Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11111 ' 2 '• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00055
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/28/2012
Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10120 SW NIMBUS AVE C3
Project: KMSS Corporation Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 2
Project Description: Low voltage for burglar alarm & CCTV (single system).
Contractor: ADT SECURITY SERVICES INC Owner: HANSON, RONALD D
2815 SW 153RD DR ROBINSON, CONSTANCE A
BEAVERTON, OR 97006 ROBINSON, CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK, WA 99331
PHONE: 503 -469 -7212 PHONE:
FAX: 503 -469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/28/2012 $75.00
12% State Surcharge - Electrical 03/28/2012 $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: N Other: Y Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued sub'ect 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 rdance with ::'roved 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 law eq ' • ' s ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 0 through OAR 952 -001 -f • •0. V• •tain a copy of the rules or direct questions to OUNC by calling 503.232.198 1.800.332.2 4
I C
Issued • f 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.
•
1 t25e -c2y- v tt - co?.. 3- 4t." - 'it to or evvriA 4. - \. r a _ ._ _ _
Electrical Permit Application 1'012 OFFICE USE ONLY
7 City of Tigard Received /)� I �, Permit No.: II,- �ol - pp05
1 3125 S W Hall Blvd., T igard, OR 97223 Plan eview Q ,
Phone: 503.718.2439 Fax: 503.598.1960 DateBy: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: HI See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items 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 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E "I -2 ", "I -3
Job t1p � Lop site address: I OOHP or more. occupancy.
Vri� V7.7'� - b t �0�20 �� � tw1 's..0 AJC_ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: - I: e'd r CIZ Q 121 ❑ Haz fcation ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: G I Project name: v.t.A6.1 r C � ❑ Service or feeder 600 amps or more.
l.o ( a �- • FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
'v .D °V(pap. 1 r 1 `af Z \�Cv� d - !` rosy C A%,da C. residential (with above sq. ft.) _
` � Services or feeders installation, alteration, and/or relocation
'`)e^µ, 't A kalt'�' , _ 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 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 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 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 I ‘Fl CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: 4. B. Fee for branch circuits without
W ^ `t' - S service or feeder fee, first
Contact name: l branch circuit 56.18 2
� , ` Each add'I branch circuit 7.42 2
Address: Zak 5 "7 \ A > Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: 67.84 2
t„t,Craan t Q'� 6t '�co�Q dwelling, service and/or feeder
Phone: (54 ) KV a _1,141 I Fax:: ( 3 4lo - 11 % o Pump Reconnect irrigation only 67.84 2
Pump or ii circle 67.84 2
E - mail: e\pNA‘®a Av. c......0-0•_ Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
panel, alteration, or extension. I Page 2 '15. c:.= 2
poi �C. xce Each additional inspection over allowable in any of the above
Address: 28t� ,,5.___ 13 %
Business name: Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: e' ca n 9 1 ��
Investigation (1 hr min) 66.25/ hr
l Industrial plant (I hr min) 78.18 / hr
Phone: ( .s3) ,lo" --.1 I Fax: ( - V 1.1k 1.Z1`� Inspections for which no fee is
- specifically listed (% hr min) 90.00 / hr
CCB Lic.: C Electrical Lic.:Z1y Z0icLel Suprv. Lic.: 5eAtf . ELECTRICAL PERMIT FEES
Subtotal: 15 , o p
Suprv. Electrician signature, required Plan review (25% of permit fee):
Print name: v e „ S Date: 31 si t ,Z State surcharge (12% of permit fee): q .c:$0
1" TOTAL PERMIT FEE: et{ . c o
Authorized Signature: This permit application expires if a permit is not obtained within 180
C days after it has been accepted as complete.
Print name:
Date:
` � 3 2. 1 Z • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doe 07/01/10 440.4615T(I1/05 /COM/WEB
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:
El Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El 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
El Boiler Controls
El Clock Systems
E l Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation
El Intercom and Paging Systems
E l Landscape Irrigation Control*
El Medical
❑ Nurse Calls
E l Outdoor Landscape Lighting*
Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
11Building \Permits\ELC- PermitApp.doc 07/01/10