Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT
Permit d: ELR2010 00226
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD 130
Subdivision: Lot: 0
Project: State Farm
Project Description: Security system.
FEES
Owner:
G &S FC LLC Description Date Amount
16850 SW UPPER BOONES FERRY RD SUITE Restricted Energy Permit 10/26/2010 $75.00
A 12% State Surcharge - Electrical 10/26/2010 $9.00
PHONE: 503 -639 -0108
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 $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: Y Other: N
Other Desc:
This perrnit 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. ATTENTION: Oregon law requires you to follow the 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 a copy of the • - • r direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344..
By: Issued B / /fr_ - % Permittee Signature:
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.
Cali 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.
/ &4s E- r ,�4/,er/12 // &fr
Electrical Permit Application • FOR OFFICE USE ONLY
City of Tigard � 6 E 1 e e° , , Permit No.: , , • _ 0
13125 SW Hall Blvd., Tigard, OR 97223 'tan Review
1 C Phone: 503.639.4171 Fax: 503.598.196 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 T 2 c� 2p1 Date Ready /By: Ile, . 65 See Page 2 for
• Internet: www.tigard -or.gov OC 1 2 Notified/Method: I {D Supplemental Information
TYPE OF WORK C OF 116 PLAN REVIEW
❑ New construction (Addition /alteration/ . DIVISIO ISIO Please check all that apply (submit 2 sets of plans w /items clicked below):
tt.�+r� ❑ 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 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION
8. .�� —,, QQ ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3"
Job no.: o f %' , J 0 - / Job site address: /(e t9 g3 St',�/ 6 4 4 0,, e ` ., tiE's I OOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: / / 4iheo/ 97aa p� , ex y ❑ Health -care facilities. ❑ Supply voltage for more than
Y ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: / 3 , 1 Project name: ��7-e- ,e,q,en, 14j S ' , ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Dercrtpdon 1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq, ft.)
Limited energy, multi - family
,/dcee,k4 /4 y� ���� 75.00 2 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
•
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 2
Branch circuits — new, alteration, or extension, Per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
- service or feeder fee, first 56.18 2
Contact name: 7:ig,Q 1/ zr, Ai o / s j branch circuit _
Each add'I branch circuit 7.42 _ 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: (27.5:5) 9/a -- 738'0 I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy °'
Business name: if D T S E e u/7 i r y panel, alteration, or extension. Page 2 �� 2
Each additional inspection over allowable in any of the above
Address: 02 8/S _51,) / 3 Rd tog Additional inspection (1 hr min) 66.25/ hr
City/ State/ZIP: 'Be /l v tt-A 7 D. f ox 97oo 6 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
P one: C53; ) q6,9 - 76 9 9 Fax: (03) #�p 9 7//4/ Inspections for which no fee is 90.00 / hr
specifically listed ('A hr min)
C CB Lic.: . 5-q e T T E lectrical Lic.:24 Zo9eW Suprv. Lic.: LEi 3 r 9 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal:
Plan review (25% of permit fee):
Print name: K Kk•pas Date:/9 State surcharge (12% of permit fee): q 00
Authorized signature: TOTAL PERMIT FEE: R I f 0 O
This permit application expires if a permit Is not obtained within 180
days after it has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit.
I:' Building \Permas\ELC- PermitApp.doc 07 440- 4615T(11/05 /COM/WEB