Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2013-00283
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/07/2013
Parcel: 1 S136CD01400
Jurisdiction: Tigard
Site address: 11654 SW PACIFIC HWY 5
Project: Platinum Elite Subdivision: 2006-016 PARTITION PLAT Lot: 3
Project Description: Security system.
Contractor: ADT LLC Owner: MASSIH,ABBAS/YASAVOLIAN, PIERROUZ
2815 SW 153RD DR 0836 SW CURRY ST, UNIT 504
BEAVERTON, OR 97006 PORTLAND,OR 97239
PHONE: 503-469-7241 PHONE: 503-704-4240
FAX: 503-469-7110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/07/2013 $75.00
12%State Surcharge-Electrical 11/07/2013 $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 copy of the rules or direct questions to OUNC by calling 503,232.1987 or 1.800.332.2344.
t
Issued By: __ _ _ - Permittee Signature: *,--e-Z"
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.
11/07/13 02:37PM HP LASERJET.4: t' iS) 5 0 3 46 9 7 1 3 9 p.0 1
Electrical Permit ApplicationfA-t‘ 1111.11111111==11111111
City of Tigard Vt ) .) Received
Date/ily: 4/ 411877-7_, Permit No.fr.,:,. ..(33gott,2,1-1
"I 13125 SW Hall Blvd.,Tigard,0 7223
' 3: • Phone; 503.718.2439 Fax: 503.598.196Q i
IIII 1 rt.%\ Plan Review
Date/By: --7
Other Peonit: .t;• t.C,i2cal-_-_crratt.7
•1.I 6 A 0.0 inspection Linc: 503.639.4 175 .„,kV Date Ready/Ely. lurir----Hilit Puge 2 for
Internet: www.tigard-or,gov rs.V.Iti: i Notified/Method: (..1-- al Supplemental Information
111 ,';',A'.'0, ;?,iii ' ,3,d4 '::alilip*tilliAt'..21;iit 1,2,1,/,1r,!.:,:r‘w'rif 9,ril.,•ItitniNdr0/204.140,Aike
r---1' . . • " . .taot. .Id.. • . '''' li'' ''' ' 4 Please chackall that Apply(81;bmila so.ta'of plans wiiteUia chOckail ltl'owj;
L.,..1 New constmetion Ia.'Addition/altei?s .ii. ■.,', merit
0 Service or feeder 400 amps or mom 0 Building over three atorict.
0 Demol it ion 0 Other: where me avoid*faith unreal 0 Marinas and boatyards,
Tr.).0414177F.S,;t1,111t41:.! r,'.',,,741g7.7-7rt..,:l' c l•;,:',,,tt 7(;', ;' i,:,',75.77, , ,,75.,„Mq,mwmg exceeds 10,000 amps at 150 volts or C3 Homing buildings.
NI re'•:';'',,fr,1 .-A-lit r, If, -, 0 viorai,-4450Nyeepu,vA;J:Atala to ground.or cxceeds 14,000 0 Commeicial,use agricultural
0 1-anti 2-family dwelling 1:3 Commercial/industrial 0 Accessory building airms cur all other installations. buildings.
0 Multi-famil 0 Master builder 0 Other: 0 Fire pump, 0 installation 01'75 KvA or
;/1 OW i'44 Millen i'''lliq,,M1r1,7„i9s1,'AV '-i'1'let'.rifirvrAVISirM.!iE xr r ,!, 477 0 Emergency system. larger separately derived sYsletri.
„...a.A 'hvgaqi tvdric05,615i6:41.iirgr.ialj-iiti0;6;Ws',.,' ekViao.1 4:101 t.1:'s ‘M,11'(::`'.j Ikea a Am.of new motor load of 0-A-,"E","1-2" "t•r,
Job no.:083-28074 Joh site address: 11654 SW Pacific Hwy 100HP or more. occupancy.
CI ial s i x or more resident uni
-- ,- ts 0 Recreational vehicle tunics.
City/State/ZIP:Portland OR 97223 0 licalth-eare facilities. 0 Supply voltage for more than
-,..-..,. .._,....,„,......_--...„._,...,_—_ 0 itayardoits locations. 600 wins nominal.
Suite/bldg./apt.no.:5 1 Project name:Platinum Elite 0 Service or feeder 600 amps or more.,,
----- gaglEi.!.4'...)61.' ginik■Jk:237..'elltigilllgi/
Cross street/directions to job site:
......-
- -------,,, " ------- ------- New residential single,.or iniiiii-fainliy-dwelling unit.
Includes attached garage.
