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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ". ' COMMUNITY DEVELOPMENT Permit #: ELR2012 00003 �'f(,} R.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2012 Parcel: 1 S 126CA00700 Jurisdiction: Tigard Site address: 9350 SW WASHINGTON SQUARE RD Project: JC Penny Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108 Project Description: Security system upgrade. Contractor: ADT SECURITY SERVICES INC Owner: PPR WASHINGTON SQUARE, LLC 2815 SW 153RD DR BY J C PENNEY 0288 -1 BEAVERTON, OR 97006 TAX SERVICES PO BOX 10001 DALLAS, TX 75301 PHONE: 503 - 469 -7212 PHONE: FAX: 503 - 469 -7114 FEES Description Date Amount Specifics: Restricted Energy Permit 01/05/2012 $75.00 • 12% State Surcharge - Electrical 01 /05/2012 $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 calling 503.232.1987 or 1.800.332.2344. Issued By: ' . — _—/- . Permittee Signature: !I / s� i -/• 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. Jan 05 12 10:34a ADT Security \ 503 - 469 -7114 p.1 Application Electrical Permit h � FOR OFFICE USE ONLY , � City of Tigard ` Keceived I Per mit tip.: ��� � p� �y�,�� A\ latc'Bv: I ©- / Pr�/-^ -0 6z 'I.Ctw3 1 s 125 S W Hall Blvd , Tigard, OR 97223 .v 0 1 0 evlew Phone: 503.639.4171 Fax: 503,598.1%0 ,� . Y: Other Permit: TIGARD w• Inspe Lion Line 503.639.4175 G\ �pN G o �� u to Ready/By: surer: 121 See Page 2 for Internet: .vw tigard -oegov Noti:edtMethod: Supplemental Information TYPE OF WORK tR PLAN REVIEW Please check all that apply (submit 3 se's of plans w. items checked below): E New construction " A :onraIteratiomreplacement ❑ Service or feeder 400 amps or more ❑ Bidding over :Om stories. ❑ Demolition ❑ Other: where the ava1able fault current ❑ Stannas and boatyards. CATEGORY OF CONSTRUCTION cr✓xds IOM l amps sl I SO volts or ❑ Floating build.nyR loss no ground, crewcut; 14,000 0 Comm _ reial -use agricultaml El 1- acd 2- family dwelling mrncrcial %industrial ❑ Accessory building amps forellothcr(nsi bLildings. ❑ M did ❑ Mzsler builder ❑ Other: ❑ Fire pump. ❑ Ins'.allation of 75 KVA or ❑ C JOB SITE INFORMATION AND LOCATION n :rgencyscalem. arger separately derived .system CCam�,,_ ❑ Addition ef new motorIoedof ❑ " "( ""I- 2 " "l - d' no.: /4V - 3 Job sitcaddress: 93 Ct .5 wf}SAi /45 jaN 1D IOOHPormorc. occupancy SIx ormore residential un ts. ❑ Recreational vehicle parks_. CityiStaleiZlP: �`4',4e./ L 6 97 3 ❑Health- canfa't n s . ❑ Supply voltage for more that ❑ Hazardous locations. 600 volts nominal. Suiterbldg.: apt. no.: Project name: C 12 / ❑ Service or feeder 600 amps or more. Cross slree /directions to job site. FEE SCHEDULE Dasc rintian Qcc. ■i "Total New residential single -or multi- family dwelling unit. Includes attached garage. ' Subdivision: "Lot no.: 1,000 sc. ii. or less i 158.54 14 Tax maprparccl no.: Oa. add'I 500 sc. R. or norton I 33.92 I Limned energy, residential ,S.OU DESCRIPTION OF WORK {mi th above sy.It.) I ' Limitcd enci 'y, multi- ldm •'v 75.00 '/ J r � �� f residential (wilt cbeve sq. It ) Y %I 7 Or — I Services or feeders installation, alteration. and/or relocation 200 amps or less 1 C0.7LI 2 ❑ PROPERTY OWNER ❑ TENANT L 201 crops to 40C- amps ( 33.35 2 dt1I amps to 61)C amps 2(10.34 2 1 Name: _ — , - .. ---_ -- ._._ 601 amps to 1,005 amps .3.0 1.104 2 , Address: (het' i_ it)o amps or volts 552.26 I Temporary services or feeders installation, alteration, and/or City/ State%ZIP: relocation Phone: ( ) Fax: ( ) 260 a ms or less 59 36 I 2 h 1 a:rips In 400 ants 125.08 . 