Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
114 2. COMMUNITY DEVELOPMENT Permit #: ELR2012 -00045
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/13/2012
Parcel: 2S102AA04201
Jurisdiction: Tigard
Site address: 8955 SW COMMERCIAL ST
Project: Essential Planning Group Subdivision:VIORIN'S ADDITION- VACATED 142/182 Lot: 26
Project Description: Security system.
Contractor: ADT SECURITY SERVICES INC Owner: KING ELAINE HOLDINGS LLC
2815 SW 153RD DR ATTN HAL MARTIN SR
BEAVERTON, OR 97006 8305 SW CREEKSIDE PL #A
BEAVERTON, OR 97204
PHONE: 503 -469 -7212 PHONE:
FAX: 503 -469 -7114
• FEES
•
Description Date Amount
Specifics: Restricted Energy Permit 03/13/2012 $75.00
12% State Surcharge - Electrical 03/13/2012 $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_ _ —i ter Permittee Signature:
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.
03/09/2012 14:07 FAX 5034697110 ADT SECURITY a00 2
Electrical Per�it Applic •' lAl. : fir lr (I 11(:l t -S1•: ONi.l'
City of Tigard ^4 i ® ^•Cl
Received
i Date/D , K=111 i�
a 13125 SW ball Blvd., Tigard, OR ' 7. . P lan Review
■ . Phone: 5031718.2439 Fax: 503,5' : '�.'. 0 2 O' . DateB : Other Permit:
Inspection dine: 503,639.4175 Date Ready /By: Mil Hi See Page 2 for
T l GA a L
Intranet w vw.ligard- or.gov CITY OF TIGAF D Notified/Method: Supplemental lnfhrmadon
N . r ^ :ca . , •.i -�. - ,.,z.� z.•��rc,—•.� Y ! ` - -. -r -,•; � - °r �. - ^n-`i 7 - i' � � i � � a A �
k t. f' . J 1 " 7• ,S $• •! J `. d ti '" .. axe
fA% - v ' ! '' n _ ,� �r �: .! i..lc °wfl�+" s ;? try?�z};w' i '.i r ,:r`'>'r. ".:' �i ^3, 'kwlr •r�`,�+�° !? .4 Vs • �� Y Please check all that apply (submit a sets of plansw/items checked below):
❑ New construction I .1 Addition /alteralion/replacement
I ❑ Service or feeder 400 amps or more ❑ Building over t stories.
❑ Demolition I ❑ Other: where the available fault cermet ❑ Marinas and boatyards.
c :,. ^r- cyW ,^ ,t :a,f•�T -tir ; se• ly.•�r <¢: f: 1 •
,7T;:': J , y? ,x" � �V —+ � - , : ti •.;,;y= . y- , �,' ;� , f ^ .6.w' a:�� .,ti' , � `' �!' exceeds 10,000 am at t5o vans or ❑ Floatin buildin
a±l r • '� r�.':r'Yi Y �y'{ ;', ti ., .3... ..c Y.'Pt,�•1N N+,:0y;.ti- a:,,�$�tw r' less tog ounttorexceeds14.000 ❑ Commercial- useagricullun l
❑ 1- and 2- family dwelling ►. Commercial/industrial ❑ ^ Accessory building amps for all other installations. buildings.
❑ Multi- family I ❑ Master builder ❑ Other: • ❑ Fire pump. ❑ Installation of 75 KVA or
�l. rc • e 5 "n' ;r" 'R�•'!SF `i", ' 1. " io=z ‘t� , .zi El Emergency velem, larger separately derived system.
yq < Pl, r�. L y e. �i 1
), `¢;�c1•',P$;,^�;; C�t�j` %;�' '` �Y r -` :! ' �C � „n ` � t � � ^'�.'i� .�h+�'� �r = i s ❑ Addili011 0fnCwm010r load Of 0 ..Ati ..R,...1_2",..1-3..
Job Job site address: /r ,rte, 100HP or more. occupancy.
n - giefie 0% 8g5es em„n o plej O six or more residential units. ❑ Recreational vehicle parka.
City/State/ZIP: d �� ❑ Health -ears facilities. ❑ Supply voltage for more than
� r Gt "127 ❑ Hazardous locations. 600 voles nominal.
Suite/bldg /apt no.: J P ro j e ct name- ❑ Service or fender doe amps or more.
