Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00108
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05(17/2011
Parcel: 2S113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE 200
Project: CBRE Subdivision: PACTRUST BUSINESS CENTER Lot:
Project Description: Low voltage for access control.
Contractor: ADT SECURITY SERVICES INC Owner: PACIFIC REALTY ASSOCIATES
2815 SW 153RD DR ATTN: N PIVEN
BEAVERTON, OR 97006 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 469 -7212 PHONE: 503 - 624 -2400
FAX: 503 - 469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/17/2011 $75.00
12% State Surcharge - Electrical 05/17/2011 $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: N Other: Y 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 ordance 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 NTION: Oregon w requir y• t• follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 10 thro gh OAR 952 -0 - -Os c'. Yo m- obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332. ..4/
Issue y: � ,P Permittee Signature: k 4114 - AILAI IF _ _
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.
/le g- /i /tb2/)),'T
Electrical Permit Application ''// —TV "` µ . FO R OFFICE USE ONLY'.•
• ., ' ' City of Tigard w � j
//69 Date/By. /7 // ••, Pet No. E���!! —OpIGg
iii
- q 13125 SW Hall Blvd., Tigard, OR 97223 p�3 - 7 /
P lan Review Other Permit:
Phone: 503.639.4171 Fax 503.598.1960 Date/By:
T;I GARD Inspection Line: 503.639.4175 C7/1 Y Date Ready /By: ions. El See Page 2 for
. Internet: www.tigard -or gov Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below).
❑ New construction ;'Addition /alteration /replacement
❑ 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 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",
y � 1001-1P or more. occupancy.
U Jo no.: S �(o� - � Job site address. � �p�O �� �� / (/� ❑ Recreational vehicle parks.
3 ['Six or more residential units. P
City /State /ZIP: �1 / / S 0 4 5 / z z ❑ Health -care facilities ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.::j,TP o? Project name: G z ,e G� ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. j Total l `
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 168.54 4
Ea add'I 500 sq tl or portion 33 92 1
Tax map /parcel no.: Limited energy, residential
sq. 11.) 75.00 2
DESCRIPTION OF WORK (with above q
J Limited energy, multi-family
/4 e(. ' - S 5 CQN rx0e, residential (with above sq. if.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or Icss 100.70 2
r
I:] 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 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 Ims 59 36 I 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 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 t
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: A) A✓s branch circuit
Each add'I branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
City /State /ZIP: dwelling, service and /or feeder
Phone: (, v69- 7 a / Fax: : ( ) Reconnect only 67.84 2
Pump or inigation circle 67 84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited energy o
Business name: ,Q / l _ panel, alteration, or extension, Page
2 75 -
z u Z 5e C),e / T }� Each additional inspection over allowable in any of the above
Address: ��,• � j &) /4-3 / 3U ,D2 Additional inspection (I hr min) 66.25/ hr
,Q `C 7- ) D� n70 0 6 Investigation (I hr min) 66.25/ hr
City /State "LIP: 'f
/ Industrial plant (I hr min) 78.13/ hr
Phone: (�3 9 9 — - 69' Fax: (�3 ) , y/p9- 7// Inspections for which no tee is - 90.00/ hr
/ specifically listed ('/ hr min) --
CCB Lie.: £ '
9 7� Electrical Lic.:24 09 e'&- Suprv. Lie.: 3 y ELECTRICAL PERMIT FEES
Su rv. Electrician signature, required: Subtotal:
p g 9 /J� ! Plan review (25% of permit fee):
Print name: 4th /6e4os I Date: State surcharge (12% of permit fee): y CC
TOTAL PERMIT FEE: gL„ 00
Authorized signature:
This permit application expires if a permit is not obtained within 180
clays after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit
I: tt tuildingiPern vELC- i'errnitApp.doc 0701;10 440- 4615'r I Ii05 /COMMft3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for Al residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
I I Heating, Ventilation and Air Conditioning System* •
Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
•
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
Clock Systems
I I Data Telecommunication Installation
I Fire Alarm Installation
HVAC
Instrumentation
I I Intercom and Paging Systems
Landscape Irrigation Control*
n Medical
n Nurse Calls
Outdoor Landscape Lighting*
I I Protective Signaling
,Z Other //2/ %E� /v� 2� y S CC Ulf %y - i7
Total number of commercial systems: / //
*No licenses are required. Licenses are required
for all other installations
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