Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11, COMMUNITY DEVELOPMENT Permit #: ELR2010 -00281
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2010
Parcel: 2S112AB01300
Jurisdiction: Tigard
Site address: 7333 SW BONITA RD
Project: Bonita Pioneer Packaging Subdivision: Lot: 0
Project Description: Security System.
Contractor: ADT SECURITY SERVICES INC Owner: BONITA PACKAGING PRODUCTS
2815 SW 153RD DR 7333 SW BONITA RD
BEAVERTON, OR 97006 PORTLAND, OR 97223
PHONE: 503 - 469 -7212 PHONE:
FAX: 503 - 469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/17/2010 $75.00
12% State Surcharge - Electrical 12/17/2010 $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. 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by callin• 03.. 2.1987 or 800.332.2344.
` �.. •.4 c / / -- -,
Issued _ _ Permittee Signature: '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 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 Permit Application y/exse FOR OFFICE II SE ONLY .
� j � / T Received _
City of Tigard r" Date/13y: 1t).. I /AC), Permit No ,� p 1 11 �` '
14 • 13125 SW W Hall Blvd., Tigard, OR 97223 L .O Plan Revie N`�' l
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
TIGARD Inspection Line: 503.639.4175 5 _ ,- /y Date t . w By: Juris: rd See Page 2 for
Internet: www.ttgard- or.gov - o i O hod: - "r l.tl Supplemental Information
TYPE OF WORK ,,t x 11'1111 ( � PLAN REVIEW
❑ New construction ❑�d"dition /alteration /replacement 1"� V u\" Please check all that apply (submit 2 sets of plans w /iterns checked below):
04 n- ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑Other: G C where the available fault current I=1 Marinas and boatyards.
CATEGORY OF CONSTRUCTION A etV A 1V `alo � exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
[1] 1 - and 2- family dwelling [s� ,Commercial /industrial 111 Acce m amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Othc ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E "I -2 "I -3
' Job no.: 7 Job site address: -73-.s-3 , 1
100HP or more. occupancy.
o�a' 7 mil` e ( A , \ J 1 ['Six or more residential units. ❑ Recreational vehicle parks.
CI /State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
ry �! l R,Qp� ' 7 0 2 � �/ ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name16, .. �.� • � /,„� -� � q ❑ Service or feeder 600 amps or more.
Fr' / FEE SCHEDULE
Cross street/directions to job site: Description ( Qty. I Fee. J Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. It. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above stilt)
Limited energy, multi family
residential (with above sq. ft.) 75.00 2
,eP /�C �! r�ON0L a� U,a z/9 be" Sys T� /Y, Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ 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 I ,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) F ax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 16854
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
C] APPLICANT El CONTACT PERSON above service or feeder fee, 7.42
each branch circuit
Business name: B. Fe e for branch circuit witho
service or feeder fee, first
Contact name: %0 17? ,5-h1/9-0.) Each circuit 56.18 2
Each add't branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 y dwelling, service and /or feeder
Phone: ( ) 6 k � . s -r-, 7 , 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 7 75-6 panel, alteration, or extension. f Page
Business name: /9 b -7- Se-C el ie / Ty Each additional inspection over allowable in any of the above
Address: .,„2,?/S- SW 4 5-3 3U � 2 Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State /ZIP: / 6& - j t /6 — /2 7 (94. 97,00 6
Industrial plant (I hr min) 78.18/ hr
Phone: ( 9,9- 7 6y.S Fax: (5 ,3 ) i/6 9- 771 Inspections for which no fee is 90.00/ hr
specifically listed (' /z hr min)
CCB Lic.: ,6 9 7V Electrical Lic.:6 • 09 e(- Suprv. Lic.: 3 �.. ELECTRICAL PERMIT FEES 1
Suprv. Electrician signature, required: .� Subtotal: r?9 ,
"'A Plan review (25 °A of permit fee):
Print name: KC K;e4vS Date:A/ / / /// �G /o State surcharge (12% of permit fee): 9 v
TOTAL PERMIT FEE: nature: �y O '
Authorized signature: T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
I:` BuildinglPermits , ELC- PermitApp.doc 07'01!10 440 - 16151(11/05 /COM"W[iB r
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*
n Burglar Alarm
n Garage Door Opener*
Heating, Ventilation and Air Conditioning System*
1 I Vacuum Systems*
1 I Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
I Audio and Stereo Systems
I 1 Boiler Controls
Clock Systems
Data Telecommunication Installation
s I I
Fire Alarm Installation
•
I-1VAC
Instrumentation 1
Intercom and Paging Systems
Landscape Irrigation Control*
Medical
I Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling-
i M/ i E2 CNC- wi y SSG ate. Ty
Other
Total number of commercial systems: /
*No licenses are required. Licenses are required �.
for all other installations
I: \Building \Permits \F LC- Permit App,doc 07i0IiI0