, ` 1 +ad"• C.V'J ` . M1 "I'1 l �v� y L :l7 .p, .. " �. ma } � •�
Cross street/directions to job site: rr J 1 , p ; 1 :''s <,� �`1 { ~ S : a I .:. Total ,.• '
• �..��at.5n 0 ..1. I dHr. I Fee. I Toter 1 •
3.— New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: J Lot no.: 1,000 aq. B. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
r � Limited energy. residential 75.00 2
9+` r. e a 'G =, J "+ ,v.Yh
; 'C S . (, r r 5 ,1 . YR, ' . ' tr'�'Y• 'e`TP^; II N ,j�a 4 R)
�1X?'�� � �r,"� I. •d • , �. ( i '. ��'• f•• iC. �o•+, �.. 'a +:l�i�':�j�'i'�t' ^j2•t'it''4; ( with above gq•
Limited energy. multifamily 75.00 2
ft.)
tor.} ti�t�..r. tar . J f &As. L a;, e ‹, 1,e..,,�1 residential (with above sq. 1i
)) Services or feeders insiallation and/or relocation
• t vt S ki o„..--- 200 amps or less t 00.70 2
^ °.�� _� -� a�,r.; r *, '+, r• a• 201 amps to 400 amps 13356 2
9 •'. :: isl ^� - rc v`i6' ''nil ., Eig` J ,, , r �„ .(,,�'� ' :5 urps
�+ , '.I' � 'i.�:c=a ... ^tw�iv , 51�3i.�..:,':'a. ,.�!, .�n �,.,YT�:r. L�'x i•.
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 30I,04 2
Address: Over 1,000 amps or volts 552,26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone ( ) I Fax: ( ) 200 amps or less 1 1 59,36 1
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 z
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: } Q Date: A. Fee for branch circuits with
U�'' t�tG i� 1V r'v ` •'1Y ' ;Rra . 1•,, `T °'7,iv x . � ' ^ ';t"•yP ii.,
.' above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without t rr . .n .. y ,r.. r 56.18 2
S service or feeder fee, first
Contact name: � i e branch circuit
Each add'I branch circuit 7.42 2
Address: 2 1,5 j •g,„.› ♦ Miscellaneous (service or feeder not included)
City/State/ - r `� J L Each manufactured or modular — 67.84 2
v �� dwelling service and /or f eeder
Phone: (r4,1 Hte9 j. l Fax:: (Cim3) 4- 1kii..1„a Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: - � e , - , c ��
Sign or outline lighting 67,84 2
Y mom + 1 � t^ ; n; Y �„ • � r . � µ w , �, �
1" T`�'.•t a `44. "„ s 'ef , 'y• •• 6 •S`3,'ry. ,,;" " "WA :•: !: Signal circuit(s) or limited-energy
Business name: panel, alteration, or extension. , 1 Pattie 2 15. 2
fy� 5 Each additional Inspection over allowable in any of the abov
Address: 7-515 J 2, �.-- Additional,'
mspection (1 hr min) ¢6751 hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
�C .ec an _ 1 . 1. ,....„
t-. industrial plant (1 hr min) 78.18/ hr
Phony. (5c3) 4 '1 -.l,L 1 I Fax: ( 5: 5 )41/4,4 - 11% in Inspections tar which no fee is 90.00 / hr
s ificall listed % hr min
CCB Lic. a ly Elect rical Lie.: , Le. Suprv. Lic.: 33RxJ ; • ', :dycle;;,: A q,; . . „ talk
Suprv. Electrician signature, required: Subtotal: `15, cup
.{� �� /LQAa Plan review (25% of permit f ee):
Print name: `e a Date: 3 ,� 1 Stan surcharge (124'0 of permit fee): Q.
TOTAL PERMIT FEE: gq • 0.7
Authorized signature:
i C a, / _ 'ibis permit appGasfion =pints ifs permit is oat obtained within ISO
� cloys after it has been accepted as complete.
J.. Print name: C! U rt Date: 3 k I • N um b er of inspections allowed per permit.
LtBulldingTerroirella .C-PenniIApp4c 07/01 /10 440 16151111Po5/COM/WEB
03/09/2012 14:08 FAX 5034697110 ADT SECURITY 2003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Wow Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Aix Conditioning System*
❑ Vacuum Systems*
❑ Other.
��1,�,, w 21KfZr --W'
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
El CIo Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom =ell Paging Systems
El Landscape Irrigation Control*
LI Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
lEr Protective Signaling
❑ Other
Total number of clommercial systems: 1
*No licenses are required, Licenses are required
for all other installations
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