Permit w
CITY - T I GA R D ELECTRICAL RESTRICTED ENERGY PERMIT
PERMIT #: ELR2005 -00269
AA DEVELOPMENT SERVICES DATE ISSUED: 9/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112DD - 01600
SITE ADDRESS: 15575 SW SEQUOIA PKWY 130 ZONING: I - P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG
Project Description: Low voltage - burglar alarm. Job #083 - 19366 - 01.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC REALTY ASSOCIATES ADT SECURITY SERVICES, INC
15350 SW SEQUOIA PKWY #300 -WMI 2815 SW 153RD DR
PORTLAND, OR 97224 BEAVERTON, OR 97006
Phone: 503- 624 -6300 Phone: 503- 469 -7244
Reg #: LIC 59944
ELE 26- 209CLE
FEES
Description Date Amount REQUIRED ITEMS AND REPORTS
[ELPRMT] ELR Permit 9/8/2005 $75.00
[TAX] 8% State Surcha 9/8/2005 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503 - 246 -6699.
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'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
09/08/2005 10 :38 FAX 5034697110 ADT SECURITY Q001 —
.-Electrical Permit Application FOR OFFICE USE ONLY
City \ �y
of Tigard u E C i 1 Hall Blvdigard, OR 9x Phone: 503.639.4171 Fax: 503.59 d 0 �; ._. v \ Date/B
O f, , I I ate/H Other Permit:
Inspection Line: 503.639.4175 4 ', 2� 4 -• i ' Date R ® see Page z for
Internet: www.ci.tigard.or.us Notified/Method: Supplementallnformedon
'+j: ` } - , 1 1 j z_1;7 7: i�Tt- _.! .I ,r 1'171fir.9Vv 1 ,, :a , ' 1'_ , 1 y 6 4 •1 �'��f -I 1t r, I, PAW 1y I,2. • '094� 'h L "'u - ,� �
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P: ` ew construction ❑ Addi i /al ati • ' replacement Please check all that apply:
❑ Demolition El Qth ti 1 - OService over 225 amps, comm'l ❑Hazardous location
i r t� . 'r it �, i t 4.,,• 1� i � > ` r ,{ir- (' >;y •{,7 s4 , ,�� i .t4 {. ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
l t � , ' 1 ' , , :r`. 1i,j i - -Pl �� I '( (L i S 14 t i�ti ka 7 h " ''' II J'41 �ktf I IFIEI •.j,' y
:t yr - ,_ �.�. 1,...,, ,..._..�... _:- • ._ar: n Lg,. ,uy, li of 1- and 2-family dwellings 4 or more new residential
❑ 1- and 2- family dwelling M Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant l over 99 pe rsons ['Manufactured structures or
i ? , t n ',. y t tl � ,r i � .' \} . T G' i Y 7.:f t r' .Y,: ft i a r L y a l l f. ] ri T y� lyi, {t+ * , , , L -E 7�k T i 1;∎- {' n il t .,Ji W ,r1. 4 0 n.L lgl asy, 1 i ,''I r21,1 ' ' - r � ❑� ess/li tm tan P
.. . }._.� . t_. . .�,. � .�,�,r?�ri r 1t� �ek hr�- ��; Ct �. R� �,. �m. �. �b5i� „— .:t � i� g P park
li RV
Job no�. • �C3j,Q(p -p1Job site address: 1.b S i) S I n P ❑Health care facility ['Other: .
( dA ubmit 2 sets of plans with any of the above.
City / State/ZIP: 9--- 11 — The above are not applicable to temporary c ble to ors cons truction service.
Suite/bldg. /apt no.: /3 D Project name: N) (" C• . < � .i i Ni f. 1 1
„ R _ + � , 1 „ s .s . - ",. '
Description y Qty. Fee. Total ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. R or less 145:15 4
Subdivision: • I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
c �r r , ,= , , ,. r , r Limited energy, non - residential 75.00 2
x! I r ' :',
.V_v.'f7�J� `.:: i V '.)' :'_ T �U J ) j 71J5l�1)I �t i V � 1 � L . ', f , ) ' � !:3 r 1 : r riP e - ,�� 1� r� , I - 1 _ h7'
1.,� 1 _� . . . _ r � tel ` '' i _�.:,.._, Each man or modular
el ir i n ,i^„ ty y dwelling, service and/or feeder 90.90 2
A ',(J l r l ��(� , Services or feeders installation, alteration, and/or relocation
U ( 200 amps or less 80.30 2
;i. r . r( 91 j 'i 1 I - > i i - :T JI �l i s . ici � "f i C i �1 { p 1» . �' r 201 amps to 400 amps 106.85 2
- =t'.1;D.2 _t z2 .. )-2rr ^::
'2�' . �,,LI.`xR.4•''1 w >_. -' :1063 i - -,v.1...,1 -1 !) �t.i. c., 1y211_,1t' 5 . 5. 1 ,.1....1.'y� 1aa, 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
Owner installation: This installation is being made on property 200 amps to or less 2 1
s 00.30
g p perry that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
' r l t t '1 r e el. L :7 �; . T ) M r r.l IF r r rf , . i , r _ • 2 ' ri •
V . ! . �, 1 r i__.�. 1 .� i 4 l t 51' 1 =t1" 1 :.1. , ::. __ ..I'' i...{ . i..It :.. ..i' 1 � . ` r. 1 ) .` . � ,,,,,, � ;0; 1. i,9 , A . Fee for branch r circuits ee with
service or feeder fee, each 6.65 2
Business name: branch circuit _
B. Fee for branch circuits
Contact name: n {I'�/ ..11, l t^ � coI , )h u ±e) without service or feeder fee, 46.85 2
Address: e � e each branch circuit
• -
Each add'i branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not Included)
SS d�1""c�� l , ^ oLIJ .._ I Pump or irrigation circle 53.40 I 2
Phone: 3) l,(! a ggER �( Fax; ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
y'r rl 17 r -, ' I I . r ` i y 1i t' : ■ l 1 `
1: k , 7t 1 0(i .1::-.7. i. J �, r 4 _,.. - '..2.2:1,,..,.,^ iat ', i ; c''r v:-,,,......4:. l
, i 1 . 1 r l j1,l Jlrl ` iik,.L - energy Panel, alteration, el' r
extension. Describe: l Page 2 ''15.(X 2
Business name: ADT SECURITY SERVICES, INC.
Address: 2815 S.W. 153fd DR. Each additional inspection over allowable in any of the above
RFAt/FRITIN, OR A7Q11R _ Per inspection 62.50
City/State/ZIP: (503) 469-7100 Investigation per hour (1 hr min) 62.50 _
Phone ( ) Fax: ( ) Industrial plant per hour 73.75
1,U5'i3O71Fi.°'� ; , 'l t.,° ' ;! si TITS :�,; �C'>?41 "l , a v >• ' ' = r ,
CCB Lic.: 596144 Electrical Lic.: � )uprv. Lic.: &G1 LFA Subtotal
Suprv. Electrician signature, required: /.,/1 A Plan review (25% of permit fee)
Print name: 14th V X � Date: el g el g 1 D5 State surcharge (8% of permit fee) t. up
• F-
TOTAL PERMIT FEE 81,00
Authorized signature: This permit application expires If a permit is not obtained within 180 -
days after It has been accepted as complete
Print name:
I Date: • Fee methodology set by Tri - County Building Industry Service Board
I a• Number of inspections per perrrlit allowed
e\ Btdlding\PemtiuAELC-PermttApp.doc 125eTe I 1 C`T 440 - 4615x(10/0 /COMNJEa