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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 14 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00219 Date Issued: 10/12/2011 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Parcel: 1S134AA02100 Jurisdiction: Tigard Site address: 10300 SW NIMBUS AVE PC Project: EID Passport Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 3 Project Description: Security system. Contractor: ADT SECURITY SERVICES INC Owner: HANSON, RONALD D 2815 SW 153RD DR ROBINSON, CONSTANCE A BEAVERTON, OR 97006 ROBINSON, CHESTER TRUST ET AL 203604 EAST FINLEY RD KENNEWICK, WA 99331 PHONE: 503 - 469 -7212 PHONE: FAX: 503 - 469 -7114 FEES Description Date Amount Specifics: Restricted Energy Permit 10/12/2011 $75.00 12% State Surcharge - Electrical 10/12/2011 $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 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 co. of the r las • • erect questions to OUNC by calling 503 232 1987 or 1 800 332 2344 Issued Bye// - ermittee Signature: _ — I✓/ - - ��� 411111/ 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. Oct 12 11 11:14a ADT Security 503 - 469 -7114 p,3 Electrical Permit Application FOR OFFICE USE,O!\LY IN City of Tigard AC D`tc °a 77 ua te4ty. P ermii h o t� pzy2t '7 - I U /' II LAC -R�3ct 13125 S W Hatk C31vd.,Ttgard,OR 9 "2�, t � �� Plan Review Phone: 503 63941 " +I Fax 503 5 ',•S C�. Dale/By Other Permit Inspection ection Line 503 639 41 75 N 'i V )\) r • to Ready. By. Jura ® Sec Page 2 for TIGARD' Interact: www.tigard- or,gov O CJ A s + - •7'7;6 Suppremantal Information T " OF WORK V O �� \ Q \ PLAN REVIEW ❑ New construction III Additionialteral10N1 ep" d l ids Plea !leek all flat apple (submit 2 sets of plans u tten checked belo,v). ❑ Demolition 0 Other: �� El Service or feeder 400 amps or inure [ Buildag over ;ice stories . where the awai.able fault ct.rrent ❑ Manilas dud boatyards CATEGORY E CONSTRUCTION exceeds 10 000 amps at 150 volts or ❑ Floating buildings less to ground or exceeds 14,030 ❑ Commercial -use agricultural ❑ t- and 2- family dwelling ortmercial-industriel ❑ Accessory building amps fur alltitlei ,n51d11sn'ns auildings ❑ Multi- family ❑ Master builder LI Other, , ❑ me pump ❑ Installalior, of75 KVA pi ❑ Cmergeitcy system larger septiratcly deni system. JOB SITE INFORMATION AND LOCATION ❑ Addnicri of new motor load of ❑ "A" "P" "I - 2" 'I - 3" 52137 I00HP or mom. ocupancy .loo no. 1 - Job site address /O3 0 c 5u ! ) yl) / m ,i5(f ❑ Six or iron: residential units ❑ Recreational vehicle parks. CityJStatelZl E': J a f ❑ IIeeIth - care lac le es 01 Supply %oltage for more than �� /� ❑ Ha�aldous beetle-is 600 volt, nominal Suite'bldglapt. no.' Project name /r' „ ❑ Service or feeder 600 amps or more FEE SCHEDULE Cross street'dlrections ro job site: Description 9n I Pet I Total I ' New residential single- or multi -famils dwelling unit. Includes attached garage. Subdivision Lot no : k, 000 sq It or less 158 54 4 1 Ea. add'I 500 sq. 11 or portion 33 92 1 Tax map/parcel no. Limited energy, residential 75.00 DESCRIPTION OF WORK (with aho'. c sri 11 1 Li energy, multi - !wind) I s 00 6 r� CJ /�- 1 ! r(/ t, 7- G r/ residential tth ben sq 11 ) C_ D /J l✓f �` o Services or - feeders insttallation, alteration, and /or relocation _00 amps or Iizs 100 TO f 2 D PROPERTY OWNER ❑ TENANT !u1 amps to 400 snips 133.56 if 401 amps in 600 amps 200 34 ' 2 Name. 601 amps to 1,000 amps 301 (:4 2 Address. 