Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00201
T [CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 1 S136CD90000
Jurisdiction: Tigard
Site address: 8060 SW PFAFFLE ST 100
Project: Gryphone Subdivision: PFAFFLE OFFICE CONDO Lot: 2
Project Description: (1) low voltage for access system
Contractor: ADT LLC Owner: PFAFFLE PLAZA CONDOMINIUM, OWNER
2815 SW 153RD DR ALL UNITS
BEAVERTON, OR 97006 00000
PHONE: 503 -469 -7219 PHONE:
FAX: 503 -469 -7128
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/30/2012 $75.00
12% State Surcharge - Electrical 08/30/2012 $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 OAR 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling �d�' 503.23 oor1.800
Issued By: Perm Signature: £ &t 4 PPIJ e_ T I /D )4
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.
08/29/2012 14:41 FAX 503469711� ►n � � DI L .S ECIJRITY 0001
Electrical Permit Apphcat Q 1tll�i l mo FOR O1•F1 ►CE USE ONLY
City of Tigard p 1 a e • 30 it Permit Noe a - p,, ao
4 . . 13125 SW Hall Blvd., Tigard, OR 97223 Z1OZ 6z ay Bad Plan Review
Phone; 503.7182439 Fax 503.598.1960 Date/E1 : Other wit:
TIC A r. D Inspection Line: 503.639.4175 ° * / Date Ready/By: hs CO See Page 2 for
Internee www.tigard
' ` -- I Notified/Method: 11 5O Supplemental Information
z� 4' r A Y. t , ,476)._ C �'',^
t f, ,1I1?!�`,�r n� -' { ^ w k ' ; w; :: + D. ( �) a lr. � .. • .- i�.: 7 ,h. u b� r '`ti \r /r. "L ' '�'.•'` i� '` .�7}L'@�.4-i it�2:.. W . �r +MJ��oN
❑ New construction ® Addition /altetation/repincement Please check all that apply (submit 2 sets of plans w /items checked below):
ID Demolition ❑der; ❑ Service or feeder 400 amps or more ❑Building over three stories.
it Demolition
i 1'" "v t/ Other: where the evlulablc faWt ctttrcat ❑Mar and boatyards.
- { r_" l ^f1i'. ct r ' �(j ( : 9:, ' 1i� 5., tl Wr iiNL vim' it'd t'`' „ -iii exceeds 10,000 amps as ISO volts or ❑ Floating buildings.
less to mind. 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, ❑ Fire pump. ❑ Installation of75KVA. r
�, �' -I; 4, y » CI Smersency system, larger separately derived system.
n `V r+ s y y ?s Mi>; o f tn h a i. j rj% 6 a a�t•[hit3 7 .. ' 4 ' ` '. ,� inn_ ,erne= rra. r1 �; fat >`•: -,. �r.s. d thy ' ,. . „ ❑ Addition of new motor load of ❑ „ n ", "E ", "1 - 2" "1.3
Job no.: 083 -26708 Job site address: 8060 SW Pfaflle St 100HP or more. occupancy.
❑ Six or more residential units, is Recreational vehicle petits.
City/State/ZIIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 100 1 Project name: Gryphone ❑ Service or Feeder 600 amps or more,
Cross street/directions to job site: Darription Qty. Pct. Mat - ' •
New residential single- or multi family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1 .000 sq, ft. or lcsa 168.54 4
Tax map /patpcl no.: - Ea. add'I 500 sq. R. or portion 33.92 1
Limited energy. residential
: ,vz- i `7 7 '. a`r;t: MY rl. ,;, s r f►Y , +r t v; l `' (with above sq. ft.) 75.00 2
Low voltage Access system Li residential (with / ab ove t sq It) 75 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
� p,RO'P x , ' ' +` 1 "' v "� r+t'� � 2012mp 10 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Gryphone 601 amps to 1,000 maps 301.04 2
Address: 8060 SW Pfalfo St Over 1,000 amps or volts 552.26 2
City /State/Z1F; Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
g relocation
Phone: (781)849 -0645 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not ?01 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
Owner signature: Branch circuits — new. alteration, or extension, per panel
gnatut Date: A. Fee for branch circuits with
cr a M a above service or feeder fee,
,; A i" I D ;_\IN.J1. "aA; # ;�# 4. ;',;, ;Ifi iif10: ;'�;77h",..�.i.�•d. !` .*1AE^� c' each branch circuit 7.42 2
Business name: B. Fee for brimcb circuits without
service or feeder fee, fast
56 18 2
Contact name: branch circuit
- - — . Each add'I branch circuit 7,42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling service and/or feeder
Phone: ( ) FAx; : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
�1 a •+e ', � r'r" ''i ." ' x:e. v •1 :r5 Ssgn alteratioa ore. itedd re 1 Page 2 75.00 2
Business name: ADT LLC
Each additional inspection over allowable in any of the above
Address: 28115 SW 153 DR ✓ Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Beaverton, OR 97006 Investi on (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78,18/ hr
Phone: (503) 469 - 7241 J Fax: (503) 469 - 7128 inspections for which no fee is 90.00/ hr
specifically listed (K hr min
CCB Lie.: 196560 Electrical Lie.: CLE3I7 Suprv. Lie.: 4252LEA + . ' } 7,' ''rt
Suprv. Electrician signature, required: .� Subtotal: 75.00
Plan review (25% of pe rmit fee):
Print name: Eric Willard --
Daze: 08/29/12 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signature:
This permit application expires if o permit is not obtained within 180
Print name: Date: cloys after it has been accepted as complete.
N um b er of Inspections allowed per permit.
I: 18uildineermilsELC- PermitApp.doc 07/DI /I0 440 -4615T(IIaVCOM /wee
08/29/2012 14:42 FAX 5034697110 ADT SECURITY Z1002
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
=1.!
Fee for 311' residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Gaxage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other
Lr CJ VY Af!'J ::ti� ���'l.Ky `��f�� !�� }�___ ' ,�,��.,r i
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
TI 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: 'SuudIog1Permi`F1C- Permiapp.doc 07/01/10
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELR2012 -00201
T [CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/30/2012
Parcel: 1 S136CD90000
Jurisdiction: Tigard
Site address: 8060 SW PFAFFLE ST 100
Project: Gryphone Subdivision: PFAFFLE OFFICE CONDO Lot: 2
Project Description: (1) low voltage for access system
Contractor: ADT LLC Owner: PFAFFLE PLAZA CONDOMINIUM, OWNER
2815 SW 153RD DR ALL UNITS
BEAVERTON, OR 97006 00000
PHONE: 503 -469 -7219 PHONE:
FAX: 503 -469 -7128
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/30/2012 $75.00
12% State Surcharge - Electrical 08/30/2012 $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 OAR 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling �d�' 503.23 oor1.800
Issued By: Perm Signature: £ &t 4 PPIJ e_ T I /D )4
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.