Permit v _ 1
y Gi TY O OF T I G A R D ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELR2007 -00396
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/22/2007
PARCEL: 2S113AB -00300
• SITE ADDRESS: 16037 SW UPPER BOONES FERRY RD ZONING: I -L
SUBDIVISION: FANNO CREEK PLACE LOT: JURISDICTION: TIG
PROJECT: FANNO CREEK PLACE
Project Description: Building A; install low voltage radio communicator.
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: RADIO COMM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
OPUS NORTHWEST LLC HSI SECURITY SYSTEMS, INC
1500 SW FIRST AVE. STE. 1100 3424 NE 35TH AVE.
PORTLAND, OR 97201 PORTLAND, OR 97212
Phone: 503 -916 -8963 Contact #: PRI 503 -287 -4604
FAX 503- 287 -1345
FEES Reg #: ELE 26 -755C
LIC 42140
Description Date Amount SUP 3778S
[ELPRMT] ELR Permit 10/22/2007 $75.00
[TAX] 8% State Surcha 10/22/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
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 dire - -stions to OUNC at 51 -. - 6.6699 or 1.800.332.2344. - PrpkrAfien
Issued By: J/ iiii/ , / ' Permittee Signature: S
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.
'''' Oct -2007 03':11 ' PM HSI SECURITY_ STEM 5032871345 6/8
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Electric ' erm i t Applica r �,t i� F �� [ j r p��! °oRo�j cl>� `�o 'LY�`��� ���� I ��1' f � ��1 �
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11115 City of Tigard ((��j 9 w I
` 't 13125 SW Hall Blvd., Tigard, OR 97223s ' ' 2 Received Plan Review
� �/ ♦ , �� y
Plan Review
16 ' J : 0 : I . : : Phone. 503 639 4171 Fax: 503 5989 f. - I IGA1 aO Date/By. Oilier Permit:
'`' laif Inspection Linc: 503.639.4175
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�j�It Internal: wwtv.ti and -or. try ��� I gi Sec Page 2 for
`- g g j �131`,,.— Notif Da i ed/Mc(had: r � Supplemental Information
TYPE OF WORK 1'LAN REVIEW
® New construction ❑ Addition /alteration/replaceiffent Please check all that apply (submit 2 sets of plans w /items checked below)
❑ 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 ISO volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agnculturat
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings
❑Multi - family D Master builder ❑Other: 0 Fire plump. ❑ Installation of 75KVAor
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "A ",' "l - ", • 'I - ",
10011P or more. occupancy
Job no.. Job site address: 16037 SW Upper Boones Ferry Rd 0 vehicle parks
❑ Six or more re idem(al units. p
City /State/ZIP• 97224 ❑ Health - care facilities ❑ Supply voltage for more than
❑ Haiardous locations. 600 volts nominal
Suite/bldg. /apt.no.: Bldg. A Project name: Fanno Creek 0 Service or feeder 600 amps or more
• FEE SCHEDULE
Cross str•eetr'di•ections to job site: Durham Rd Description I Otr. 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
Tax map /parcel no,: •
DESCRIPTION OF WORK Ea ndd'I 500 sq. Ii. or portion 33.40 1
Install Radio Communicator
Limited energy, residential 75.00 2 .
(with above sq. fl.)
® PROPERTY OWNER I ❑ TENANT
Limited energy, mule- family 75.00 2
Name: Opus NW, LIC residential (with above so ft )
Address: 1500 SW ! Ave. Services or feeders installation, alteration, and /or relocation
City /State/ZIP: Portland, OR 97205 200 amps or less 80 30 2
Phone: (503)478 -8008 Fax: (503)4'78-8038
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 106.85 2
intended for sale. lease. rent, or exchange. according to ORS 447. 449. 670. and 701.
Owner signature: Date: 401 amps to 600 amps 160.60 2
® APPLICANT I ❑ CONTACT PERSON
Business name: HSI Security Systems, Inc. 601 amps to 1,000 amps 240.60 2
Contact name: Barney O'Donnell
35th Over 1,000 amps or volts 454.65 2
Address. 3424 NE 35 Ave.
City/State/ZIP: Portland, OR 97212 Temporary services or feeders installation, alteration, and/or I
relocation
Phone: (503) 287 -4604 Fax: : (503) 287 -1345 200 amps or less 66.85 I
E-mail:
CONTRACTOR
201 amps to 400 amps 100.30 2
Business name: HSI Security Systems, Inc.
Address: 3424.NE 35th Ave. 401 amps to 599 amps 133 75 2
City /State /ZIP: Portland, OR 97212 - '
Branch circuits - new, alteration, or extension, per panel
Phone (503) 287-4604 I Fax: (503) 287 -1345 A. Fee for branch circuits with
above service or feeder fee. 6 GS 2
CCR Lie.: 42140 Electrical Lic.: 26 -755C Stlprv. Lic.: 3778S each branch circuit
B. Fee for branch circuits
Suprv. Electrician signature, required:
without or feeder fee. 46 85
first branch circuit
Print name: Greg Borosund If • Date: 10 -22-07
�
� � Y �
Each add] branch circuit 65 2
j . �!,
Authorized signature. .e../
Miscellaneous (service or feeder not included)
Print name: Barney O'Donnell Date: 10 -22-07
I 'Bwldinglpennits\ELC- PcmhimApp doe 0503,06 440.4615711 INS/COMAYI;B
,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 00396
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/22/2007
Phone: (503) 639 -4171 ,,1 i+i
Inspection Requests (24 Hrs.): (503) 639 -4175 s'!!� F__..
INSPECTION WORKSHEET FOR DATE: 12/18/2007 TIME: 7:01AM PAGE: 19
SITE ADDRESS: 16037 SW UPPER BOONES FERRY RD CLASS OF WORK:
SUBDIVISION: FANNO CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: FANNO CREEK PLACE
DESCRIPTION: Building A; install low voltage radio communicator.
OWNER: OPUS NORTHWEST LLC, PHONE #: 503 - 916 -8963
CONTRACTOR: HSI SECURITY SYSTEMS, INC 1\ PHONE #: 503. 287.4604
Inspection Request Scheduled For: Date: 12/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # .essage
135 Low voltage 061755 -01 503 -936 -1070 Y
19 q F NAL.-
Corrections /Comments /Instructions:
\
\ \N
q ,..:7\
! \
/ \
111
x PASS ❑ PARTIAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G 1 v VE5L2 Date: 1141'01 Phone #: (503) 718 - 1....40
CITY OF TIGARD
BUILDING DIVISION PERMIT #:0201 _Q 7�
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 I�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 6 0 3 7 ' CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME.
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: /6 ` y' —t9 7 Pour Time:
Code # Inspection Description onfirm # Contact # Message
/.35 SS -0I 9., - 8 136, - /07 0
Corrections /Comments/ Instructions:
❑ PASS ❑ PARTIAL APPROVAL ►I CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION I I " ONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-