Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I I II 11 . COMMUNITY DEVELOPMENT Permit #: ELR2009 -00183
Date Issued: 07/13/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S115BA02600
Jurisdiction: Tigard
Site address: 16230 SW PACIFIC HWY 100
Subdivision: Lot: 0
Project: Panda Express
Project Description: Low voltage for security system integration.
FEES
Owner:
SN PROPERTIES PARTNERSHIP Description Date Amount
1121 SW SALMON ST Restricted Energy Permit 07/13/2009 $75.00
PORTLAND, OR 97205 12% State Surcharge - Electrical 07/13/2009 $9.00
PHONE:
Contractor:
SIGNATURE SECURITY INC
2917 WASHINGTON ST SUITE #104
VANCOUVER, WA 97682
PHONE: 360- 750 -6000
FAX: 360 - 883 -1557
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 Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: Y Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Sp ialty C des and all o er applicable law. All work will
be done i ccordance wi . •proved plans. This permit will expire if work is not started within 180 day of issu ce, or if •rk is suspe d for more the 180
days. ENTION: Oregon la re• ' -s you to follow the rules adopted by the Oregon Utility N tificatio ' Center. Those rule-" r set forth in OAR
952 -00 -0010 through OAR 952 -001 r r r ou ma stain a copy of the rules or direct questions to OUNC by ca in 3.2 6 . • • 1.:00.3 •4
r
O I I
Issue By: 4i / Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY ,,� (�
Received Electrical Ea /�w / -6 V /�$ 3
Date/By: Permit No.:
City of Tigard Piamting Approval Sign
4, g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Pa � lr ,��� �
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 / pia 1,� Post - Review Land Use
„ � Date/By: Case No.:
w
Internet: ww.ci.tigard.or.us N ,A �i I V Contact Juris.: 181 See Page 2 for
4 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
C)
o-pro ot. ." .. :;:z-,,"
F. . , , :, �' � W'' PI fclieck;"71 thaf ' . I
'NiNew construction 0 Demolition ❑ Service over 225 amps- • Health -care facility
commercial ❑ Hazardous location
• Addition/alteration/re • lacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
. rEGo " .vi SWIM ti : , _ a I & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling O. Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
• Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
0 ° ° 0 ; Q e Submit sets of plans with any of the above.
'�' �• �^ above are not a � � licable to rem construction service.
Job site address: �� � ��� «��L� �- The abo � ora constr
t 3 :AMIE ‘
Suite #: OD Bid :. /A • t. #: Number of inspections per permit allowed
Project Name: 5 - oti - D211 U Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential- single or multi- family per
dwelling unit. Includes attached garage.
Service included:
* Ck ` I I w f ' ` ' . ^ 1000 sq. R or less 1 33 . 40 4
Each additional 500 sq. R or portion thereof 33.40 1
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax ma ./ • arcel #: Each manufactured home or modular dwelling
Y rtZWIff 1 ni 7 5 service and/or feeder 90.90 2
Z . I I W HI M M � Tut/arm. Services or alteration o feeders relocation:
- installation,
�� � r relocation:
- 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
0
®t i';, 147P- 601 amps to 1000 amps 240.60 2
�� Over 1000 amps or volts 454.65 2
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
4 01 t 600 amps 133.75 2
' ., f , : , f • . y ' ` rl Bran circuits - new, alteration, or
Name: extension per panel
A. Fee for branch circuits with purchase of
Address: 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: I Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
Each pump or irrigation circle 53.40 2
� , 1��/ � Each sign or outline lighting 53.40 2
Job No: 1 Signal circuits) or a limited energy panel, 1 ?�j 2
// �" alteratio or extension I Page 2
Business Name: i�'i .1 (1�� �Il' /.2� Description:
Address: , 41 1, yR _ `�62�
m��n W it Each additional inspection over the allowable in an of the above:
- • `,�� U h l l IVAM FA i Mad NII 4 A Per ' . - ction . hour min. 1 hour 62.50
Phone: ' _ ,1' 1 1i�iR;igir/a' Investigation fee:
CCB Lic. #: 1 . z z s i "3 e $ a. 3 ) zM • i � .
Supervising electrici. - 145 " tt Subtotal $ S
si : ature re • wired: ∎� /�"�
• 7 it t1( Plan Review 25% of Permit Fee $ t1
•'I► • u$\ O .1, t.J Lic. #: • 6 L,e/? . State Surchar:e :° .. • ermit Fee $ -
TOTAL PERMIT FEE $ . D
Authorized Frit lir `�� / ' / Notice: This permit application expires if a permit is not o tamed within
Signature: AIL AM,. Date: fL ft it has been cepted m.
* 180 Fee met hodology days aer set by Tri ac -County as Building coplete I ndustry Service Board.
(Please print name)
is \Dsts \Permit Forms \ElcPermitApp.doc 01/03 „
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information " %
LIMITED ENERGY PERMIT FEES: .-v
RESIDENTIAL WORK ONLY: N�
Fee for all systems $75.00 \t
Check Type of Work Involved: /' _i t)`(1 k -
D Audio and Stereo Systems �
n Burglar Alarm ,i'l Y
n Garage Door Opener v q
I I Heating, Ventilation and Air Conditioning System * ,
ri Vacuum Systems
O 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
Data Telecommunication Installation
Fire Alarm Installation
n HVAC
C ?:::C)1,
0 Instrumentation
n Intercom and Paging Systems
D Landscape Irrigation Control
0 Medical
D Nurse Calls
n Outdoor Landscape Lighting
0 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