Permit IN X CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
8 COMMUNITY DEVELOPMENT Permit #: ELR2011 00076
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2011
Parcel: 2S112AA00600
Jurisdiction: Tigard
Site address: 6713 SW BONITA RD 270
Project: ServPro Subdivision: NELSON BUSINESS CENTER Lot: 0
Project Description: Security system.
Contractor: ADT SECURITY SERVICES INC Owner: WALTON CWOR NELSON 13 LLC
2815 SW 153RD DR BY TTA/EPROPERTYTAX DEPT 735
BEAVERTON, OR 97006 PO BOX 4900
SCOTTSDALE, AZ 85261
PHONE: 503 -469 -7212 PHONE:
FAX: 503 - 469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/29/2011 $75.00
12% State Surcharge - Electrical 03/29/2011 $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 1
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 ru • the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You mays' rue • • - - - lions to OUNC by calling 503.232.1987 or 1.:00r32.2344.
Issued By / _� Permittee Signature: _ I :lI L i/ '1 -
-AP 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.
Elec/9/i9-S- 7 20,X f trical Permit Application FOR OFFICE USE ONLY
City of Tigard Dat /B cj aiT/1�1• Permit No - c
- — i..
• 13125 SW W Hall Blvd., Tigard OR 97223 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 ate/By:
Inspection Line: 503.639.4175 / to Ready /By: El See Page 2 for
TIGARD
Internet: www.tigard- or.gov � 3 (l/�" N tified Method: Supplemental Information
TYPE OF WORK + -
a, '� PLAN REVIEW
- ❑ New Construction Addition/alteration/1N ent %\\ Please check all that apply (submit 2 sets of plans w /items checked below):
�� r ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other: ` t� p� V where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2 - family dwelling "ommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder Q Other: ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
of n
❑ Addition of new w motor load of ❑ "A ", "E ", " I -2 ", "1 -3 ",
Job no.: /i /� Job site address: ? ! A �,/ IDO or more. occupancy.
�T S7� �� 7/ J J �N /T�r f"r/" ❑Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: TI 4 44/ 04 9 'Z 2 a ❑ Health - care facilities. ❑ Supply voltage for more than
7 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 0 7 , 70 Project name: StCte'iP,O ❑ Service or feeder 600 amps or more.
q. FEE SCHEDULE
Cross street/directions to job site: ,.5 / in 0 P
,/ L Description I Qty. I Fee. I Total I
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: -
Limited energy, residential
DESCRIPTION OF WORK (with above sq. fl.) 75.00 2
Limited energy, multi- family 75.00 2
/40/x/1 EX % .SAE b To F44 /sA f . ysTen2 residential (with above sq. fl.)
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
a
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation a
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
le
201 amps to 400 amps 125.08 _ 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: _ Date: A. Fee for branch circuits with
❑ APPLICANT 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: M9 27 L , vje/e/YJ /' /v branch circuit
/ Each add'1 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:
(573 ) )( ei „5-7,29 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: SE ry panel, alteration, or extension. Page 2 a 2
C ei - Each additional inspection over allowable in any of the above
Address: ?/� SW /53 " , 2 Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: ,g�jg Y 67 7ZjA) €9,e. 970 t5 Investigation (I hr min) 66.25 / hr
Industrial plant (I hr min) 78.18/ hr
Phone: (5P3) 94,9— 7699 Fax: (5,3 ) -//69- 7 � / Inspections for which no fee is 90.00/ hr
'/ specifically listed ('A hr min)
CCB Lic.: . 9 7y Electrical Lic.:Z4 • 0 9 c« Suprv. Lie.: 3d5-zs/3 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal:
/A Plan review (25% of permit fee):
Print name: 4% /' ,24, Date: 44// State surcharge (12% of permit fee): q 0 TOTAL PERMIT FEE: $L�. 06
Authorized signature: ;
This 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. Buildineermits'ELC- PermitApp doc 07 440.4615T(I 1i05!COMrWEB
I
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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
D Audio and Stereo Systems
Boiler Controls
• n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
• Landscape Irrigation Control*
n Medical
Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
.i Other L /7/2' re d7Al6 /1 -SLG 0 /z/ 7Y -5 ys% -7
Total number of commercial systems: / r
*No licenses are required. Licenses are required
for all other installations
I: 1Building Permits`ELC- PermitApp.doc 07 10