Permit " CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
`7' =' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00184
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/03/2011
Parcel: 2S 112 BA05900
Jurisdiction: Tigard
Site address: 14058 SW MILTON CT
Project: Transcat Subdivision: Lot:
Project Description: Low voltage: reconnect (3) smoke detectors.
Contractor: ADT SECURITY SERVICES INC Owner: GOODHEAD, DAVID D & JAN M
2815 SW 153RD DR 9846 SW PEPPERTREE LN
BEAVERTON, OR 97006 TIGARD, OR 97224
PHONE: 503 - 469 -7212 PHONE:
FAX: 503 - 469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/03/2011 $75.00
12% State Surcharge - Electrical 08/03/2011 $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
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 a ••rdance wi proved 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 , TION: Oregon la requir- 0. to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 0 throu•h OAR 952-001-0,1•0. Yo m -y obtain a co. of the rules or direct questions to OUNC by calling 503.2321 or 1.800.332.2344.
/ /
Issued = : Permittee Signature: X L
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.
e / //se ?fil/ ea'y Tb .
Electrical Permit Application FoR OFFICE USE ONLY
C of Tigard Date / Received (Ot 1/ , / Permit No.. X.N40 -0e/
• 13125 SW Hall Blvd., Ti Bard, OR 97223 y
g 7// Plan Review Other Permit
Phone: 503 639 4171 Fax: 503.598. I960 y Date /By:
TIGARD Inspection Line: 503.639 4175 Date Ready /By: Doris. ® See Page 2 for
Internet www.ttgard or.gov Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ,Addition /alteration /replacement Please check all that apply (submit 2 sets of plans whte its checked below)
❑ 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 I50 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: 0 Fire pump ❑ Installation of75 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 ",
83/ Q �„ ^ , I OO or more. occupancy.
b no: Job site address /� �/ Jo. //•� ,� 2 y � / � (i / or / /�
SLC/ y/ // G �6/ ❑ Six or more residential units. ❑ Recreational vehicle parks
Ci ' ❑ Health-care facilities. ❑ Supply voltage for more than
ry /State /ZIP: —7 / / � !� 97aa y ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no,: Project name: 77/9 A/S e, /— yyr ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street /directions to job site: Description 1 Qty. I Fee. I Total I
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. ft. or ponion 33.92 I,
Tax map /parcel no.• Limited eneigy, residential
ti.) 75 00 2 '
h above s
DESCRIPTION OF WORK (with sq.
Limited eneigy, multi- family 75 00 2
4=0/1/4)6.-di \� s / C / /i - e- 7TC � residential (with above sq. ft.)
� 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
r
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
200 amps or less 59.36 1
Phone: ( ) Fat: ( 1 p
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.
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 2 2
(VVI each branch circuit 7 ' 4 `
Business name: B. Fee for branch circuits without
service or feeder fee, first 56 18
Contact name' 6e./2 / e /..cs ,f7 branch circuit
J Cc /� Each add'l 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: ( ) Sge J2700 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 U 7.� to
l panel, alteration, or extension. Page 2 2
Business name: y9 / 5 ,e /Ty
G �l Each additional inspection over allowable in any of the above
Address: ,72,?/.,72,?/...c / ,S a) /6-3 3 a ,)2 Additional inspection (I hr min) 66 25/ hr
N � /! / ie �A) (9/e. 7()I!, Investigation (I hr min) 66.25/ hr
City /State / "LIP: �!
/ Industrial plant (I hr min) 78 18/ hr
Phone: (52)? ) 9, 9- 7 Fax: (, 3 ) -9'69- 7// Inspections br which no lee is 9000 /hr
specifically listed ('L hr min)
CCB Lie.: ,6 9 5/,' Electrical Lie 'Z6 • 0g eel- Suprv. Lie.: 3 y' / 9 ELECTRICAL PERMIT FEES I
Subtotal.
Suprv. Electrician signature, required
/A Plan review (25% of permit fee):
Print name: 4/t..._4) ! l ;e4 I Date: Y////' State surcharge (12% of permit fee): , C C 1
TOTAL PERMIT FEE: ,9:. CO
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 o inspections allowed per permit.
I: Building ,Permns -i'cn mit.App.doc OLOIr10 440- 46 15i'(11,051COPV WEti
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*
Burglar Alarm
Garage Door Opener*
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:
Audio and Stereo Systems
Boiler Controls
Clock Systems
Data Telecommunicanon Installation
Fire Alarm Installation
HVAC
PI Instrumentation
1 Intercom and Paging Systems
I I Landscape Irrigation Control*
Medical •
I I Nurse Calls
I Outdoor Landscape Lighting*
Protective Signaling
Other / /?2 . 71-2, -SC UPI, % / yS% g/V
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Building \Permits \ELC- PennnApp.doc 07/01/10