Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• I COMMUNITY DEVELOPMENT Permit #: ELR2012 -00102
T I G A.R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05!21!2012
Parcel: 2S 101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 460
Project: State Farm Subdivision: VARNS ACRES Lot: 9
Project Description: (1) signal circuits limited energy
Contractor: ADT SECURITY SERVICES INC Owner: GK TRIANGLE CORPORATE PARK III L
2815 SW 153RD DR BY THOMSON REUTERS INC
BEAVERTON, OR 97006 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD, CA 92013
PHONE: 503 -469 -7212 PHONE:
FAX: 503 -469 -7114
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 05/21/2012 $75.00
12% State Surcharge - Electrical 05/21/2012 $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 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
i' 987 or 1.800.332.2344. ) r
Issued By: � tLa_.
� Permittee Signature: Oki x i e �/� 7 k t
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.
Sr May 18 12 08:01a ADT Security 503 -469 -7114 p.2 f
L
Lf Permit APolicatioI> FOE l \J '' FOR OFFICE LISE ONLY v"'
d eceive
City of'figard R S .2-I 2- sr j Prinrit 4,d�_ /o3—
13125 SW Hall Blvd.,Tgprd,OR 97223 MAY 18 2012 c eil3
_ Phone! 5113.639.4171 Fax 503.598.1960 Drddfy: UlhaPorta
T lG ARD Inspecdon Line: 503.639.4175 CITY OF TIGARD oate xeadymy: ®sR Pubs z tar
Internet: www.tigardo 8111! nlju: r.gov „. , 14siti lol� Notified/Method: Supplemental infermatlon
• rt �
TYPO OF w071K PLAN REVIEW • :
•
Plrasc chock all r apply 2 xh of �rn tcm� chcot cd below I:
❑ New construction Addition 'alteration /replatxment I
I ❑ Service m feeder 400 amps or more ❑ Building over three stories. [ 1:)
%
❑ Demolition ❑Other: where the available fauh current ❑ Marinas and boatyards.
. . • ' :. CATEGORY OF'CONSTRUCTION : • • exceeds IMO amps at150 volts or ❑ Floating buildings.
building lens far sit outer intonations buildings. (�
CI R
Multi- family ❑ Master builder ❑ Other ❑F'pu p. ❑ Inualladonof75 KVA or `�
JOB SPl'E INFORMATION AND LOCATION - ID Emergencysystem larger separately derived system.
• _ ❑ Addition ofrsw nmtor load of CI "A ". 'E' . "1 -2 ", "1 -3".
8 7 . 3 Job no.: ( 3 9 / - / lob site address: /3,, j,, / 5w t S 1� trceupncy.
PA /2 / A,/ a� room O Six or more residential Lcits ❑ Recreational vehicle parts, ` 4
Ci /Statc/ZlP: T�C�'A b o e 97a 3 ❑ Healtha�e facilities. ❑Supplyvoltage for more than v
❑ Hasmdors locations. 600 volts nominal. Nc
Suite/bld /a t, no.: ' Pro name: f�R 49 ❑Serviceorfeedert00ampsor
a� p g4, 0 3 ST/�7 — E"
FEE SCHEDULE
Cross street/directions to ob site:
J tlanitrtioa i Qr2. 1 Fa. I Toms .
New residential single -or multi- family dwelling unit.
includes attached garage -
Subdivision: Lot no.: 1,000 sq. f. or less ' 168.54 4
Tax map/parcel no.: Fa. add'l 500 sq or portion 33 1
. R.
Limited energy, residential
75.00 2 \
DESCRIPTION OF WORK • - (with abovesq. R.) i
Limited energy,mulii- family � i \�•
rcsiderttial with above 75.00 2
E�v,e . r y ys re/if c �q. R. ) _
Servic s or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I . . ❑ TENANT . ' 201 rums to 400 amps 1)3.56 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 � lA J J � j
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Ck l relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 t
201 camps to 400 angn 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 arrtpsto599arops 168.54 2
intended for sale, lease, rent, or etchange, 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
I
ID APPLICANT 1 ❑ CON1:iC1 PERSON. PERSON. aboveservice or feeder fee, each branch circuit 7.42 2
Business name: B. Fee for branch circuits witorr/
, / service or feeder fee, First 56.18 2
Contact name: ��� i �U S - branch circuit _ `
Each add? branch circuit 7.42 2 'N. Address: Miscellaneous (service or feeder not Included)
City /State/Zi P: Each maaufac[nred a modular 67.84 2 X.
dwelling, service and/or feeder �(\
Phone: ( 3) .46 9 _ 7,1. J, Fax:: ( ) Reconnect onl 67.84
Pump or irrigation circle 67.34 2
E -mai I: .
Sign of outline lig;nia 67.84 2
... CONTRACTOR -. . .. .. . . Signal drcuit(s) or limbed -enma „�°
Business name: aT S6 C G e ir . ✓ panel. alt ration, or extension. Page2 %� 2 N(
Each additional inspection over allowable in any of the above
Address: jgy_s s to /s3 .)i2 Additional inspection (i br min) 6625/ hr
City/State/ZiP: 64- 41,6 -•-4 7 t9, / ir O 6 Irvcstigetion (l hr min) 6625 / hr
Industrial plant (1 hr min) 78.18 / hr IC
Phone: („12,3 ) 9 (,ej - 7 69'S l F rc: (193) 9 • 9 7/Jl Inspections for which no fee is 90.001 hr I
epeeificaI ly listed ('it hr min)
96B Lie.: , lj/ 9 4 \� ectrical Lic. :24 ! 09 k e� e' b I rv. Lie.: �F(, - : ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 1�d� (u1t (4 Subtotal:
Plan review 25% of it :
( pcxm foe)'
Print nacre: // le fewvs . Dateg b/ //z, State swcharge (1296 ofpmnit fee): 9 O D
TOTAL PERMIT FEE:
Authorized signature: 1 D 6./
This permit appilatien espires if a permit is net obtained within 1110
days after i1 has been accepted as cochleae.
Print name Date: • Numberof inspections allowed per permit.
I:1 Baildiod∎Paraii0E .C- Petmi7App.doc 07,1,10 440.46151(11105 /COMAVEB
May 18 12 08:01a ADT Security 503 -469 -7114 p.3
Electrical Permit Application - City of Tigard
Page 2 - Supplcmcntal Information
LIMITED ENERGY PERMIT FEES:
.TRESWENTIAL WORK ONT X:
Fee for all residential systems combined ... $75.00
Chcck Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
U V acuum Systems*
❑ Other:
- COMMERCIAL WORK ON Y: _
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
❑ l -IVAC
❑ I nstrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
U Nurse Calls
❑ O utdoor Landscape Lighting*
❑ Protective Signaling
.S Other C- / .02/ 71-21 4: gi y/ ✓ PG 64, ry Sys! £49
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
l:`. Huilding'.PermitsTIC- PermilApp. dx 07)01/10