Permit " CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'! COMMUNITY DEVELOPMENT Permit #: ELR2011 -00105
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
Parcel: 1 S135DD05106
Jurisdiction: Tigard
Site address: 11999 SW PACIFIC HWY
Project: BANK OF AMERICA Subdivision: Lot: 0
Project Description: Low voltage for CCTV.
Contractor: ADT SECURITY SERVICES INC Owner: CCC PROPERTY MANAGEMENT LLC
2815 SW 153RD DR BY CHERI LETHIN
BEAVERTON, OR 97006 3443 SW DOSCHVIEW CT
PORTLAND, OR 97239
PHONE: 503 - 469 -7212 PHONE:
FAX: 503 - 469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/11/2011 $75.00
12% State Surcharge - Electrical 05/11/2011 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: Y 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: N 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 ac • _ _ __ .' h 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. A • NTION' Oregon - • requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 952 -00 • • I. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.2 L .1987 or 1 800.33.. . 44
Is- ued By: • /1 .4� �` A Permittee Signatur =. � ' i • .I 1 . ...10I
OWNER INSTALLATION ONL
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 FOR OFFICE USE ONLY • '
City of Tigard
Date/By: S /( / Permit No.. f/..../ ��/ �O�Q S '
111
- q 13125 SW W Hall Blvd , Tigard, OR 97223 Plan Review
Phone: 503 639.4171 Fax: 503 598.1%0 Date /By: Other Permit.
TIGARD Inspection Line: 503.639.4175 Date Ready /By. Suers: ® See Page 2 for
Internet: www.tigard or.gov Notified /Method: Supplemental Information
1� TYPE OF WORK PLAN REVIEW
❑ New construction . Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w/items checked below):
T Itq ❑ 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
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation o475 KVA or
❑ Emergency system. larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I- 3 ". "I -3
Jo 10013P or more b no.: Job site address:// ,,s-e,76/ ��ci�i� ❑ occupancy.
Six or more residential units. ❑Recreational vehicle parks
City /State /Zl P: 7 - 7 4 9 7 3 ❑ Health -care facilities. ❑ Supply voltage for more than
7 ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: & ,y4.- 01/ ty / z) n . 2/ /G ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Description I Qty, I Fee. I Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 165.54 4
Ea add'I 500 sq. fl or portion 33.92 1
Tax map /parcel no : Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. It.)
Limited energy, multi- family 75 00 2
dGi 1/.' 7 7 / /e2 cig',S / JAms, /hi-r/Jl J z)ei,:e' residential (with above sq. It.)
. / Services or feeders installation, alteration, and /or relocation
■PCP /i9 C' el Si4 enm S 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 i
Address: Ovei 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps of le 59.36 I .
201 amps to 400 amps 125.08 2 r
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 16854 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
El APPLICANT ONTACI' PERSON above service or feeder i'ee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits wu /holu
service or feeder lee, first 56 18 2
Contact name: A) AS,77A-9 branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP Each manufactured of modular 67 84 2
dwelling, service and /or feeder
Reconnect only 67.84 2
Phone' (,..,q3 '70 y- 70 / Fax: ( ) Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy 7 7.S
Business name: /J ll panel, alteration, or extension. Page _
/7 U / Jlh�(� (J,e/ ry Each additional inspection over allowable in any of the above
Address: c „?, ?/,s- ,$ ( /53 3a �2 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: C/5' /e /z roil) Q� 9700 Investigation (I hr min) 66 25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (�3) , 9, Gf - 7 69 y Fax: (55,3 ) yep 9- 7// Inspections for which no fee is 90 00/ hr
specifically listed ('' hr min)
CCB Lie.: �9 9 4//,/ Electrical Lie.:2t • 09 e!e-- Suprv. Lic . 2,f y'ze- ELECTRICAL PERMIT FEES
Subtotal.
Suprv. Electrician signature, required: e
7 � ��
Kc ,� � Plan review ( 5 /o of permit fee).
P rint name: I Date: State surcharge (12% of penult fee): y C 0
�rz��s
TOTAL PERMIT FEE. g/, 00
Authorized Signature. This permit application expires if a permit is not obtained within 180
days after ii has been accepted as complete.
Print name: Dale: ` Numbei of inspections allowed per permit
I\Buildmg,Perimrs'ELC- PennApp dos O7,Oi. IS 410 - 4515.1 I I,O5 :COt'WFB
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*
II Burglar Alarm
I I Garage Door Opener*
Ti Heating, Ventilation and Air Conditioning System*
Vacuum Systems*
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
'Check Type of Work Involved:
fl Audio and Stereo Systems
Boiler Controls
' I Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
I I HVAC
I I Instrumentation
Intercom and Paging Systems
•
I I Landscape Irrigation Control*
I 1 Medical
Nurse Calls
Outdoor Landscape Lighting*
Protective Signaling
.1Z Other /g2/ 71 - 2, C/ y SeGa/et �ys7
Total number of commercial systems: /
*No licenses are required. Licenses are required
for all other installations
1.\B ldm \Pc.ts \ELc- Permii.App.dec 07/01/10