Permit i.s.7'� qr q�z�,
2 :g . CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00090
',1r I GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/20/2010
Parcel: 1 S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY Y
Subdivision: Lot: 0
Project: Ace Cash
Project Description: Low voltage for protective signaling.
FEES
Owner:
PACIFIC CROSSROADS PROPERTIES, I Description Date Amount
BY WYSE INVESTMENT SERVICES CO, 1501 Restricted Energy Permit 05/20/2010 $67.84
SW TAYLOR ST STE #100 12% State Surcharge - Electrical 05/20/2010 $8.14
PHONE:
Contractor:
ADT SECURITY SERVICES INC
2815 SW 153RD DR
BEAVERTON, OR 97006
PHONE: 503 - 469 -7212
FAX: 503 - 469 -7114
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 $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: Y
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and at other applicable law. All work will
be done in ac • • . • - 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: Oreg• law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -• • 10 through OAR 9 •01 -• 100. ou may obtain a copy of the rules or direct questions to OUNC by cal • .2.6.6699 or 1.800.332 2344. •
t i i
Issue. y: • 1 /IL�4 1—. Permittee S t -' " (
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 [N TALLATION ONLY
SIGNATURE OF SUPR. ELEC' ( y �� 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.
J /eAve -- -:m-4( P6- it c'o,o y 4 r � a
Electric, i'R11t Application 7 .50 — ` � vF OR O F � F t ICE"l`15E tiO N LI ' r` _:
n.• A _"dp 04 illar'1Fr' .w yct�.l 1.- d tat iikit,
F V City of Tigard lv� 7 //y Deceiv S IS /0 Permit No.: C /Z /0 /e ---C.)00 p�
d. <p C� 4
- - '{ ° 1 3125 SW Hall Blvd., " ligard, OR 97223 Plan Review
F f ; Phune. S03.639.417 1 Fax. 503 5 ) Date/}3y: Other Pernul
0 ) ' ' " L i n e : Inspection t c � Date Reads By ur E] See Page 2 for
LGARD Internet: tvw wdigard- or.go Q NoafiedNethock / / . Supplemental Information
TYPE OF 1i 'o AAAAnn iY 18 Zu1O PLAN REVIEW
Ip�/
e I Please check all that apply (submit 2 sets of plans w. items checked below):
111 New construction ®t \ddthon /el[Cr IV 0 iRD ❑ Service or feeder 400 or more ❑ Buddin over three stones.
❑ Demolition ❑ Other: f 1 where the available fault current ❑ Mannao and boatyards.
CATEGORY of c 1 I 1 � . c 'ISION exceeds 10.000 amps al 15(1 volts er ❑ Floating buildings.
less to ground, or exceeds 14.0(1(1 ❑ Ccnnunercial -ua0 agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps litr all other installations. buildings.
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 Ev:A or
❑ Emergency system. larger separately derived system,
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of
❑ ": "IS" "I- " "I 3"
X i v occu
� _� //7& � l A IOOFf occupancy.
1
Job no.; Job site address: (
❑ Six or more residential units. ❑ Recreational ve parks.
Clly/ State /LIP: \jt �azi, gV6P ❑ Health -care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 molts nominal.
Suite /bldg. /apt. no.: [ Project name: wC ❑ Service or feeder 600 amps or more.
.. FEE SCIFEDULE i
Cross street /directions to job site :si /v^7e L S�iS_ N (lJN� n'0 241 Vescripaon I QV. I Fee. [ — marl I_i
/_ � // L QQ ,�� New residential single- or multi - family dwelling unit.
5i1e r ,ff Lime, C'e—SA T rS /1/7/71 /efto'/o Includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl. or less 165.54 4
Ea. add'I 500 sq. 0. or portion 33.92 I
Tax map /parcel no.: ___
Limited energy, residential
(with above sq. 11..) 84
DESCRIPTION OF WORK
Limited energy. multi - Family I 1
l : 7 Dcni2S ,2 SAFE 7/7 7ibws S" ,e/X - -- (, i..1
residential (with above sq. Il)
�., Services or feeders installation, alteration, and /or relocat
I I _
1Ce t-Urt J e , t Co t∎ /t L I. 002 200 amps or less 1 1 0(1.70 2
❑ I'ROI'ER'1 Y OWNER I ❑ TENANT 201 amps to 400 amps j 133.56 1 2 .
