Permit C ITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
DEVELOPMENT SERVICES PERMIT #: ELR2006 -00230
I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/25/2006
PARCEL: 2S1 12 DC - 01400
SITE ADDRESS: 15865 SW 74TH AVE 105 ZONING: I -P
SUBDIVISION: CREEKVIEW INDUSTRIAL PARK LOT: 004 JURISDICTION: TIG
Project Description: Install cellular backup system for alarm system.
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: ALARM X
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
JDS, LLC & SANTA FE CORP SELECTRON INC
17700 SW UPPER BOONES FERRY RD 7225 SW BONITA RD
PORTLAND, OR 97224 TIGARD, OR 97224
Phone: Contact #: PRI 503- 639 -9988
FAX 503- 684 -4357
FEES Reg #: ELE 26- 497CLE
LIC 64341
Description Date Amount SUP 974LEA
[ELPRMT] ELR Permit 9/25/2006 $75.00
[TAX] 8% State Surcha 9/25/2006 $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 direct questions to OUNC at 503 - 246 -6699.
Issued By: 4 „a„ � t.v t J Permittee Signature: O)'�
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.
• • a1 Permit A liC f OII t6 FOR OFFICE USE ONLY
Electrical PP � , _.
Citl't�' of Tigard S Received •
SEP `� Date/By: Mao 66 Permit N. _ 006.... 4 00A30
13125 SW Hall Blvd., Tigard, OR 97223 4 : 11 i I Plan R eview
Phone: 503.639.4171 Fax: 503.598.1960 C ITY OF Date/Bv:
• Other Permit:
�I
inspection Line: 503.639.4175 B G i •ef • Date Ready /By: iari See Page 2 for
Internet: www.ci.tigard.or.us LDIIUG DI ,• O p _ Notifted^.1lethod: Supplemental Information
• TYPE OF WORK . ' PLAN REVIEW
•
❑ New construction • 14 Addition/alteration /replacement Please check all that apply: i
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ['Hazardous location
EService over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ I - and 2 family dwelling g Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure I
❑ Multi ❑ Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SiTE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: S3s 1I Job site address: l os SW `7/-0 R 4-1(� ❑ Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: r x 4 c 1 (3 e g72)►./ The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite /bldg. /apt. no.: Project name: l '
A1yQ D escripti on I Qty. I Fee. I Total i ••
Cross street/directions to job site: J New residential single - or multi - family dwelling unit.
includes attached garage.
1 ,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft or portion 33.40 _ 1 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
• DESCRIPTION OF WORK Each manufactured or modular
- �. —1 dwelling, service and/or feeder 90.90 2
■ rsta11 _' Ala✓ �Zcka to �V1TU• —M _ `TW alafi ��ISIC* l Services or feeders installation, alteration, and/or relocation
T — � 200 amps or less _ 80.30 2
• ❑ PROPERTY OWNER F ❑. 201 amps to 400 amps 106.85 3
TENAN �
401 amps to 600 amps 160.60
Name: 601 amps to 1,000 amps 240.60 2 • I Address: - Over 1,000 amps or volts I 454.65 2 •
-- Reconnect only 66.85 2
City /State /ZIP: • Temporary services or feeders installation, alteration, and /or
•
Phone: ( ) r Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that i own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
•
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each . 6.65 2
Business name: branch circuit
. B. Fee for branch circuits
Contact name: without service or feeder fee,
. each branch circuit 46.85 2
Address: Each add'l branch circuit 1 1 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
• CONTRACTOR . . energy panel, alteration, or
extension. Describe: ( Page 2 - 2
Business name:
S e. _ ... t \ -c ' OD
Address: -- 7"z2 j S 1 \,, • Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: '7) Of / 0R qrr,)J -1 , f Investigation per hour (i hr min) 62.50
Phone: c'5153 )1 _ (�(,� Fax: (`JU3 )- '� t��-{'-1 -15-7 ustr
indial plant per hour -... 73.75 :• . , ..
.. . ELECTRICAL. PERMIT FEES*
CCB Lic.: LA -5)...1 1 Electrical Li 2L_: a -:: Suprv. Lie.: q7/4 LE Subtotal ,tom • •
Suprv. Electrician signature, requ -- / �c '{ / Pla review (25% of permit fee) . '
7. Print n 3 " / Date: 4 i � of State surcharge (8% of permit fee) l ,GO -
FT TOTAL PERMIT FEE % ` Qp :
Authorized signature: This permit application expires if a permit is not obtained within 180
I days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is \Bui !ding \Permits \E LC-Permit App .doc 12103 O -340 -46 (10 /02 /C0�1/WEQ a i
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