Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELR2012 -00108
TIGA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2012
Parcel: 2S 101 AC01600
Jurisdiction: Tigard
Site address: 7150 SW HAMPTON AVE 226
Project: Mustard Financial Subdivision: BEVELAND NO.2 Lot: 18 -19, P
Project Description: Low voltage burglar alarm installation
Contractor: ADT SECURITY SERVICES INC Owner: NEIMEYER, JOHN
2815 SW 153RD DR 15 82ND DR STE 210
BEAVERTON, OR 97006 GLADSTONE, OR 97027
PHONE: 503 -469 -7212 PHONE:
FAX: 503 -469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/30/2012 $75.00
12% State Surcharge - Electrical 05/30/2012 $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: Y
Security Alarm: N 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 0 52 -00 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:
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.
Electrical Permit Application FOR OFFICE USE ONLY
~ .: �'f..T' Cl of Tigard Received J � / y `�
-E
y g Date/By: 4 , 1 30 6 � Permit 1 / Q W r a.. onto'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �
. Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TI GARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ` 63 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 'cl Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ 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 0 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: 0 Fire pump. p ❑ 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 nq,r, - Z lad` Job site address: 1 t So 5 N a M S I Six or or more. occupancy.
`' ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 1 OV 611 /Z� ❑Health -care facilities. 0 Supply voltage for more than
t 4,71 ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Ak 2 �� Project name: 0,4 p ,� „ 2 0 Service or feeder 600 amps or more.
Cross street/directions to job site: t FEE SCHEDULE
Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
i Limited energy, multi- family 75.00 2
..J V oV}A3e C <, '3( a 1at„�' i ,, ..5, A �,� residential (with above sq. ft.)
J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ 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: ( ) Fax: ( ) 200 amps or less 59.36 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT C ONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: A171T �i°r v L ti i ce6 B. Fee for branch circuits without
1 Pt service or feeder fee, first
Contact name: �An it( 0a' f \ branch circuit 56.18 2
Address: ��` ��� ` JJJ Each add'I branch circuit 7.42 2
2Te,x I�i 0.J Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP:
�uC �-T t7� �, c t p dwell in g, service and/or feeder 67.84 2
Phone: (-i., ) c{Loi - ZI q t I Fax:: (5) yw . — 1 t% Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E eke\Ac ® • , o
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: '�`� ; ” L � _panel, alteration, or extension. 1 Page 2 15, � 2
� ' �� " ^ 7�ut cc- Each additional inspection over allowable in any of the above
Address: 2€1°7 5-AD 5 Vf t 1, Additional inspection (1 hr min) 66.25/hr
City/State /ZIP: ��
j � r � �1 �v Investigation (I hr min) 66.25/ hr
` Industrial plant (1 hr min) 78.18 / hr
Phone: (6 , $) L46 71 1 , 9 I Fax: 6 Lilo - 11% Inspections for which no fee is
specifically listed (% hr min) 90.00 / hr
CCB Lie.: 51944 I Electrical Lie. : 26 , - t. , 1 L I Suprv. Lie.: '55ILEA ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / Subtotal: —�5 on
/\ Plan review (25% of permit fee):
Print name:
YeAft 1)5 I Date:6 A I Z State surcharge (12%ofpermit fee): Ct �t p J
Authorized signature:: V TOTAL PERMIT FEE: t
This permit application expires if a permit is not obtained within 180
Print name:
days after it has been accepted as complete.
D �� l Date: I�o1 it • Number of inspections allowed per permit.
l:\ Building \Permits\ELC- PermitApp.doc 07/01/1 440 -461 /05 /COM/WEB •
Electrical Permit Application - City of Tigard
.13a 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
❑ Other
Total number of commercial systems: `
*No licenses are required. Licenses are required
for all other installations
1 :\ Building \Permits\ELC- PermitApp.doe 07/01/10