2 Owner installation: This instailation is being made on property that I own which is not 7 40 l amps to 59S a lot.54 intended for sole. lease, rent. or exchange, aecordinp to ORS 4w , 44 ), 670, and 01. - Branch circuits - nets, alteration, or extcnsionter panel Owner Signature _ _ . Date: A. lee for branch cal mirk I: APPLICANT El CONTACT' ---1 PERSON � above secs tee or feeder tee, 42 eac i nraneh uacuit Bussrte s f1 a1Ce: Ii Fee rim branch circuits rrifhr.nsr servic_ or feeder Ice, first Contact name. /2�LUS — ? 742 / /)111 N branch circ•ui. Each add'1 branch Wait 7 42 2 Address: Miscellaneous (service or feeder not included) fach manafartured or ;nodular City /Stare!ZI P. 67 84 . _ dwelling, sctce er :d or Iccdcr Phone: (.3 ) /.76 % 7 c ;,.2/ o�. Fax: ' ( ) Reconnect only 67,5•) 2 I Pump of irrigonty o(le)o 57.84 ; ! _' E-mail: Sign or saline lighting 57.84 I 1 2 CONTRACTOR Signal e or limited- cncrgy + �y ey Business name: /7 U ��^ C panel, alteration, ortxtens :on, t Page 2 / 2 �l ( r7 Each additional inspection over allowable iii any of the above Address 7'/S SW /s3 26 ' 22 Additional inspection (1 hr min) 66.25! hr , Ci ty/Staxli_IP: ,8 j / ` 2 7 - 0 ,0 Q 7/� 70 6 (I hr min) i I 66.25! hr ndustrial p lant (I hr min) 78.18! hr Phone: aly) 9 9 - 7 6,9 y I Fax: (in3 ) -//69- 7// 4f Inspections for which nc lee is 90.00! hr - • specirrca ly listed ( ': hr min) _ CCB Lie.: ,c9 9 4/ I E:cctrical Lic.:2 X09 eye: SJprv. Lie.: 2 ' /9 ELECTRICAL PERMIT FEES Suprv, Electr:cion signature, required ° - 1 Subtotal �� ii ��/A _ Plan review (35 °vn of permit fee): Print name: De: / State surcharge (i 2% of permit fee): r' a O K� /6e/9-1.4r I at � �� TOTALPERMITFEE. ly, 06 Authorized si j This pt•rmit appltcatiun expires if a permit is net obtained within 1811 d.ty, after it Inn I,ce n acceptant as roml.lexc. .. Print name: Date: ^ Nuuncttr a inspections allowed per permit /�7 0 L- Bnildmg Kamits ELC- PnmiiApp JOt O / :.).lip �/ a =f - ' CiUtwl WEB Jan 05 12 10:34a ADT Security 503 - 469 -7114 p.2 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES; 925 4V Z RESIDENTIAL WORK ONLY: . Fee fur all residential systems combined $75.00 .d2 -� 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 n D ata Telecommunication Installation n F ire Alarm Installation HVAC ❑ Instrumentation ❑ Intercom and Paging Systems Li Landscape Irrigation Control* Medical Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling j Ocher /M/ TEty CNC -`2 y SSG ? Ty Total number of commercial systems; *No licenses are required. Licenses are required for all other installations Haui din 0.Perm rtslELC- Permit App aler 07,01:10