Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00174
T I
GAR R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/06/2012
Parcel: 1 S135BA01802
Jurisdiction: Tigard
Site address: 10101 SW WASHINGTON SQUARE RD
Project: Bank of America Subdivision: OAKBURG Lot: 27
Project Description: (1) limited energy panel for CCTV
Contractor: TYCO INTEGRATED SECURITY LLC Owner: PPR SQUARE TOO LLC
2815 SW 153RD DR BY BANK OF AMERICA
BEAVERTON, OR 97006 NC1- 001 -03 -81
101 N TRYON ST
CHARLOTTE, NC 28255
PHONE: 503 -469 -7206 PHONE:
FAX: 503 -469 -7114
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 08/06/2012 $75.00
12% State Surcharge - Electrical 08/06/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
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: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through O R 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232,1987 or 1.800.332.2344.
Issued By: A, ,� J 1/4144)4i Permittee Signature: Oki A or ' IPPv/ (4770 At
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each Inspection.
Aug 02 12 01:07p ADT Security 503 -469 -7114 p.2
Electrical Permit Application II,, D Its // ?7 �/f/1
"
City of Tigard I f raionsy: 5 fin // l 1 f Y PQLmtNU�/a-.2{ 0. - 00 {
o a MO= l3 625 SW Halt Bhrd, Tigard, OR 97223 A l� G O z 201, rbuRr.iew /DO ll Y� �t Pu MO= ]03.6394171 Pax: 303.398.1%0 I�IdBr Date T t r: a r, n Wand: w ww.li 501639.4175 OF' D Ploti tt Supplemental Information
_.. I 11t Dd�►��IVIS$YIN.�,. .
_„ :-: 6S: EC::;:. -! _ . _ • . - P1AT1 REVIEW,. . .
❑ New consirtllxio) Addition/alteration/replacement - Floor check ell list appl Goland 1 sets of plow o itow checked below):
❑ service or feeder maws or came Q Building over de m stoner_
❑ Demolition D Other where the evadable Nutt current pkesmms and boatyards.
:-: . • • : CAT&;fsORY, OF CO*TRUCY_7ON:. • :
`: . ' MOOD lacteds 0 rerrpo at 150 voila or El Ong buadiess
171 1 - and 2 - family dwelling �Commcrcial/industrial 1:] Awe:nary building be ell other but � d � amt uhurai ldings
❑ Multi- family D Master builder ❑ Othe -: O Fire pump. ❑ /awes moon of 75 KVA or
Flay sy�m larger separately derived system
.. - • - . _ JOB'sr 11VFt7RmATtt)N. Amp LOCATIOT ❑ Addition of new motor load or 0"A'. " E". "1.2". "1 -3 ".
et-5'
Joh no.: z Job site addr ess: Sy S 1001IP or mope- oeeepmey.
/0(24 -- I /a /O / sW ( 41 9 ke>C
❑ Sir or more residential colts. ❑ Recreational vehicle pinks.
City/StatcJZIP: 7 v Q,e 97 .2 a...? 0 FtwUh - car facililies. ❑ Simply voltage for TOM than
❑ I locations. 600 vole onmiaal.
SuitefbldgJapt. no.: 1 project lima �! N /c d 4-/1/Y)�.e /G/f' ❑ Service orfeeder 600 amps ormote.
• FEE SCHEDULE
Cross strtxt/eiirtxxiorts to job site / s7r/�, b h /Q/► /S' 2) 2 o I QM � I 'raw 'raw
•
L New residential single- or multi- family dwelling oak.
includes attached garage.
Subdivision: 1 Lot t3a:
1,000 sq. It. caters ` I 168.54 I 4
Tax map/parcel n0,: Fa add'1 son aq. R or portion 33.92 1
LmMed muar' residential 75.00 2
: : ... HESCRWTiON OF WORK , .. . .� (with above sq. R)
,/ ^ ' ' �� // � / Limited energy, multi - family
ee / j /' .' r/ / / L - /� ' 7/,; /,-0,, residential (with above sq. fl.) 75.00
Services or feeders insinllation and/or relocation
/ d .7 T'G /L / O /4- eri // i e/Lf,/.S 200 Imps or less 100.70 2
o . OWNER :' - : j: ` . ❑ 1ENANT , ' . : 201 amps ro 400 amps 133.56 2
Names 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
( Address: Over 1,000 amps or volts 55126 2
City/StateJZIP:
relocation
services or feeders Installation, alteration, and/or
l
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1 i
201 amps to 400 amps 125.08 2 1
Owner installation: This installation is being made on property that I owr which is not
40I amps to 599 amps 168.54 2
intended for sale, lease, rent, or exehange, aecotding to ORS 447.449, 670, and 701.
Brandt tirea11s- new, alteration, or extension, per panel
Owner signature Date: A. Fee for branch circuits with
above servtceor la=rder lee,
❑ aPPI;IQANF C' CONTACT' Pk"0i9: : 7.42 2
- .. each branch circuit
Business name: B. Fee for branch cimtilswirhoue
service or treader fry first
56.18 2
Contact name. ^ j Os 7/71-J b ands circuit
Each add'I branch circuit I I 7.42 I 2
Address: Miscellaneous (service or feeder not included)
Each rramuftcnucti or modular
City/State/Z1P: dwetli rVi, service and/or feeds 67.84 2
Phone: (03) 7 %e - 70 ,2 / I Fax:: ( ) Reconnect only 67.84 2
Pump or inigation circle 67.84 2
E -mail:
_ Sigo 67.84 2
- . - cON TRACEOR / Signal dresrit(s) or 6mirod cnergrr �y�
Business name: /9 b Se- d - 1 - '4 Co lk.11 �itotA �d' nhaation,oreteosiam Paget /.7 2
n Eaeb additional inspection over allowable in any of the above •
Address: ,2f f/� . /S3 " �2 . ` 4 Additional inspection (I hr min) 6625/ in •
City /State/ZIP: o e& - / 9 ' - j)j Q,e. 9700 I0vestigalioa(1 hr min) 66.25/ hr
�/ Industrial plant (I tar orin) 78.18/ hr
Phone (�,J�) ./ 9- 7 a O � O Fax: (,3) 4 6 9 7//4" Insperdons ibr which no foe is 90.00/ hr
specifically tamed (V. hr min)
CCB Lie.: / 970/ 4 Electrical " ( c_•GLC S LLie. G EA : : PERMIT .FEES
Soprv. Electrician signature, requirett • , :// t r ,&" 5ubtomt
Per r eview (25% of pencil fee):
es �)f�G /,d TEzT 6-€4.4//I ��a 8.� i, Z_ State mange (12% of penult fee ): 9 0
O
Print name e // TOTAL PERM IT FEE: 0 06
Authorized signatur
rhir permit application spire if o permit Is not obtained within 180
Print name Dam • days after B bas been weaned se complete
Number of inspections allowed pee permit.
•
I ^.Baikfmg∎Percoli LC-tkrmHAppdee 01/01/10 440.46157(1U05PCOMIWFB