Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
q. .11 1 COMMUNITY DEVELOPMENT Permit #: ELR2009-00119
TI C A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/28/2009
Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10260 SW NIMBUS AVE M4A
Subdivision: SCHOLLS BUSINESS CENTER Lot: 0
Project: Pro Video
Project Description: TI - Security system for areas 1 & 2. Job No. 83 23432 -
Owner: FEES
ROBINSON, CONSTANCE A & Description Date Amount
ROBINSON, LYNN ET AL, BY KG INVESTMENT Restricted Energy Permit 04 /28/2009 $75.00
MGMT, 10240 SW NIMBUS AVE #L3 12% State Surcharge - Restricted Energy 04/28/2009 $9.00
PHONE:
Contractor:
ADT SECURITY SERVICES INC
2815 SW 153RD DR
BEAVERTON, OR 97006
PHONE: 503 - 469 -7212
FAX: 503 - 469 -7110
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm:
HVAC: Instrumentation: Total $84.00
Intercom/Paging: Landscape /Irrigation:
Landscape Lighting: Medical: Required Items and Reports (Conditions)
Nurse Calls: Protective Signal:
Security Alarm: Y Other:
Other Desc:
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 • rdance 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 d s. ATTENT N: 0 gon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001- 010 through OAR 2 -0 1 O. You may obtain a copy of the rules or direct questions to OUNC by calling 03.246.6699 or 1.800.332.234' -
Issu By: '`�` °C�'N`'�y -r - Perm ittee Signature. � - *1 .
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'N Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
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.
l ,
503-469 4. iegtel'OC 9e9 101 7
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. . zl, c.;1,1 icai rermit Appiicatio ,, -.,_.:.:....:..,..-..!..-. - -FOR‘OFFICE VSE ONIX
...
._ ._.. City of Tigard
A, R 2 3 ZC1° 9 R.i L 1,13, ey • - Xy y 1 Porno* No.E1.X)eel F-00 //
.....1 n t 25 S"W Hall tilyd.. Tivaid, OR 97723..P
km Review • . -- ..
1 1; Fixate: 503439.4171 Fax: 503.508.1960 TIGARD -.1)-11J..Y.L- 1 Othcr Itrmit..
-.,
. dx Inspection Line: 503.639.4175 CIT CSF
NGDIVISW
i Date Ready/11y:
Notitied:Methuit: iiros/.
4 10, la S'1. F2T i f
suppternent inrorm$11..
iftlefillt WWW.figdrcl-or.pov
_ ___ jauLpj•:.___, ____':'-- -__
•
• TYPE OE' WORK.
-. --
0 New const-i-uction 0-----Atklitiontaltcrationtrephiccinont
T __, ,___. .._______....----
PLAN REVIEW
'` 1 all that acuity Cxchnict 2 scL w:tioro3 c/r;at
OSerVito Or fOciit r 400 a KIX Of Atom 0 liutitliIV avcr I hro: Samr!..
4!....)efIll/illt(X1 D other:
-.---- - where mr, available butt zunent 0 Malin:. mil !iortivart1;t.
.-- , - .
CATEGORY OF CONS eiteCtaki 10,1X/04mits at 150 vom oe 0 Plowing building.,
.-
- -- •_ less fo. ground. or exceeds 1 0 Cotranerci.tkr.e Nriculium I
0 I - and 2-rarnily dwelling El C.ommerciatiindvstrial 0 Aecesory boikling amp. Iur All 0111-7 InWarie es ht.tildir4.0.
,__ 0 Nilt111-fitritily 0 MiriLa built:kr 0 Other 0 Fire Poorgfs 0 insunabinn of 75 KVA or
". 0 1 7, 1 *-Ytzt:itcy NyStrert. arucr l
scpittaely kriVcri n3,:0,0
Fa-- , JOIt SITE INFORMATION AND LOCATION l
• 0 Addilion anew motor lead or
______,.., .....,...... ,
' . . ..
lob no.: -1 Job situ address:- /0Alpe2 1001IP ur nxtrc.
-Afigt74417/Perei r-i . dcCUTNIK!..
,...•- --•-• . ..... • _. _ 1.„, JO. or IrbuTZ IrSokntial 011e). 0 Itceroat:061.3!
City/Suite/ZIP -- 2 , q zi.? 3 iigit.- /2/ ,` 1 0 l'irdidi care fac Ana= 0 StIrtO:y volt-4w for 01N 0 7.11
,_•-.I 0 Flaiardnus loi:mions. GOn wills ftuminlii.
Suite/bldg./apt. nu.: M'/ft I Project nittne:- /./; 1 CISt rvic e ot (ceder 600 amps ri, inm
r --
,. _..
,
FEE SCHEDULE
,g/14.1 7?'
