Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I ; COMMUNITY DEVELOPMENT Permit#: ELR2013-00277
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/05/2013
Parcel: 2S 102AA01100
Jurisdiction: TIGARD
Site address: 12035 SW PACIFIC HWY A
Project: Tigard Auto Stop-Brake Team Subdivision: PAYLESS SHOPPING CENTER Lot: 4
Project Description: Security system.
Contractor: ADT LLC Owner: TIGARD AUTO STOP PARTNERS
2815 SW 153RD DR 2829 RUCKER AVE STE 100
BEAVERTON,OR 97006 EVERETT,WA 98201
PHONE: 503-469-7241 PHONE:
FAX: 503-469-7110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/05/2013 $75.00
12%State Surcharge-Electrical 11/05/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 1 Other: 0 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 952-001-0090. You may obtain a cooy o •- -- • direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /J
Issued By: s�i Permltte= -ignature:
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l °, /"7/4/
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 503.639.4176 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.
Electrical Permit Application , FOR orrice use ONLY City of Tigard ,V� Received
Date/B : / iii Permit No.: . , di -
n 13125 SW Hall Blvd.,Tigani,O
.13 Plan Review Other Permit:
- Phone: 503.718.2439 Fax 503. 98.1 `' S _ Date/B :
TIC,A R D Inspection Line: 503.639.4175 V Data Ready/By: HI See Page 2 for
Internet: www.tigard-or,gov 1(a gAp Notified/Method: �Dj Supplemental Information
a�1•At:«,'-.'?i! - i�-� _=a `=-� ��n .2�.,�? 4:4"7,1 : 'q �� ;F:"aG*? '�`re�T;,, 7 i� g� �ai-.�-�^F5`t:� `.c':a.,,,1 ;4�;
x.�'_:r7 ,�tq�.. s�i''4G'>f.�„�., ,,�.. �_.'t��_���7;,� ?�1.? 'f' ..�'.`.;;>_. "��;:'�^�'�"::<:.. _:.:'•.. � .-. -',:.;s:-' ,�.
❑New+construction (►ii Addition/al ttlf���ll�cement Please check all that apply(submit 2 sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available faun current ❑Marinas and boatyards.
r Q �s ;'.t exceeds 10,000 amps at 150 volts or ❑Floating buildings.
ri. :ti`" ; -_a4•V -i' A, e,C"xO U `.s:.[# rp,'.42-7''.,:;:-.1s. ", ': .3 i,.
*'z";-: : - � °7� `:� ��'- � �°`~ '�`"�~ ` less to ground,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 of 75 KVA or
y r,-..,� ❑Emergency system. larger separately derived system.
.�x:>.:.�1�: ._.. - .�}ua�• . �t° Tio��Yn4�l�ic 'ri% ';,z_`''';'^:..,.,.,,� A•:
_ - KGs._ -�r-sa=� ❑Addition of new motor load of ❑"A","E",°1_2","I-3",
Job no.:400081090 I Job site address:12035 SW Pacific Hwy tour or more. icy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard ❑Healthcare facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:97223 A I Project name:-Brake-Feree -t ❑Service or feeder 600 amps or more.
I,IA(a, L�wI �'�I P.7Ke :P:t:}. .5tc-;) hEg;$ DL)�Ez'' ° =r r"'?s`.=It71
Cross street/directions to job site: 10rn1{,[; /w Description I Oj. I Fee. 1 Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq.ft or less 168.54 4
Ea.adki'I 500 sq.ft or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
«- -• ,,:';,t-z "`-. �;t;i`:p X1.'0 ▪ 7• _,'4i'g;,,)_ :r4.;;'.�c:,..x..41 with above ft.) 75.00 2
4 ,r :> Y Limited energy,multi-family
Low voltage burglar alarm residential(with above sq.ft.)
75.00 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 100.70 2
""zc' - ;, ;•.� -,--1 ��" �}• `. •` +".'.`;-'j 201 amps to 400 amps 133.56 2
•
,��t��.�• ��,.> ;;._t::�:w.�_� .,j^..�- .�"�`.�},'sac:;- ,:.r,_>� +�; rvs v'< �L�.>�'.
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2 •
•
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: a Temporary services or feeders installation,alteration,and/or •
Phone:( ) I Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2 •
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps . 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. •
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
N?=h •:�---'. above service or feeder fee, 7.42 2
'y.4:"6 %i'; -7!=:: iFPG i7,IVT'1r:`�'':;t.t: ':-k ., : t=1 J':: -7',-- 4,-- -,i.:-�.
a. -r- , t , e:.,t_` 1' each branch circuit
•
Business name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2 '
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included) _
Each City/State/ZIP: manufactured or modular 67.84 2
ty mg,service and/or feeder
Phone:( ) I Fax::( ) Reconnect only 67.84 2
Pump or irrigation circle _ 67.84 2
E-mail: . 67.84 2
Sign or outline lighting
' ::: , . g_,.S.•' b' a.. ?. .,,_- t'.,:' :'4;-,e -.'•' Si this)or limitednergy
Business name:ADT LLC panel,alteration,or extension. 1 Page 2 75.00 2
Each additional inspection over allowable in any of the above
Address:2815 SW 153ie Dr Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Beaverton,OR.97006 Investigation(I hr min) 6625/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(503)469-7241 I Fax:(503)469-7110 Inspections for which no fee is 9000/hr
s iftcally listed('b hr min)
CCB Lic.: 196560 I Electrical Lic.: CLE317 I Suprv.Lic.: 4252LEA _-;:141:�:- 4-�-�9.��, 0P fe.•,5:.��-:a;.e.;ca,:W
Subtotal: 75.00
Suprv.Electrician signature,required: Plan review(25%of permit fee):
Print name: Eric Willard I Date: 11/5/13 State surcharge(12%of permit fee): 9.00
- TOTAL PERMIT FEE: 84.00
Authorized signature: _ ......./10e- 'Ibis permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: f a ate: • Number of inspections allowed per permit.
I:\Building\PermitslELC-PermitApp.doc 07/O1/IO 440-4615T(I IPoS/COM/WEB
Electrical Permit Application - City of Tigard
Page 2-Supplemental Information
LIMITED ENERGY PERMIT FEES:
:14.17M.alatiWalit707-74L-Yi.teaRaMil.ME
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
O Audio and Stereo Systems*
• Burglar Alarm
• Garage Door Opener*
Ei Heating,Ventilation and Air Conditioning System*
• Vacuum Systems*
El Other.
Ki.,,P.7J77"7. Fi*:,70W.:0-;N''t_;tingilarinkilg:M
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
ED Data Telecommunication Installation
0 Fire Alarm Installation
El HVAC
El Instrumentation
• Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
ElNurse Calls
El O• utdoor Landscape Lighting*
ri P• rotective Signaling
Ell Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
IABuildingTerrnits\ELC-PennitApp.doc 07/01/10