401 amps to 600 •imps 200.3 4 --
Name: —
601 amps to 1,000 amps 301.0 .1 _
Address: Over 1,00(1 amps or volts 552.26 _'
"temporary services or feeders installation, alteration, and /or
City State /Z11 relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I I
2 01 amps to 400 amps 123.08
Owner installation: 1 his installation IS being made 00 property that I own which is not --
1(11 amps 10 59) amps 165.5 4 2
intended for sale, lease, rent, 00 etchaite.e. according to ORS 447, 44 670, and 701.
-
Branch circuits — new, alteration, or extension2te anel
Owner 9glifiture: Dale: A. Fee lilt branch Circuit: wrth - -i
above service or feeder Ice.
❑ APPLICANT CONTACT PERSON
each branch circuit
Business name:
B. Fee for branch circuits nvirhunr
n service or feeder fee, lies( 6. S
Contact naive: C� ae branch circuit _ -- _ _ --
E aclt add'1 hranch circuit 1 7.=12 2
. Address Miscellaneous (service or feeder not included)
Each manufactured or modular 67.1 -1
Cats /State /ZIP:
d n' ling, scn'ice and /or Feeder
Reconnect only 67.1 -1 . Phone :03) 49_6,_/0 /U !MN: . ( )
-
I'ump or rneauon circle � _ —• n74S -1 ,
E - mail:
Sign or 0011100 sighting 61.3 - 1
CONTRACTOR Signal circuits) or limited energy
Business name: :1U h SECURITY panel. alteration, OrCXICIISIOn. Page 2
`i7 -S_1 1 .,
Each additional inspection over :111015 ble in any of the abuse
Address: 2815 SW 153 1)12 Additional inspection ( I lir min) 1 1 a .25 -' hr
Investigation (I hr min) 1 (ir. hr
City/State/ZIP, BEAVERTON OR 97006
- _ Industrial plant (1 hr min) S. 8' hr
tla Phone: (503) 9(19 -7699 Fax 469 -71 14 Inspections for which no lee is
(- ) " hr
specifically listed 10 hr min) _
CCI3 Lic.: 59944 Electrical Lie.. 26209CLE Suprv. Lie.: I389 Lt» ELECTRICAL I'ER :MIT FEES
Subtotal: 67.64
Su yrv. Electrician signatue. required:
I Plan review (25 °s rof permit fee•):
Print name: KIN KRAUS Date State surcharge (12 0810 n lit fee). 5.14
TO "I'AL PERMIT FEE: 75.
A uthorized sI 5nature:
� � �� This permit application expires if a permit is not obtained within 1811
day's after it has been accepted as complete.
Print name: Date a /(/ ' N un nber ofinspections allowed 111(111 esi 1'°' p0110))
1:, Huilding :I'cnnitslllC- 501,11.App.doc 100 I:09 a 10 161z'I - (1 IrOSCUPI' 10TH
'.41# Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
I Audio and Stereo Systems*
1 Burglar Alarm
I Garage Door Opener*
1 (
Heating, Ventilation and :Air Conditioning System*
I Vacuum Systems*
I Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
ISL:L OAR 918-309-0000) •
Check Type of Work Involved:
Audio and St Systems
Boiler Controls
Clock Systems
Data Telecommunication nication installation
Dire .Alarm Installation
HVAC
1 Instrumentation
1 1 Intercom and Paging Systems
1 Landscape Irrigation Control*
I 1
Medical
Nurse Calls
1 Outdoor Landscape Lighting* •
Protective Signaling
Other
'Dotal number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
I..13uddingTt:rmiis'[LC- Perin itApp.doc IU- UI!n9