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Permit (103) N (A CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY 4 DEVELOPMENT SERVICES PERMIT #: ELR2005 -00005 ^` ' =-- 13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/5/2005 SITE ADDRESS: 16200 SW PACIFIC HWY D PARCEL: 2S115AB -01900 SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G BLOCK: LOT: JURISDICTION: TIG Project Description: Installation of limited energy for security 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: SECURITY. X TOTAL # OF SYSTEMS: 1 Owner: Contractor: BIT HOLDINGS LTD PARTNERSHIP VISION SECURITY SERVICE BY FORUM PROPERTIES INC 10874 SW ROLAND CT FIVE CENTERPOINTE DR STE 290 WILSONVILLE, OR 97070 LAKE OSWEGO, OR 97035 Phone: Phone: 503 682 - 6713 Reg #: LIC 152497 ELE 3- 544CLE FEES Required Inspections Description Date Amount Low Voltage Inspection • [ELPRMT] ELRPernmit 1/5/2005 $75.00 Elea! Final [TAX] 8% State Surcharl 1/5/2005 $6.00 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 -0 $1 -0010 thro • OAR 9 ' 001 -0100. You may obtain copies of these rules or direct questions to c I C at (51.1 1 : 4 0.99. / Iss d b 1 _ �� ' Permittee Si nature )/' / . 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day Electrical Permit Application FOR o i i i i i um.) .). City of Tigard Received. ! � D nem Perm No.: E I , D %,-f_,' 13125 SW Hall Blvd., Tigard, OR 97223 plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/B . Other Permit: r.. Inspection Line: 503.639.4175 _fir, 'J' J„ Date Ready/By. WRII HI See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction An:Addition/alteration/replacement Please check all that apply: ❑ Demolition ❑Other ❑Service over 225 amps, comm'l ['Hazardous location 0 Service over 320 amps — rating ❑Buildngover 10,000 sq. R, CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential ❑ 1 - and 2 family dwelling ,ommercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑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 ti Wy RV park ���,,� �^ (� ❑Egress/lightingnlan Job no.: 'Job site address: � SW e.. ❑Health -care fac ❑Other: Submit 2 sets of plans with any of the above. City/ State/ZIP: T , ) Oa • 1 a a.L.1 The above are not applicable to temporary construction service. Suite/bldg. /apt no.: ✓ Project name: (,, Klr, FEE* SCHEDULE Description I Qty. I Fee. I Total I Cross street/directions to job site: 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 Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 1 75.00 2 DESCRIPTION OF WORK Each manufactured or modular Z a l , dwelling, service and/or feeder 90.90 2 � " \ tV Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 ❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) Fax: ( ) 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 I ❑ CONTACT PERSON A. Fee for branch circuits with V ` S O ( -� �� n ernice or feeder fee, each 6.65 2 Business name: J -Iw "'ca branch circuit /�, -,1 rIN z ` , ^ c B. w ee ith o ur ut service circuits or feeder Contact name: f'- �iVJI�T� t.1� w ee sevic feeder fee, 46.85 2 Address: ' O t1" f SA) e-©c t. c Or Each branch branch it Address: Each add'I bach circuit 6.65 2 City/ State/ZIP: tX))15 y) ') 4°00)0 Miscellaneous (service or feeder not included) Phone: ( J � ' Q 3 1 . � 7 r 3 I Fax:: ( ) y, �$ D. 1 133 imp 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 V ` t . Is mac ' pA l2 ` 1 extension. Describe: Page 2 2 Business name: t �`��6 � S6 /`'� Address: Each additional inspection over allowable in any of the above Per inspection 62.50 City/ State/ZIP: Investigation per hour (I hr min) 62.50 Phone: ( ) I Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* CCB Lic.: ' yC1r) I Electrical Lic.: • (6 , Suprv. LIC.:39gq LeA Subtotal i6", DO Suprv. Electrician signature, required: 6.2 Plan review (25 %ofpermit fee) Print name: �Q 35 - Upo, 0�Pa Date: 1151,9 State surcharge (8% of permit fee) (Q . �� TOTAL PERMIT FEE g / i c90 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: I DateI • °E12 • Fee methodology set by Tri -County Building Industry Service Board �`7 _ `� ( ` (- .7'.� /4,//- � �j - t Number of inspections per permit all owed IABuildina tPernits\ELCC- PamitApp.doc 12/03 v v 7 4104615T(IO02/COM/WFB / 5 oZ L ig 7 6l ►a-Iolo Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined........ $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* r ' ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* El Other: COMMERCIAL WORK ONLY: - . Fee for each commercial system. $75.00 (SEE OAR 918 260 - 260) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems El Data Telecommunication Installation El Fire Alarm Installation • El HVAC • El Instrumentation - El Intercom and Paging Systems El Landscape Irrigation Control* El Medical El Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other Total number of commercial systems: " *No licenses are required. Licenses are required for all other installations i:\ Building \Penniu\P1.C- PennitApp.doc 04/03