Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
C.',°. COMMUNITY DEVELOPMENT Permit #: ELR2012 -00203
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 1 S136DB02400
Jurisdiction: TIGARD
Site address: 11642 SW PACIFIC HWY 100
Project: Pixel Battles Subdivision: AZOIC TERRACE Lot: 1
Project Description: Low voltage for burgar alarm.
Contractor: ADT LLC Owner: CHAMPION, RONALD V & ROBERTA E
2815 SW 153RD DR 16449 LEXINGTON CT
BEAVERTON, OR 97006 LAKE OSWEGO, OR 97034
PHONE: 503 - 469 -7219 PHONE:
FAX: 503 - 469 -7128
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/04/2012 $75.00
12% State Surcharge - Electrical 09/04/2012 $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 $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
•
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance. or if work is suspended for more the 180
days.TION: • -. • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 0010 through OAR 95 1 i 1091 You may obtain a copy of the rules or direct questions to OUNC by calling 5'3432.1987 or 1.800.332.2344.
Iss d By: ! lirJ /LJ�� Permittee Signature: �. f _ •' a , ' � ' 4F
OWNER INSTALLATION ONLY .
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
•
07/19/2012 11:47 FAX 5034697110 ADT SECURITY Z 002
Electrical Permit Applicatr4MVED FOR OFFICE USE ONE)
°
City of Tigard
R 97223 JUL J, ate
L 1 9 2012 it .•
Received 911EIMO P • N E '
0
13125 SW Hall Blvd., Tigard,
1/ 1, e r 1 n . .
11111 Plan Review
0 • phone: 503.718.2439 Fax: i Date/By: Other Permit;
TIGARD
Inspection Line: 503.639.417 art typ TIGARD Date Re.dyffil hiri.. E3 See Page 2 for
rn
Inteet: www.tigard-or.g.BUILDINGDIVISION Notified/Method: Supplemental Information
'.1.1vrr '.01 • l',.'-'•' • ". ; ' i n t ' .:■. - .. : ■'.
). • : :f 1" Ci . '612: : :!C O 'il l 1 : 1 ; t i l0:411 ; : -' 1'.{. '": 1 ii . A : 1 :1 ■##*•10 1 .04$Agi ," 'in : ! : :::Vt i!R
; ..1 ! : : ..il! '5 .. :(1.i i ; ini. ! ;! ::::::■';',,Iii:i:::•1,::::ir•'1•":1,:.'litk*NYAWIl;..,...,: Z.P' !!•:'
' ...:.:„:•-:: .
rg) New construction 0 Add ition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
El Demolition ______ Other: where the available fault current 0 Marinas and boatyards.
N!•i' , , ,.:1';eoge.6•Ryi...cicitoiltiiiittioril; i , ; , ; :.;..d,; ..,:!,:.:. :,,,.... :,... . exceeds 10,000 amps at 150 volts or 0 Floating buildings,
" ' l'': '' l '''''''' ' ..'' I '•- :7 ' ; :• ! • - • - " : F . ' •.:''"' '' ' - ' '''' l '• '''' ''' less to ground, or exceeds 14,000 0 Commercial-use agricultural •
9 1 - and 2-family dwelling g Commercial/industrial ID Accessory building snips for all other installations. buildings.
El Multi-family 0 Master builder 0 Other: IDFire pump. 0 Installation of 75 KVA or
., . • :., - • . ,....,-- - .;,. ",...A4 .., • 4s ...... ......,",:,.. ,. .,L1,;.;., ..■.; .,..;;,...,■ . ii, 0 Emergency system. larger separately derived system.
tig'IP:k -Ar. 1 ;::;":.::: 0 Addition of new motor load of 0 "A" "B" "1-2" "1-3",
100HP or more. occupancy.
Job no.: 083 Job site address: 11642 SW Pacific Hwy
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/Z1P: Tigard, OR 97223 I:Health facilities. 0 Supply voltage for more than
1:IHazardous locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: Pixel Battles ElService or feeder 600 amps or more.
--, !1:■!ii'!X:ili!...;.!:!iilil,iitt.,60-10001.C":,ii,:i:.,.;'%:',:i2P.iMii';::14:•.'.:V,
Cross street/directions to job site: Description I Qty. I Fen I Total i •
New residential single- or multi-famiIy dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential
7100 2
IR::::';'!■:]! ?'• , ■ ' ...ii::if (with above sq. ft)
75.00 . 2
Low voltage burglar alarm , residential (with above sq. ft)
Services or feeders installation, alteration, and/or relocation
-
200 amps or less 100.70 2
PV:Itt k
VOFiiiitik rfiWa
ii 201 amps to 400 amps 133.56 2
,,, ii, ....- ,..s, ”..,-,-.;.,,,... ..r.... ' . .■...,.. ■, ..', .. :.:.
401 amps to 600 amps 200.34 2
Name: Pixel Battles
601 amps to 1,000 amps 301.04 2
Address: 11642 SW Pacific Hwy Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard, OR 97223 Temporary services or feeders Installation, alteration, and/or
relocation
Phone: (541)513-2320 Fax: ( ) 200 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 125.08 2
intended for sale, lease, tent, 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
!':;:finalcotio,4.:Nsrei..,!:1;;.:!;[...!::IF,.;:.iltOrtai f . :0!:I . 3... ......,....„,.
— ' - 0 ■,...;.::' above service or feeder fee,
742 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP:
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
.. . . .,..,. Sign or outline lighting 67.84 2
i'i;iVAI 0, i ; V: 1 ? !. . '-' signal circuit(s) or limited-energy I
75.00
Business name: ADT LLC
panel, altemtion, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: 2815 SW 153 Dr Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr mm) 66.25/ hr
City/State/ZIP: Beaverton, OR 97006
Industrial plant (1 hr min) 78.181hr
Phone: (503) 469 E A I ,.., Fax: (503) 469-7128 Inspections for which no fee is
90.00/ hr
V
. specifically listed ( hr min)
CCB Lic.: 196560 Electrical ibi c.: CLE317 s1Suprv. Lic.: 4252LEA, "a j ii
/0/1/11 Subtotal: 75.90
Suprv. Electrician signature, required:
Plan review (25% of permit fee): '
Print name: Eric Willard Date: 07/19/2012 State surcharge (12% of permit fee): 9.0 1 e)
TOTAL PERMIT FEE: 85.
Authorized signature. . This . 01.1r - A110111 11
/ - .../ - ■0 1.°111. - is permit application expires if a permit is not obtainesrwithin ISM
■4 days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1: \Building\PerminNELC-PermitApp.do: 07/01/10 440-46157(11/05/COM/WEB
07/19/2012 11:47 FAX 5034697110 ADT SECURITY 11003
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for a residential systems combined ... $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
0 Burglar Alarm
0 Garage Door Opener*
0 Heating, Ventilation and Air Conditioning System*
1=1 Vacuum Systems*
El Other: _
. .......................................................................................................................
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
O Audio and Stereo Systems
• Boiler Controls
O Clock Systems
El Data Telecommunication Installation
▪ Fire Alarm Installation
El HVAC
O Instrumentation
Ej Intercom and Paging Systems
0 Landscape Irrigation Control*
O Medical
Nurse Calls
O Outdoor Landscape Lighting*
El Protective Signaling
O Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I:\Buildln5\Pcrnuts\ELC-PnilApp.doc 07/01/10