Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11114 2 COMMUNITY DEVELOPMENT Permit #: ELR2012 -00086
TI G A RJR 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2012
Parcel: 2S102BD00701
Jurisdiction: Tigard
Site address: 12785 SW PACIFIC HWY
Project: Burgerville Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 8
Project Description: Low voltage for alarm system
Contractor: AMERICAN SECURITY ALARMS, INC. Owner: BENNETH, CATHERINE MCNICOL
5411 SE MCLOUGHLIN BLVD 3830 ROBIN CREEK LN
PORTLAND, OR 97202 WEST LINN, OR 97068
PHONE: 503 - 231 -0303 PHONE:
FAX: 503 - 230 -1044
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/09/2012 $75.00
12% State Surcharge - Electrical 05/09/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N 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: Y
Security Alarm: N Other: N Total $84.00
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 • . e - • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules a set forth in OAR
952- 001 -0010 thro gh OAR 9 = 001 -. :10. •u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19 or 1.800.33 . 4.
/1 0 2 /1 4
Issued By: • Permittee Signature:
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.
Electrical Permit Application RECEIVED I•(llt (11 1 1(:I': us, 0,1.1
114 City of Tigard Received Date/By: / y: .4 7 — -, / Permit No.; SAAR as .64660
u J (3125 SW Hall Blvd., Tigard,OR 97223 MAY — 7 2012 plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
T I i —,1,1; Inspection Line: 503.639.4175 CITY OF TIGARD bate Ready/By: furls: 10 See Page 2 for
Internet: www.tigard-or.gOit Notified/Method: 1 ■ D ISM Notified/Method: Supple Information
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❑ New construction ® Additian/a Please cheek au that apply (submit 2 sets of plans w /items oheoked below):
❑ Service Or feeder 400 amps or more ❑ Building over three stories.
0 Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
� r , 1i � , , r II , ) ! ■ , r �bt, li ( ! } ra, ea � exee9d5 10,000 amps 81 1 SO VOItS Or Q Floating buildings.
ice. ., ,,...:., , . ti- u«.,. _ _ . !:.....7... , .1 - Y+,..',:: a,. _ _ — .:. Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling (3) Commercial/industrial ❑ Accessory building turps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Piro prop, ❑ Installation of 75 KVA or
t 3 s r p : 1 ;i ❑Emergency system. larger separately derived system.
. -- - , - ?. ,__....... _�'�1 (� Addition of now motor load of ❑ "A" ''E" "1- 2 ",''1 -3"
Job no.: Job site address: SW Pacific Highway 1001.11 or more occupancy.
0 Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR. 97223 10271C— ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Burgerville USA ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description Qty. Fee. Told -
' New residential single - or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: ^ 1000 sq, n. or less
_ 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map/parcel no -
r I energy, residential 75.00 2
i I . 1 ° i i ! i J I (with above Sq.
mu )
Lt rtcd energy, family 75.00 2
Installation of Alarm System _ residential (with above sq. ft.)
Services or feeders installation alteration, and/or relocation
200 amps or less 100.70 , 2
i 1 I 1 a I i
, , it I . 2: . , : . , ....„1, , ..31 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Holland Inc. 601 amps to 1,000 amps 301.04 2
Address: 109 W 17 Street Over 1,000 amps or volts 552.26 2
City/State/ZIP: Vancouver, WA 98660 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (360)694 -1521 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to don amps 125.08 2
intended for sale, lease, rent, or exchange, according to OILS 447, 449, 670, and 701. cent amps to 599 amps 166.54 2
Branch circuits — new, alteration, or extension, panel
Owner signature:, Date: A. Fox for branch circuits with
I
' above . service or feeder fee
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i Y : , each brenoh c 7.42 2
Business name: American Security Alarms, Inc. B. Fee for branch circuits wtrhour '
service or feeder foe, first 56.18 2
Contact name: Sara Patterson branch circuit
Each add'I branch circuit 7.42 2
Address: 5411 SE McLoughlin Blvd. Miscellaneous (service or feeder not included)
City/State/ZIP: Portland, OR. 97202 Each manufactured or modular 67,84 2
dwelling, service and/or feeder _
Phone: (503) 231 -0303 `, Fax:: (503) 230 -1 I • ' AM Reconnect only 67.84 ' 2
Pump or irrigation circle 67,84 . 2
E Sa ra a@asalarms corn Sign or outline lighting 67.84 2
w.._ _ _... _._ . _ Signal circuits) or limited energy
Business name: American Security Alarms, Inc. panel alteration, or extension l Page 2 75 2
Each additional Inspection over allowable in any of the above .
Address: Additional inspection (1 hr min) 66.25/ hr _
Investigation (I hr min) 66.25/ hr
•
City/State/ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) 0 , / Inspections for which no fee is 90,00/ hr
-
s. cificall listed 14hrmin
CCB Lic.: 58640 11 Electr c. 26283CLE I . uprv. Lie.: 774Iea _ 1 n l :i r G s{ 1 1 I , tv :iii.: GAS °
Suprv, Electrician signature, required:, a Subtotal: 75.00
�i I � Plan review (25% of permit fee): N/A
Print name: lames D. Liston / ,1 Date: 5 - - State surcharge (12% of permit fee): 9.00
I TOTAL PERMIT FEE: 84.00
Authorized signature:
Thin permit applicafion expires if a permit is not obtained within 180
days after it ban been accepted at complete.
Print name: Date: • Number of inspections allowed per permit.
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
1,; �1'�t' \!
Fee for all residential systems combined ..... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Hearing, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
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
1: a.H00 Permi,A 07/01 /10
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