above.. ft
Services or feeders Inetallation and/or reloea(Io
200 amps or less 80,30 2
0 PROPERTY OWNER . Millitg 201 amps to 400 amps 106,85 2
401 amps to 4 mn 160 2
Name: V_ _, S 6 ' r t 601 amps to 1,000 amps 240.60 2
Address: I I yv 1 , 01. Ilail. _ . Over 1,000 amps or volts 454.65 2
Cl imcsuwaimiimm
1v /StawJZIP: Temporary services or feeders installation, alteration, and/or
v I 1� f1 rr relocation
Photo: (jj) 1p ' 1 (0 Fax ( )
200 amps or less 66.85 t
o Installation: This installation Is being made on property that I own which is not 201 amps to 400 maps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 40l amps ro 599 snips 133.75 2
Branch circuits – new, alteration, or extension, per pond
Owner signature: _ Date: A, Fee for branch circuits with
all APPLICANT • ' • Cl CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
business name: : •r _ • • a - , ,. - 19. Re for branch eirouits
wrthvtrt setvico or .feeder fo, 46.85 2
• . _. • .. - . ■ first branch circuit
Each add'I branch circuit 6,65 2
Ad 411 - u • l • • - • Misccllaneoas (service or feeder not included)
City /5tate/ZIP: P orte :.9 • . • t I Becmanufactured or modular 90.90 2
dwelling, service and/or tbeder
Phone: ( I ) – I I 1 t I • , Reconnect only 66.85 2
Pump or irrigation circle 53,40 2
CONTRACTOR sign or outline lighting 53.40 2
" - Signal accuit(s) or tlni bed- +
cnor panel, alteration, or I 2
Address: extension. Descry; Pogo 2
54 1 SE McLou 1i I : .
City/State/ZIP: Portland OR. 97 202 Each additional iaspeetioh aver allowable in an of the above
Pet inspection 62.50
I I I
A. F 1 I– I lnvest1g811onperhour(' 62,50
ACS to,: 5'J ,140 Elcetri • Is .: , -a ',; E t industrial plant . -r hour 73.75
_ ELE'' - ' 17 , 'PE FEES
— prv. Electrician signature, required:
II
� _ Subtotal: .Oa
„� I Plan review (25% of • itfce): al
�.�,,.. bate: t
•�1.u117� State surcharge (12% ofpl:mth fee):
Authorized signature: to PEE: TOTAL PERMIT $1�-,�t7
�f w1►,11
This pet sppllrntfan aspires it a parmlt o f obtained not I within 110
�� �y Date: 1 a e 6 n days after h has beep accr asit as obta n
a Number of inspections allowed per penult.
1:tsuil6MMMPen"tu1F.L .P,,mitApp,don 05/2 � 1JT(Ilrosoc4MAV®
1 .d 1861 'c'N 10E6 :6 8006 '0E 'ter
CITY OF TIGARD t
BUILDING DIVISION PERMIT #: ELR2008.00028
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/W2008
Phone: (503) 639 -4171 J.. � 1 l
Inspection Requests (24 Hrs.): (503) 639 -4175 ,, „. __..
INSPECTION WORKSHEET FOR DATE: 2/28/2008 TIME: 7:00AM PAGE: Al
SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: WESTSIDE SURGERY
DESCRIPTION: security alarm system installation
OWNER: PACIFIC PROPERTIES, PHONE #:
CONTRACTOR: AMERICAN SECURITY ALARMS PHONE #: 503 - 231 - 0303
Inspection Request Scheduled For: Date: 2/28/2008 Pour Time:
Code # Inspection Description ,- Confirm Contact # Message
199 Electrical final r 065785 -01 503. 231 -0303 Y
Corrections/Comments/Instructions:
(
N
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G 1 Date: L14' O Phone #: (503) 718-