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Permit r� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2013 -00005 Date Issued: 01/09/2013 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 2S110A600200 Jurisdiction: Tigard Site address: 14363 SW PACIFIC HWY Project: Las Jaras Subdivision: CANTERBURY PLACE, AMENDED Lot: PTS 1-4 Project Description: Low voltage for CCTV Contractor: ADT LLC Owner: KOLVE, G C 2815 SW 153RD DR 14389 SW PACIFIC HWY BEAVERTON, OR 97006 TIGARD, OR 97224 PHONE: 503 - 469 -7219 PHONE FAX 503 - 469 -7128 FEES Description Date Amount Specifics: Restricted Energy Permit 01/09/2013 $75 00 12% State Surcharge - Electrical 01/09/2013 $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 dens This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days ATTE • Oregon .' qui -s you to follow the rules adopted by the Oregon Utility Notification Center Those rules are *set forth in OAR 952- 001 -0 0 through OAR 952' -0090 may obtain a copy of the rules or direct questions to OUNC • = _ •.-4w• 2 1987 or 1 800 332 2 '4 Iss ed By: f ermittee Sig - _ � � .___._�! ✓� 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. 01/09/13 01:20PH HP LASE p.01 Electrical Permit Application rot, oIF,c .: us, (:),'i.' City of Tigard JAN 0 9 2013 potd `' : 9 Permit Nn t 1 " t.'s ate/ . 13125 SW Hall Blvd., Tigard, OR 97223 "" " p �'�` II I I . Plan Review Phone, 503 718.2439 Pax: 503.598. t o Other Permit. 1,16 A RD Inspection Lim: 503.639.4175 (I ' Y OFTIGARD Date Ready /8y• Juru la see Page 27' — Internet. www.tigard -or gov BUILDING DIVISIO Notitied/Mathod: Supplemental Information pq��� ai l. ITEM ' "r 51 3m sp + J ' " � r - � _ - �, . ti � `�{ " -- - - -- , Nh ;d 0 406, -,... '.Y ` �t J t $' r r ,' • . . '',1011' ' , ,F WI , ((� r .9� Ow' ' ,h�¢ . i i.. ' u I,` " � ., ,41 IJ" I r y� ^N i -. 4 .. .�wi. u. +a�sa �n i,tt i4t�r�'r w' 9i, /�, !.,n.,t .��i.' jl :>?'I.�4; ,A r 4 3 + 7,, ... , 0 New construction Eg Addition !Altcration /repIncemetlt Pleas* chock an that ripply (submit 1 sets of plans writems checked below): © Demolition Service a' feeder 400 amps or more 0 Building over three stones. 0 Other: ee µ�� where tho aysi table fault current Cl Marinas and boatyards. d ' � ++ r �kti �,• ) i s , s u.S � T ate; i r (YY ' Z nq b ., 9•, Pl ' �,�•0) J; 1;% exceeds t0,(i0U ISDvoltsor C7 Floating buildings ti t, t a, 4 d v "� ' j ' less to ground, us exceeds 14,000 Q Commercial -use aviculture! 0 I • and 2- family dwelling CO Commercial /industrial ❑ Accessory building amps for all other Installations. buildings 0 Multi - family 0 Master builder 0 Other: 0 rite pump. K + 'T't��� � m t , ' Mx�cn � a u � L,.1 P P• ❑ Installation o f 75 or V {� :' ' " t d a�i• i t F9 � va ,w, a r +i ❑ Emergencysystem. larger , I, 1 Y r A h a i a o t t i S y gar separately derived system. L :,tiM1 c , :n u z'� ,n. ,G> �, , : � �Mrt%tr� >8 t A l . '� % ,. a, 9 © Addttton of new mot t Q Job no.: 083 - 26086 Job site address: 14363 SW Pacific Hwy )00NP or more. occupancy, - - 0 Sir or more rosudoaual unite 0 Recreational vehicle parks City /State /ZIP: Tigard, OR 97224 0 Health•eare facilities, 0 Supply voltage fun more than " ° — ' - Q Hazardous locations. 000 volts nominal. Suite /bldg. /apt. no.: Protect name: Las Jaras _ ^ " - -W. © Ser Service or feeder 600 amps mpS o � r g � m � or �* n a ;�r ^ Crm _ ss streel/directi ..._ . -- !`V' t RS A2iV,vi1( " �,{tJr ' �ra'� t � iY l M1 *all tons to job site k� Per r'pt New residential single• or multi-family distinct* unit. Includes attached garage. Subdivision: � Lot rtes -: 1.0(10 so ft. or less - 168 54 4 Tax niap /parcel no.: Ea. add'! SU0 s<). R. or portion 3392 , above s r4, E' ^r N g l �� 1ws. i a I n y Limited energy, residential i r ' s ;t ai ,.M = tt e IN,l t, 4 rh +$., i� n i, —Judith q_ It.L 75 a° 2 Limited energy, multi "family 7500 2 CCTV to urglar alarm residential with above _srt. tl ) - Services or feeders installation alteration, and/or relocation Frill r i,� rsY r, , , , p�," yy't�in f''i tP r r ;, • s r, vi� o. > �; 200 amps or less 100.70 T I ' ,�{I„ `1,!? � ', ISM 1`G� j . i:' ii�. R , 1 * >' Y• 4 t:., u + •i'�,`f 7 . O . tii fi r • I g F 'r, / i° 2 to 400 am.,•.