Permit 1 y CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1 1 COMMUNITY DEVELOPMENT E 5 �I Permit #: ELR2012 00127
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
�� Date Issued: 06/19/2012
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15955 SW 72ND AVE
Project: Guitarish Music/Advantage Point Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Low voltage for burglar alarm system. 2/13/12, reprinted to correct address and project name.
Contractor: ADT SECURITY SERVICES INC Owner: PACIFIC REALTY ASSOCIATES
2815 SW 153RD DR ATTN: N PIVEN
BEAVERTON, OR 97006 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 -469 -7212 PHONE:
FAX: 503 -469 -7114
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 06/19/2012 $75.00
12% State Surcharge - Electrical 06/19/2012 $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: 0 -!on law requires
503.23you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 thro a OAR 9 - 001 Jc You may obtain a copy of the rules or direct questions to OUNC by calling 2.1987 or 1.800.3V.2,344. •
Issued By: a Permittee Signature: C OP 6-'( �fiLCt�
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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELR2012 -00127
T [ GA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/19/2012
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15957 SW 72ND AVE
Project: Guitar Fish Music Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Low voltage for burglar alarm system
Contractor: ADT SECURITY SERVICES INC Owner: PACIFIC REALTY ASSOCIATES
2815 SW 153RD DR ATTN: N PIVEN
BEAVERTON, OR 97006 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 -469 -7212 PHONE:
FAX: 503 -469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/19/2012 $75.00
12% State Surcharge - Electrical 06/19/2012 $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 52- 01 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987
� 32.1987 or 1.800.332.2344.
e 2. .24 2344 4.TT 10J
. / I
Issued By: Permittee Signature: ( w 4PPL.J
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.
Jun 19 12 01:17p ADT Security 503 -469 -7114 p.2
Electrical Permit Application RECEIVED FOR OFFICE USE ONLY
- City of Tigard Received
Date!By: to ( 14112 Permit No eLQ C2Di p 01 d-7
N
• 13125 SW Hall Blvd 1 9 , Tigard, OR 97223 JUN 2 012 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date.'By: Other Permit:
1' l G A K ll Inspection Line: 503.639.4175 ;i Date Ready/By: Tura / 63 See Page 2 fur
Internet www.tigard- or.gov CITY OF "� NottiledlMethod: IIY/ Supplemental Information
BUILDING D!visiorg
TYPE OF WORK • PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets ofpinns w/derrs checked below): A
❑ Service or feeder 400 amps or more ❑ Building over three norms.
0 Demolition or where the available fault current ❑ Marinas and bcatyards. t:1
CATE ORY OF CONSTRUCTION cxcuds 10.000 amps at 150 volts or ❑ Floating buildin�•s. (t\
less to ground. or exceeds 14.000 ❑Commercial -use agricultural
❑ I- and 2-family dwelling CommerciaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family Master builde- ❑ Other. ❑ Fre pump. ❑ Inutallauon of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. `\
_ ❑ Addition n of new motor load of ❑ ".4 ","E', "1.2 "1 - } ".
t�� ll A I COMP ur mare. occupancy.
Jobno.:a(,O7_/ I Job site address: /59s S SW 702 #d am
❑ Six or more rcsldential units , ❑ Recreational vehicle parks.
City /State/ZIP: 7-14-* k D ox 9 4.2 a ❑ Nealth•caro facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ' f F 5 /r /17 as „ . ❑ Service or feeder 600 amps or flare.
FEE SCHEDULE .
Cross street/directions to job site: Description I Qty. ' Fee I Total I •
New residential single- or multi-family dwelling unit.
• Includes attached garage.
Subdivision: Lot no,: 1,000 sq. 0 or :css 168.54 4
Ea. ndd'1500 sq. ft. or portion 33.92 1
Tax snap /parcel no.:
Limited energy, residential • 75.00 2
DESCRIPTION OF WORK _ (with above sq. II.)
Limited •energy, multi - family 75.00 2
fPva %G i1litx y ins rein residential (with above sq. ft.)
J Services or feeders installation, alteration, andor relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER l ❑ TENANT 201 amps to400 steps • 133.56 2
401 amps to 600 amps i 200.34 2
Name: .�
601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps or voles 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation ` •
Phone: ( ) I Fax: ( ) 2.00 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 135.08 2 2 ,��
intended for sale, lease, rent, or exchange, according to ORS 447.449, 670, and 701. 401 amps to 599 amps 163.54
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits tvirh
❑ APPLICANT I CONTACT' PERSON above service or feeder fee,
7.42 2
• each branch circuit
Business name: B. Fee for branch circuits without f, �
service or feeder fee, first 56.18 I `
• Contact name: 77, 7:)p / 475 G ff if i1/ brunet circuit
Each add'/ branch circuit 7.41 _
j Address: Miscellaneous (service or feeder not included) n •
Cit /StaIC•ZIP: Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder _
Fax: Reconnect only 67.84
Phone: (503) 90 ( /3 Qt'J ( ) Pump or irrigation circle 67.84 _
E
Sign or outline lighting 67.84 3
CONTRACTOR Signal arruit(s) or limited-energy r 7 2
B usiness name: � br S _, r n/ panel, alteration. or extension. Page
CG Each additional inspection over allowable in any of the above
Address: 0 ?,?/ . 5” 0 ?,?/ 0 ?,?/ . 5" � S /6-3 / 3Q' �2 Additional inspection (1 hr min) 66.25/ hr
CityiStatec7.IP: ,6 , /�- 7-0A) (94- 9700 6 Investigation (I hrrnin) 66.25/ hr
Industrial plant (I hr mm) 78.18 / hr 1
Phone: OP? ) 96 9- 7 69 y' Fax: (�3 ) S/69- 7//4C Inspections for which no fee is 90.00 / hr (.
/ spec:flcally listed (A hr min) t
CCB Lie.: S9 9 e7 Electrical Lic.:247 09 ea Suprv. Lie.: 2 y.es ELECTRICAL PERMIT FEES
Subtotal:
Suprv. Electrician signature, required: Pla review (25% .71. l parts it fee):
A.
Print name: le t l C e41,0s Date, 6. 9 /, State surcharge (12% of permit fee): 9 O 0
TOTAL PERMIT FEE: gy, 00 .
Authorized signature: This permit application expires If a permit Is not obtained »Ithin 180
Print name: Date: days after It has been accepted an complete.
N um b er of inspections allowed per permit
I f- Buuldine+?ermns`ELC- PermitApp ccc 01,0!'10 401- 161Sr111,05.00M/WEB
Jun 19 12 01:17p ADT Security 503 -469 -7114 p.3
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 Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
Li Vacuum Systems*
❑ Other:
COMMERCIAL WORE ONI;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
❑ HVAC
❑ Instrumentation
Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protectivee Signaling
• .175 Other C_ f • n71 % E� �/!/[ -!1 J! y/ 6e6 U/P, T/ .51S7
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
BBuildinglPermilet [UC- PegaitApp.doc 07001/10