Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00165
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/31/2012
Parcel: 1 S136CD00100
Jurisdiction: Tigard
Site address: 11705 SW PACIFIC HWY Z
Project: Petco Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: (2) signal circuits or limited energy panel for TI
Contractor: SIMPLE SECURITY Owner: PACIFIC CROSSROADS PROPERTIES IN
PO BOX 80577 BY WYSE INVESTMENT SERVICES CO
PORTLAND, OR 97280 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: 503 - 574 -2254 PHONE:
FAX: 503 - 245 -2998
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/31/2012 $150.00
12% State Surcharge - Electrical 07/31/2012 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: Y 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 $168.00
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. hose rules are set forth in OAR
952- 001 -0010 through OAR 5 001 -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 00.332.2344.
Issued By: e1 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: p A) (y J,J
LICENSE NO. 7- l t , C �—
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 IOR orhlcl: usl.: ONI,
City of Tigard D ma y° 7 (�3 (y Permit No.�L l�ao(�. & d�
13125 SW Hall Blvd., Tigard,OR 97223 Plan Review �1 �_
14 • Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit: �,(,� �d v
T I C. n R D TIC" Inspection Line: 5013.639.4175 J U L 31 Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: " Supplemental Information
TYPE OF W : ' OF'FIGARD PLAN REVIEW
I G DI r yIo`v P check all that apply (submit a sets of plans w /items checked below):
❑ New construction dition/alteratio rep acement
❑ 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 dwellingommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: 0 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 ", "1 -2 ", "I -3 ",
Job no.: Job site address: Z ((70.5" 5,t� I'tgW'l`j 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: t A J c ,,,rpe f4 t Vy C , ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Z Project name: fC t'c 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 4- ! p Description I Qtr. I Fee. I Total I
t 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 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
C Cr ✓ 1- 2 l u{ " q • residential (with above sq. ft.) _ _
l / Services or feeders installation, alteration, and/or relocation
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
h relocation
Phone: ( ) 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
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 I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: S ; ty- 4 R C v r t , B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: DOA M.11 •P v branch circuit
Each add'I branch circuit 7.42 _ 2
Address: 1. 0 , ", Y ^ � 0 5 3 7- Miscellaneous (service or feeder not included)
City/State /ZIP: ? D L t Litt , � y 0 � q 1 .--A 0 Each manufactured or modular 67.84 2
J CJ dwelling, service and/or feeder
Phone: (11:3 ) i, "7 - (-- '� Z 5 ti Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy �1
Business name: . panel, alteration, or extension. • v Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) ( 4 Fax: ( ) Inspections for which no fee is 90.00 / hr
C. (r specifically listed (% hr min)
CCB Lic.: / r)„..01 et Electrical Lic.: 3 q —( Suprv. Lic.: 9.1/ CC — ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7/a W jjj' ier Subtotal:
` Plan review (25% of permit fee):
Print name: p a IA _ l ( �V Date: — 3 (, ,, Cy 20(Z State surcharge (12% of permit fee):
n 1 / G' 1 / TOTAL PERMIT FEE: / ‘g; 0 Authorized signature: / ��` This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
N um be r of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11/05 /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:
❑ Audio and Stereo Systems*
• • ar 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
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
•
❑ Landscape Irrigation Control*
❑ Medical
•
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
rff--Protective Signaling
Other � V ther u�
•
Total number of commercial systems:
•
*No licenses are required. Licenses are required
•
for all other installations - •
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