CrosN stn.:cc/directions to job site. 91
.---i"--1!.,MT:r..1=-7071T1 1 -
---___,. - ,, ...____ ... _... ..
• - New residential single- or multi-family dwelling unit,
Includes auavhed garng.
Subdivision:
1..ot no.: ... ,000 &IQ rt. or les ...,
- - -
- Ea. add'l 500 sq. II or portion i - 13.4.0 ---- i
Ta.x num/parcel tio.:
Litnite •
______ li energy. residarial
DESCRIPTION OF WORE. ._-__.-
(with Abo, mi ft.)
.-...... - , - ..... .. _ -
Limited taiergy. mutta•ramily .
75.001 2
y..____. )1,S2:6 1/f / .1 ) 2 ... . ____, residential,(wan abdve sq. 11.) .
Services or feeders insta1tation teration and/or relovatio
, ZOO amp. or less I - 10.30
0 PROM:12TV OWNER J 0 TENANT _______ 201 amps to 400 amps 106.35 1 ",
...-
i___
- - 401 aaHp. to 600 amps ., .. . 1(0.60 _.. .
1 7 :
Name:
601 amps to I ,000 tulips 240.60 j 2
A tldnzss!
___ _ Ova 1.000 amps m volt
City/SiateiZ1 P: s 454.65 1 2
' .
Temporary services or feeders fte•tallati;11.,. nIterniion, nnif/ur
-.--
...
Phon: ( ) I Fa-( ) 27 " amp!: ur I:4 _1 -- -
. . ..... . , .4 3:
1 ..._._
• 'r
Owner instaliation: ! fhis installation is hcing rnactc on property Nit I own which It.; not 1_2. 1 P' In 44(K am P` ;
100. N)
intended for sale. lcAse, Rtnt, Or excbtin according to ORS 447. 449, 670, and 701_ IL I amp). to 5 .19 -ielps
J
..,_________ 1 2
• _
Brunch circuit& - new, alteraiinn, or es ten skno, per panel
Owner signaturul Lbw: -- A. l'i..•;:'ior brancii circuits-with 1 -
i APPLICANT I CONTACT CT PERSON above Nervicc or reader fee,
6.65 2
. _ _ .
- - - ...._ - _. cub branch circuit
Busi»c name:
h. Fee for branch circuits ' ---- ' '-----
, .__„
.
without sov ice or tcecler fee,
COT11fICI narilej/i c. ‘e 4 .. first hooch circuit
-
.• ...- .. .,_
Each Wel branch circuit 6.65 - r,
Address:
- - ---- Mixvellancoux (service ur feeder not utetutivd) -
.....___
City/Suite/Z.1P!
F2ch ileinufacrored or modular T -
2
-
090
.,.___.
,5 ti
..
' . wcilii3.7: so (ceder 0.
Phonc: 15e 2 )5- y I Fax: ( ) -- Reconnec
_ --„ ._ _.
t only 66.85
-_....___ .... _ ..
•• --, -
[ E-mail:
- 1 rump or gation eircle - i 53.40 -•
.__.__
(.70NTRACTOR
- Sign or outline tichung 1
--
__.„. ,
------• _ -. .._.
-- . . r Signal circuit(s) or limitv4-
Business name.: ADT SECURITY
._ energy parte& atto ation, or
____.
1 i I 7$.00 I
extension. Describe: I Page. 2
Address: 2815 :5.0•Y 153" PR
CitN 1 3€AVER"l'ON OR 97006 F.uch additional inspection over utlow in of the above
-
--, ----, - -----
Pcr inspiruon i 62.50 I
Phone (503) 40-7212 ' - - Fax: (503) 469-7114-"-■ - .
Imvstir.voot■ per hour (1 hr min) 1 b2.50
--'---•
CCI Lie,: 59944 Ekctrkal Lie.: 7.0209CLE Supry. Lk.: LEA389 FIrdustrial plant !ICI hoW' 1 .. i ... 7 „ 175 I ,.
.---
--.......____. .
ELECTRICAL I' EICHIT 1;EES
......
Supz-v . Vicar' ciun signature. roquired: _. -
Subtotal: 75.1X i
. _
-
pim .1,-view (25% of permit fec):
Print name: Y.F.N KRAUS _Iate:
-,... _
- • SLITe Sore113/ge ( 12 OrnVinn fee): 9.00
--
Authorized • .' ____......._(. 't VIAL Pf:.R.N117"1112. 34.00
This cilia applialliolt rtcrtIft`A it a permit k not obtained N•ilbiWrIV/
Print zi.1111C:
:11%:'
dayc aftft itas kern accepted a!, compute. - • 1)
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• Nunto ut innpectio3a; alkwiej Ix, p
1 .. 11 . 11 dirm•Paildss,1,1.1;•I'vmliN.J. A.: US•23•0(1
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