Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2012 -00014
Tt�ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2012
Parcel: 2S112AD01000
Jurisdiction: Tigard
Site address: 7007 SW CARDINAL LN 185
Project: Cricket Communications Subdivision: PACIFIC CORPORATE CENTER Lot: 1
Project Description: Security system.
Contractor: ADT SECURITY SERVICES INC Owner: PACIFIC REALTY ASSOCIATES LP
2815 SW 153RD DR ATTN: N PIVEN
BEAVERTON, OR 97006 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 469 -7212 PHONE:
FAX: 503 - 469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/26/2012 $75.00
12% State Surcharge - Electrical 01/26/2012 $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 - • • re rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By• iii - ✓� i - Permittee Signature:
A r _ ✓
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 24 12 10:43a ADT Security 503 -469 -7114 p.2
Electrical Permit Application �';''' FOR OFFICE USE ONLY
CI of TI and ; , ' s Received Permit No. —
1 3125 S W flail Blvd.. Tigard, OR 972 . q , o. Yt ri Yeview
r' 7 Phone: 503.639,4171 Fax 503.598.1 ., ; • tr4 Qa Other Pcrmt_:
r �o\tcil3v:
TIGARD Inspection Lin: 503.639.41 75 t \ �j Date Ready. /lay � � I See Page 2 for
Iniei, ci: www ligard -orgov P,`t r Natitieddv1elhod: Supplemental Information
TYPE OF WORK O 1 • S PLAN REVIEW
New construction ❑ Additi[1nr'aheration /re
.- t- Picric check all il.at apply (submit 2 sets of plars w'aems cheei<ed below);
O i ❑ Scrncc or feeder 1 awes amps or ,nor: ❑ Building over res stories
Demolition ❑ Other: V 1 where the available foul current ❑ Menges and boatyards.
CATEGORY OF CONSTRUCTION eacccds 10.000 amps at 150 volts or ❑ )luting bJildinbo.
less to Around. or exceeds 14.200 ❑ Commercial -use Kgncultural
❑ 1- and 2- family dwelling ❑ Commerciallir,duscrial ❑ Accessory building amps for all athar installations buildirlts.
❑ M ulti - family ❑ Master builder ❑ Other; ❑ Fire pomp ❑ lnstnll.r : inn 01 75 KVA or
dOB SITE INFORMATION AND LOCATION ❑ Encrgcncy system. larger separatcly system.
Q Additicn oF new motor load of ❑ - A "I -2" "l -3"
� — � 73s- Z / I00HPormore. occapancy.
Job no.: � � - Job si: ^7 c address: 7 � eA� d,.1,,�� VL
❑ Six nr more residential thus. ❑ Recreational vehic.e parks.
CityiState,tZlP: q 0/e. 9 � y ❑ licz care o es. 12 Supply \°tinge for more than
�4 ❑ hazardous locatirations. 600 volts nominal
glgr no.: o` d s- Project name: e� r e. �, ❑ Service or feeder 600 amps or S C
FEE S CHEDULE
Cross streettdirectiOns to job site: Description 1 Qty. I Nee. I rolxi 1
- — Nei• residential single or multi - family dwelling unit.
Includes attached garage.
' Subdivision: Lot no.: 1,00 sq. f.. or less 163.`4 r 4
— Ea. ado.' 1 500 sq. 0. or portion 33.5: 1 I
Tax map parcel no Limned energy., residential 75.00
DESCRIPTION OF WORK (with above sq. fl.) I `
Limited energy, multi family
j B ecg residential t +i.h above sq. ft.) 75.00 ' 2
services or feeders installation, alteration, and/or relocation
/ il 200 amps or ,ass 10170 _
i❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps l 200.34 2
Name:
501 amps to :.000 amps 30I.C4 2
Address: Oscrl,o:io amps orvolts 1 552.26 2
Temporary services or feeders installation, alteration, andior
City'Statc''ZIP relocation
I 2 202 amps or bits 59.36 1
Phone: ( ) Fax: ( ) --
-- .',tiI ampsto400am)a 125.b8 i 2
Owner installation: This instal:ation is being made on property that I own which is not - } 1
all l camps to 5' - J) amps 1 16t..54
intended for sale, lease, rent, or exehaage, accord ng to OILS 447, 449. 670, and 701 -
_
Branch circuits - new, alteration, or extension,ycr panel
- - __ . - - Date :� Fee for branen circ n sh 1
Owner signature j
- above service or feeder lee, 4
ED APPLICANT CONTACT PF PERSON - each branch circuit 7.42 2
Business name: 13. I-ce for branca circuits r:ilhur+t
service or feeder ice, first 56.1S -,
branch eimuit
Contact narnC N Ka US
Each ede'1 brenc! circuit 7 a'_
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular ; 67 ; 1
City.(Stale +ZIP: • : dwelling, service andmr feeder 1
-
-
Phone: ' 5 3 I ii‘y. 7L/ 02 Fax: : ( _ ) I Reconnect only i { 6 % . .4 -
L i Pump or ari�uuun c i r cle ( ..)7.'. , -1 ,
E - maa: Sign or outline lighting 67.64 I 2
CONTRACTOR S anal circuits) or li;mled energy 1
panel, at:eration, or extension. Pape 2 7.5
1
1 Business name: /9 b-7— SEC U ,ei E Each additional inspection over allowable in any of the above
Address: o7g -LS" 5 /) l j e 3d T J /� i Additional inspection (I hr mil) 66.25' hr
lnccstiga :ton (I '.ir inin) 66..5 hr
City %State /ZlP: ,6„ „. 2 7,) ( / , , e.. X700 6 --
Industrial ?lent (1 h r min) 75.15- hr
Phone: 1 p ax , .1 /69-
7�/ (� Inspections rs fir which lee is t
94,9 769 1 �3 ) 90.001 hr
specifically listed (' /= hr min)
COB Lie.' s - 4 4/ 9 9 � Electrical Lie 2/ 0 9 eee j Suprv. Lie.: 3 yL6- ELECTRICAL PERMIT FEES —
- , - '' Subtotal:
Suprv. Electrician signature, required' - -
Plan review (2:)% of pe ttti; I'm:)
Print name: Kr id ! c"12AUS I
Date: 0 v /z State surcharge (12°io of permit fee): y v v
—
1 TOTAL PERM IT FEE: I g.lJ. 00
Authorized signature:
This permit application expires if a permit is not obtained within 18U
days after it has been accepted as complete,
Print name: Date: - Ncmher of inspections allowed per pear :n.
I guild ,n(;- I'_rmrt ('- ecrmilwpp JM t:' -el IL' a- r -aLl> 1 ( I I.U5 :1'..Ii
•
Jan 24 12 10:43a ADT Security 503 -469 -7114 p.3
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 Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
•
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
,VS Other /'/Y7i 7C �1 I - �C�'F//�i7 y - $f�S%£
Total number of commercial systems: ! /
*No licenses are required. Licenses are required
for all other installations
1: Building ■Permns■ELC- PermitACP.doc 37,0110