-
Subdivision: Lot no; Lnoo so ft.or less
--..-- .__ __„*„.„. 168.54 — 4
-.- Ea.addi 500 sq.ft or portion 33.92 1
Tax map/parcel 110,:
Limited energy,residential..--- —
75.00 2
tnitlfERNali. ‘‘r 7""ri. -11. 'i 77"o.-..,1 0 1 ,'.47,77rum,orralwowi j.,viii,00,1_, Lf11_____
, '1J1 .'1,. '!` . ' ''''..11i ''''' ' '" ".'''-- ' '4'' : ' l''4''''i'. ''. l'2"1"Crl'rul" ''') °'4 -1.,i1Tan-ergy,mul'f • ----- ____..—..
II-amity
75.00 2
Low voltage burglar alarm residential(with above all_ ......_._,......,.........___ ..._
- .,..............___........._ „,,,..........„...........___ .....„,..,..,.,.,......,.........._ _..Services or feederspstallation.alteration and/or relocation
200 amps or less 100.70 2
....
7.77,1Wei Etr7KntIr' 1 IPVIRFEFTiln-Cif417.4104"7177779,1,577:71; 201 amps to 400 amps 133.56 2
401 amps 10 amps ,,--....
200.34 2
Nallie: 1T Ow
601 amps to i .__—)00 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
----------- Temporary service;or feeders installaiWnTaitera-tion,and/or
City/State/ZIP:
relocation
.---
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 propeny that 1 own which is not ________
401 amps to 599 amps 168.54 2
intended Or sale,lease,rent,or exchange,according to ORS 447,449,670.and 701,
Jiranch circuits alteition or e.xtenalotiLper_panel ___
Owner signature: Date: A.Pee for branch circuits with
.gl'op ao 1,7gee,c;,,‘i'lii tn17;. ,'''''',;ti.77,miv, ,;17, above service or feeder lee,
7.42 2
L'iFA604.1't:.421.4s4/11iroii,I oftai.,,,,.4.,r,','.:!,..,!..4 circuit
—
B.Fee for branch circuits warm
8 tiSiness name;
- service or feeder fee.first
56,18 2
Contact name: _ branch circuit
Eaeh add'I branch circuit 7.42 2
-----
Address: Miscellaneous(service or fecdcrnot included)
-.....„--
Each manufactured or modular
/St 67.84 2
c ity -ate/Z I P: dwe(linksurvice and/or feeder ,,
Phone:( ) 1 Fax: :( ) Reconnect only
67.84 2
- . Pump or irrigation circle 67.84 2
F.-inail;
Sign or*ad ine lighting 67,84 2
ilavgiikatiii ...2b, Amn.,5140,,Nlvii;;Ivapifilvoqfpipla,4,N,\?51;,,,,',,, Signal orcuit(s)or limilcd-ettergy 1 „-
Business name:ADT
75,00
_pat151 alteration,ot exten.sion. Pae 2 2,1,I,C
.. . ------- Each additions)imection over allowable inAn of the above
Address:2815 SW 153"1 Dr Additional inspection(I hr mill) 66.25/hr
-----•----- _ _________ __
Investigation(1 hr min) 66,25/hr
City/State/ZIP:Beaverton OR 97006
Industrial plant(1 hr min) 11 78.18/hr
Phone:(503)469.7241 Fax:(503)469-7110 InsOccliOns for which no lee It
90.00i hr
.'".""'""-- S viticall listed(1/2 hr min
COB Lic.; 196560 I Electrical Lie.: CL 117 ---1 Suprv.1,:ic.: 4252 LEA !. M"'fliL; .'11.:?&E.frii...32tFialik,L,... ''!'1'11!')4.1 kat
— -.----- ..,
Subtotal: 75.00
Suprv,Electrician signature.required: ,-,----- .
Plan review(25%of pemtit fee): -
......_........______
Print name: Eric Willard Date: 11/07/13 State surcharge(12%of permit fCc): 9 00
•
TOTAL PERMIT Ffil5.; 84.00
Authorized signature:
This permit application expire*if a permit it nut obtained within 180
days after it bas been accepted as complete.
Print name: Date: . Number of inspections allowed per permit,
'------
i:■noildinv■Permits1111,C,Pcvm MI>p.egh:07/0 1/10 440-46IST(I I rOS/COPAAVIA
11/07/13 02:37PM HP LASERJET FAX 5034697139 p.02
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
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rf t� tt��''((, f un hEi� O
t.YmM. 7xu vAN/1i.1r Nn+l�!u1 a.. ..`ry�!. w�dnlwr,c�'l t, �it��1Q rS��h 6!Se�l1f 7�.S°�.�.r�,?�
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.
m Q4ii:�.1iiL ko.::Amormsolmvi«:�I�atimg
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
U 1 Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data'Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
t:alddinglRerm fig\HI,C-Pottivw.uac O r(,uto