�•..•.. ".... MEW ,.� 2 , 1 e da ' atta r. o ar,, n ' ■ 4:' ,. , i ,' ".v J1+ , e,1 ,, ' S, ; , ti ;, E'i ; (,' 4,01r Sri 01 amps )YS ^ 2 •, �a ,t�, inlcr(Sr,1,I, _ Name: 401 amps to 600 amps 200.34 2 ___ --'^- -- ___...' 601 amps to 1,000 amps 30104 7 Address: Over 1.000 amps or volts 552 26 - -__, 2 City /State /ZIP: Temporary services or Feeders installation, altcrotion,and/or ____ - -.. TM relocation Phone: 7.00 amps or less I () Fax: ( ) p� T 5936 , Owner installation: This installation being made on property that I own which is not 201 amps lu 400 amps 125 08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. - 401 amps to 599 snips 166,34 - Branch circuits - 1 2 new alteration, or extension er anti Owner' Signature: +,, t Date: � A Ca: for branch circuits with }} Rr4t � r, t ' !' v s - r . c 1 ' ... M1 i r ., - _ - „,, i ts uq artY� "t+�r 4 ,� t e I l r. ap �'. } �,• +�` } �: jk l 5 ' � C Y�' # 1 P 1 �' 1 '1��f', (ll�i r ay �t : ' , Y �1 y� + �y + Y above service or feeder tee, /ILA a ,t, � lka.,,, i1111r��' °�' w, 0 t , $ t AN,.a l�� A 2. u a;' . each branch circuit Business name: B. Fee for branch circuit 7,4 s without ” — ° • ----' -- service or feeder fee, lint 56 I R 2 Contact name: branch circuit _ "'"' - '-- "'""'^-'" ^•-- ••••• Each add'I branch circuit ^ 7,42 2 Address: Miscellaneous (service or feeder not included City /StateJZ(P; Cych manufactured or modular 67.84 2 - dwelling. service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 6784 2 E �- "' °° """" " "` -- rump or irrigation circle 67.84 2 R F . q lw r Sign or outline lighting 67 84 2 • 1f 1h p ,i1' 'AVM °1`. t r ' ,,,i,ri, ( 0 t o y K' . ; „ f ��r� . f ' "� Signal cttcuiUs) or limited - energy Business name: ADT LLC nand. olterauan m extettslun. I 7S.0p 2 I a sh additional p aRC y i ns lion r►ver allowable in an of th e above Address: 2815 SW 153' Dr ° - - - - " " W. _ �_ ..,. -. d ," , .�.- -- ,...• "" Additional inspection (1 hr mot) t±tS 25/ hr City/State /ZIP: Beaverton, OR. 97006 - - - -_- - - ^-. " tnvostiganon (l he tans) 66 25/ he --- "� '" ""'•"" Lie.. , °-----• Industrial plaid (1 hr min) 78.18/ hr Phone: (503) 469 - 7241 _J Fax: (503) 469 Y Inspections for which no fee ma [Lie.. 196360 s. tficali , listed V h r min) 9owow hr Electrical Lie.: CLE3I7 S CC ttprv. Lic . 4 S�f .F. Vic' ' .,:, , Npp�� ti �_. ....ter �.. tl .. M1 , ,, n:. ' Q .�`�J.1H Y , J Sttprv, Electrician signature, required: ' _ Subtotal: t 75,00 _.. "� ` ` _ _ Plan review (25%of permit fee); - Print name: Eric Willard `'- _- c Date_ : 1/9/13 State surcharge (12%of fee): 9,00 Authorized signature: TOTAL PERMIT FEE: 84.00 nix permit application expires if a permit is not obtained within 1.80 Print name: 1- Date: ,T " " - days after It has been accepted as mason., • Number of inspections allowed per penult I.1 8uildmg\Permits\ELC.PennitAppttoc 07/01 /10 440.461 ST(I11a5f('QM/wE8 01/09/13 01:20PM HP LASERJET FAX P.02 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: t ,.. si • •,r r !• r xn,u , Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: r i a:v ; �:' :M. Sp1. ;U: p . .. � 3, ��ti� s.�v r , t r', Ji at �fi. �1 Lma . fr r ! iP � n )�acXA. -0. Nu7.. � i 4 �dt. .{� .. � .�. �r �'t �f • 1 � L %1 •�j7��, � Pee for gad commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: [� Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ IIVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling Other c cT V "Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I Mudding \Pe$01118 LC•PermeApp dm 07/01 /!0