Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
NI ' COMMUNITY DEVELOPMENT Permit #: ELR2012 -00043
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/07/2012
Parcel: 1 S126CA01000
Jurisdiction: Tigard
Site address: 9009 SW HALL BLVD 140
Project: Santiam Bicycle Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: Security system.
Contractor: ADT SECURITY SERVICES INC Owner: CAFARO NORTHWEST PARTNERSHIP
2815 SW 153RD DR PO BOX 422
BEAVERTON, OR 97006 FLORHAM PARK, NJ 07932
PHONE: 503 -469 -7212 PHONE:
FAX: 503 -469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/07/2012 $75.00
12% State Surcharge - Electrical 03/07/2012 $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. 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.
-
Issued B . /If - Permittee Signature: _ i. /. _ —
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.
03/06/2012 15:26 5034697110 ADT SECURITY (1002
Electrical Permit Applica = ill pcivED Received FOR c)Nt•ICE USE ONIx
City of Tigard
° 13125 SW Hall Blvd., Tigard, OR 9 ' • ■ 6 2012 pi. n Review Other Permit;
Dateat ' i.:.,.. ezemm
'• r
i
Phone: 503.718.2439 Fax: 503.59: Y . .4 Pla
Date/8 :
r r cA 1; o Inspection oII ti gardor gov 5 CITY OF TIGA� sD ate led/M e the d; KM Supplemental Information
/Mtho
°� w "'0.'; r. 7; f.� `*kz "" � � ir..• a tit^.• .,. . m�.� -� .
"'•'.': , .,+. •" td 'c!� ts''.. - ^' ..." :1 t �3 .•;;�„`:; ' , :KCVO v;T D ',' ie'1 .4 n• ;! (''''. ,.1424,. <:rt `.�+�o '.; P ...,o ...•,;, 1
❑ New construction a Addition/alteration/replacement Please chafe all that apply (submit a seas of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three atones.
1=1 Demolition ❑Other.
� , whew the available fault current CI Marine and boatyards.
1tiA� : e c= rJ'4 'i ,hlr'•'a% 1y ; `•,: ti • "44 exceeds 10,000 amps at 150 volts er ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ 1- and 2- family dwelling '� Commercial/industrial ❑ Accessory building amps for all other installations, ❑ buildings. isi -le agricultural
❑ Multi- family 0 Master builder ❑ Other: ❑ rim pump. 0 Inetauuion of 75 KVA or
„, g o t� r ''n �r,4+ , ❑Emergencysystom. larger separately derived system.
ra - i rnar ` .:.� - :, , r " '' , : `,C )? • d+ ;. : e AL.; r ` ❑ Addition of new motor toad or
Job nom- '� ct Job site address: �vo'ot "S►..� N „ "311 44
10010
ueormo more, occupancy.
te+r+ ❑ Six or more residential units. ❑ Rectemional vehicle parka.
City/State/ZIP: liealth.cme facilities.
❑ Hazardous locations. 0 Supply voltage for more than
�r rd , o G1 2Z3 600 volts nominal.
Suite/bldg. /apt. no.: ty d Project name: L � , • d e .5 ❑ Service or feeder 600 amps or more.
mo'^ r a ° t' ° � h'` t
Cross street/directions to job site: C t �
Via. ..4 s: ;&° 1 :5 `,lie • f Elk∎ ; , I4 :1: .n 3. ,+ 1
_ .11 e r ntieriel eo I Qty. J 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
Tax map/parcel no.:
Ea. add'! 500 sq. ft, or portion 33,92 1
• �-' s �cT r w� =s�aa� w rs t � Limited energy, residential
,? L G J 4. �4' F c .., a ( 75.00 2
i4 E l .;., .:' j:'rd• '� �: "1 '; � .' .�l. ti4 + „�iti ;F• P1 V•t ti�4• .,'.? � _ thaboveS JL
Limited energy, multi - family
75.00 2
1 d-.. •111 7I I". .41 me ?Nor ..a •....tka .� residential (with abovesq.R)
J Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' r +;�'• • yIET`;tfr:,�+�q�tr,,�. .�, ::","lv:`' 201 amps to 40 amps 13
,. � :,!1.`.i.�ti,li y .�iK♦�.` •�.'i.1 d.a'F!%a�r;5 ps 3,56 2
Name: 401 amps to 600 amps 200.34 2 I 601 amps to 1,000 amps 301.04 2
'ddb: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
made on property 201 amps to 400 amps 125.01s 2
Owner installation: This installation is being p petty 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
I. - 4;: -- :i . i "i?'.. :. 'r `' . ”` '*`' ., ';� c i ; , ? . ..� r - , < ., -, .�;.; -+'• +C each service rc or ui[ feeder fee,
a ,:- k, ,' :',j .;;�'; +t re 7,42 2
Z,•;,,';61
- z each branch ei
Business name: A Stst...;.1 1..,.. tee B. Fee for branch circuits without
service or feeder fee, first 56,18 2
Contact name: . branch circuit
Each add'I brunch circuit 7.42 2
Address .j� Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
67.84 2
� r n.tefare.n. 09— s dwelli service and/or feeder
Phone: C Reconnect only 67.84 2
(F3) t -3�o9. ..7_1 q Fax: : ( 3) Lik p , ....Ili o Pump or irrigation circle 67.84 2 •
E - mail: - 1e1nr ) o . - c..,.-A, `:�'�' 1m �;f � 4 � �• :r�.,... -• .. Sign of outline lighting 67.84 B
,rj�' : :IrS? i:Sik,4:44 :.`lt T#di1� y y : I �• tit: -o `" g ' v
3: ^1 i'• o1H• „�,�rv : ' ▪ �' :•'• 2tK�,t?:. �c1t,1
� �••• ^• �'• �y M�" Signal circui[(S) Of limited-energy p
Business name:
panel, alteration, or extension, I Page 2
"" 1. '`•\ 4"i. 5 Each additional inspection over allowable in any of the abov
Address: '2-8,5 7 t a)*-.r A —V c. Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: . 011.-- "t- �l.p
Investigation ri (1 hr min) 6625/ hr
tndusuial plan[ (1 hr min) 78.181 hr
Phone: ( 9 ti - -?' t Q Fax: (5, 4 t g - - t t Inspections for which no fee is 90.00 / hr
■ s iftcall listed t4 hr mm
CCB Lic.: C..,59 I Electrical Lic.: t , Suprv. Lie.: 3 s o r " c ; U c . i .. - . ''; l :'... t s
'7 tt t39r.E1� sr� c : - . ;o, : t cb ' - ..' - s • i
_
Suprv. Electrician signature, required: A - Subtotal: -15 _ _
i �_ Plan review (25% of permit fee)
Print name: , Daze: It
�
State surcharge (12% of permit fee): r , -
TOTAL PERMIT FEE: Authorized signature: / / - .4==. �• Th is permit application expires if a permit is nos obtained within 180
Print name: • � • Daze, • days after it has been accepted as complete.
•
_ _ L Number of inspections allowed per permit,
IAlluldioglPemitsIPl C•PerrnhAcp•doe ' • /01 /10 440-0615T(11/05/COM was
03/06/2012 15:27 FAX 5034697110 ADT SECURITY 11003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alartin
❑ Garage Doot Opener*
❑ Hearing, Vea and Air Conditioning System*
El Vacuum Systems*
E Other
Fee for egg commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems •
El Landscape Irrigation Control*
❑ Medical I
❑ Nursc Calls
❑ Outdoor Landscape Lighting*
Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
[:5Buildiog\Per h 5LC- Permitnpp,doe 07ro1110