1 0 1,11.0:) amps or s uits 55126 '_ Temporary services or feeders installation, alteration, ardor City/State/ZIP: relocation Phone: t, I ' Fax' ( 1 201) a nts sir lasts I 59 36 I I i - 2 01 amps to 400 a 1 25 08 Owner installation: This insla lation is king made on property that I own which is not 401 amps to 59• amps 1 64 54 2 Intended for sale lease, rent, or exchange, according to ORS 44:, 449, 670, and 701 Branch circuits - new, alteration, or extension, per panel Owner signature - -- -- . Dar e. _ - _ -- -- A lice ft_r branch cacaos with . e shove service o1 feeder lee, © APPLICANT C CACT PERSON 42 .t each branch circuit Be fitness name. U 13 lie.: fm branch cirem.5 ,vi+Fuu+ service or feeder Ice, l"rst 56 1K ? Contact name: i (� Z17 /2,504.) branch circuit _ / Each ad_l'I branch circuit 7 42 2 Address: Miscellaneous (service or feeder not included) Each manut'aclutedor.nodulnr ,» Ci(}' ta[uZIP ( dwel ing scr endic r tuck: Phone: (, 77 6/ 773 Fax ) Reconnect en 1■ 67 3 2 -"- --- -- ---- Pump o - irrigation circle 67 44 2 E - mail: ' Sign Dr Outline lighting 67 -84 2 CONTRACTOR S•gne cnrcu t(s'i or }tmited cnargy , y am sane., alteration, or extension. } a e _ / Business name' /7 S6—GO,e y r • I/ Each additional inspection ever allonahle in any of the above Address' oZgA , 7 /s3 3d � _i_) 2 Addi'ional tuspectron (I h• rein) 66 25: hr Investigation (1 hr min) 66.25: lir City /Stater ,g TO /0 tie ' 70a 6 Industrial plant (1 hr mm) i 7S 13: hr Phone ) 9 y- ( �j S Fax: (g)3 ) -1/6y'-- I nupectx , ns for which no 7ec n5 90 9- 7�r� ht - _ specifically listed ('': hr mint I CC13 Lie : 5 9 -/5/ 1 Electrical Ltc..Z` • ogee S'aprv. Liu 2e ff / ELECTRICAL PERMIT FEES Subtotal )S, Suprv. Electrician signature, rcquire ` , c' A - •, / -_ 1 - Plan review (25 °% of pe nip; fcc) - Print name' 4,/ � / ,�� 1 Ua'c /( /� Stale surcharge ( i2 %oi petini: fix) F. o ! TOTA FEE. gq, 06 Authorized signature This perm!! application expires if a permit is not alai lied ,within 180 days :lift!' it has been accepted as complete, Print name: I Date .‘rii„ber e4 ln;pcn,onc al lowrd p r a r ,u 1 13mldmg .Perm,ts 1-err,lAc•Jdoe Cr.01 III 4 =0.4511 Dl' pa 000 -wrn Oct 12 11 11:13a ADT Security 503 - 469 -7114 p.1 Electrical Permit Application - City of Tigard Page 2 - Supplemental Information /' ii 7 LIMITED ENERGY PERMIT FEES: g3 - AC-s-9-7- I RESIDENTIAL WORK ONLY: /d SvQ $) / '1)4) .6v-s Fee for all residential systems combined ... $75.00 Check Type of Work Involved: n Audio and Stereo Systems* ❑ Burglar Alarm 7 Garage Door Opener* L Heating, Ventilation and Air Conditioning System* n Vacuum Systems* I f _ Other: '..el COMMERCIAL WORK ONLY: f Fee for each commercial $75.00 sys tem 1 4' 1- (SEE OAR 918- 309 -0000) / Check Type of Work Involved: / t ❑ Audio v udio and Stereo Systems 1 ❑ Boiler Controls i n Clock Systems i Data Telecommunication Installauon 3 o 7. Fire Alarm Installation In � WV' a n H\TAC ❑ Instrumentation 9(irl ii ❑ Intercom and Paging Systems f_�; ❑ Landscape Irrigation Control* r. ❑ Medical ( n Nurse Calls Outdoor Landscape Lighting* ❑ Protective Signaling ' 0 Other C / /171 7 Z i y -52"e '2t Ty 5 /'S% (O7 Total number of commercial systems: *No licenses are required. Licenses are required for all other installations 1. auilding .Permits'ELGPcrmitAppdoc 07 /0I'i0