Permit �, q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
C COMMUNITY DEVELOPMENT Permit #: ELR2013 00036
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2013
. Parcel: 2S112AD00700
Jurisdiction: Tigard
Site address: 14830 SW 72ND AVE
Project: Pioneer Waterproofing Subdivision: BONITA GARDENS Lot: 4
Project Description: Low voltage for security system.
Contractor: QUADRANT SECURITY INC Owner: UNION CENTRAL LIFE
PO BOX 14833 TREASURY SERVICES
PORTLAND, OR 97293 ATTN: DIANE THOMAS
PO BOX 888
CINCINNATI, OH 45240
PHONE: 503 - 234 -5558 PHONE:
FAX: 503 - 236 -2322
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/14/2013 $75.00
12% State Surcharge - Electrical 02/14/2013 $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: N
Security Alarm: Y 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. ATT ION: Ore! I law re• uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR,
952 -001- 10 through OAR 95 60 1094. . • may obtain a copy of the rules or direct questions to OUNC by callin! . " = 1987 or 1.800.332.2344.
Issue y: I i a / .41... � Permittee Signatu! % ice1a+fL!!� l
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 )Electrical kcrrnitApplicatian RECEIVE ruin. OFFICF r-_ �:
: t 5)� IA
IN City of Tigard 1 � �e�� a Permit No.: l� ' . Ol3lGY�0
13125 SW Hall ilvd., Tigard, OR 97223 - r ��
Phone: 503.639.4171 Fax; 503.598.1960 r CB 1 3 201 p, , `" Other 4 u e 0/.. —40 ass--
1 u : Inspection Line: 903.639,417,5 /� LattaReady/Ity; r B See Pirpe 114r
Internet: www.tigatd- or.gov r -CI�T ' OF TIG `' ' 1 lied/hdettted: � Supplemental toformsdoA
.. TYPE OF wt,„- UILDINGDNISION. •. „ r: izl.uN reni*w;
TYew construction 0 . Addition/alteration/replacement roam check MI Met apply (submit Z sera of
CI Demolition ❑ Other ■ �. Marlow. mid boxyarda. .
. CATEGORY OF CONSTRUCTION . . 10,000 amps et 150 vein or ■
lam to mound, or estectle tt ■ Commercial-mu apiculture'
❑ I- and 2-family dwelling '7:4 Commercial /industrial 0 Accessory building romps fir all other installations. buudinxs,
0 Multi - family ❑ Master Wilder ❑ Other:
• on 91C11'B »FORI► oN AND LOCATION ■ 1:1Additiot oleos mow road of ■
Job no.: Job site address: 1 A : 1 • ■ r ■ occupancy,
i, •.. P . .a !A. ' CI Manardatia locatirma. 000 vets aoreleal.
Suite/bldg. /apt no.: # Project name: * i , ._,l_ ► ■
it GL. ■t! ♦ i.w :r F
Cross street/directions to job site;
•
New residential Map. or roatti -family &yang unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 M. ft., or less ” 145,15 111
Tax map/parcel no.: F . & add'1900 RI. R orportlen 33.40 1
Limited energy. IP idential 75. 011 2
DESCRIPTION OF WORK vrhA above d
M 1/ /.!. Sll •�. �_ -r_ _ .. 1,.= 75.00
al • ii Services 6r fterl • t "oxtails . alteration andfor relocation
200 . s or Icss — 110.30 1E11
PROPERTY OWNER • I ❑ !rum. ' 2
r tl amps 160.60 2
Name:
601 amps ta 1,000 am 240.60 2
Address: Over ,,, mmps or volts 454,65 2
Temporary Writes or feeders installation, situation, andier
City/State/ZIP: relocstion
Phone: ( ) Fax ( ) 200 ,s or
r - . - . v . Owner installation: This installation is being made on property that 1 own which is not ' 0 to ' t amPs MI 100.30 �11
intended for sale. lapse, rent or c cltongc, according to ORS 447, 449. 670. and 701. t
Owner signature; Date: Deana cireaib - new, alteration, or extension, • - panel '
!3n A. Fee for branch circuits with
0 APILIICANT • - ❑ CONTACT ?EPSON above servile or tbeder !be, 6.55 2
Business name: each branch circuit
B. Fcc for branch circuit
mi►haur acrvleo or feeder Fee,
M Contact name: first branch circuit 461.85 2
Address: Each add't'branch circuit 6.65 _ 1E11
MI.. , laneoos (service orfeeder not iadnde
City/State/ZIP: E:ech MenuMoved or modular 90.90 2
dwellin L service sad/ot ibcdcr
Phone: ( ) Fax: : ( ) Rectum= III �
E-mail: Pump or irrigation circle
. .... C4rvxRncrOlEt 53.40 EV
silo& circuit(s) or limited- 111 1
Business name: Gl)b .,,1 r + s
An s'tS cncrgy panel. alteration, or
Address: ♦,Q, (30 fH83 extension. Describe! -7
City/State/DP: Per 1 , 0d'" ei 7.R 9.3 Each addltitmal , tenon over fillownble In a r . gibe above
inspection PCr �
Phone: r IA 'j 37 3 Fax: (5ZJ3) _. ,R1 • I I �
CCB Lie.: 9 b 80 6 Electrical Lie -: at-516 : Suprv. Lic.: r i g q L EA Tndustrial •taut per hour 73,75
Suprv. Electrician signature, required: 5 E . PERMIT NEES
. Subtotal: `�
" ..rsl ■Date; State surcharge (12% of permit fee): 1.0.e.
Authorized sign= 1IIII •
.L,L.r4« `, .00
y �' bale , • � application cayman if • permit is net /Maimed wltate a8A
eta► IL . �. 1 •. , i bete: + ; erg otter it hes berm accepted as com aka/. ` n y , /�j�
• Number of Impearioee allowed per remit.
1.1Hoitdhpt\Perm6,t s,C.PvmitArp. 023 440.461_ (I IKeiCr1MMR9
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LZMITEI) ENERGY PERMIT FEES:
: lsiuiEr;xoi[orrx.Y:
Pee for a(( residentiial systems combined ... $73.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
�] Vacuum Systems*
❑ Other.
C ? 1ttlAL a NLYc ^T .,,_ .. •
Fe forsarb commercial $75.00
system.
(SEE OAR 918.309-0000)
Check Type of Work !nerved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fite Alarm Installation
• HVAC
❑ Instrumentation
0 Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Other __ti,Liej 4 Sq s f
Total number of commercial systems; I
"No licenses are required. Licenses are requited
for all other installations
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