Permit 1
II . CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
q
COMMUNITY DEVELOPMENT Permit #: ELR2012 00230
TG
[ARD , 13125 SW Hall Blvd.. Tigard OR 97223 503.718.2439 Date Issued: 10/02/2012
Parcel: 1 S 1360000900
Jurisdiction: Tigard
Site address: 6830 SW ATLANTA ST 200
Project: Tillamook County Creamery Subdivision: WEST PORTLAND HEIGHTS Lot: 24
Project Description: (1) low voltage for burglar alarm
Contractor: ADT LLC Owner: ATLANTA STREET LLC
2815 SW 153RD DR BY SCHWAB, DWIGHT
BEAVERTON, OR 97006 15450 SW BOONES FERRY RD, STE Z
LAKE OSWEGO, OR 97035
PHONE: 503 - 469 -7219 PHONE:
FAX: 503 -469 -7128
FEES
"Description Date Amount
Specifics: Restricted Energy Permit 10/02/2012 $75.00
12% State Surcharge - Electrical 10/02/2012 $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: Y
Security Alarm: N Other: N Total $84.00 r
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. Oki_ Issued By: )fl.i iL 0a•K ti / C`
Permittee Signature: Did 4 /C1 OkL
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.
10/02/12 10:32PH HP IIE771441kf' J3 p. 01
Electrical Permit Applicati '� FOit 011 ash: (.)M.\
City of Tigard OCT 0 S 20 2 taa toy . i a- s Ott). ( A
1 14 . P ermit N 410.3.36 13126 SW Han Blvd., OR 9 ;�_ , , - --- Other - ----
;/ = a �' Plan Review
Phone 503.718,2439 Fax: $03.59 t>,0 ) r +' '" - tsri.• q y; Permi�.
tt t J
Inspection Lint: 503.639,4175 a ; fit,,'.; r"" 4F Date Ready /By: It s- i� See Page 2 for
TicJAn1,) ,.
Internet; www.tigard- or.gov " Notified/Method: W .M (� Supplemental Information
. V1 r + 4 D x � r, 4t yt v,u .p ,� .t t' .� t, t n � u G
� �� Ail 1 AR �„ J ! S
)� ,� � F 1' 1 f ' nt)11
13 4" ,, ' 0 . ; � yi�'�1., 4!'' �Y,C �'�, 1: I FIR �� ; 1' . �j( d !�f�'s`� � IM t � � i '�1 : ,W 1,k N it efi e c .' 7 . ' I f 1 i,. , ' ;1 ,�P, i' � IR 'Z +p T t r ' '', t . 14 6 . • AA lints kb ;lri css,vtt:t: fll ht(t i d o..1, . xe U: .Aix .1.,: ) 01i11:4I„i. .., _ ::I a 4 .•. • iV:v,, / 4 .i; - a .1� '.... - .rntd.t. �rw.w4..'.)16'!�i�' .7.4-..1 ..i, It;i'1f 3%..1,tm::
0 New construction ® Addition /alteration /replacement Ream check alt that apply (xubmit.1 sets of plans Witco's checked below):
C] Soviet of feeder 400 amps or more 0 Building over three stories
CJ Demolition 0 Other: where the available fault current (a Marinas and boatyards.
�� ' N. x +" ry +r �yr't' " ";fix $! exceeds 10,000 amps 150 volts or Floating buildin
:•3;;.71w A p� w )7 ¢ is t'c' .ti� a ;f;t�1r" + i '' "Iv'p + i1Fi 9'!° t" 'i: t P Q 8 is
i :! ft><�:: 3t r4 +.ue n.,tlry sre evfr t ri�r. 1 �'a•I less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1 - and 2 family dwelling EI Commercial /industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi- family 0 Master builder 0 Other. 0 Fire pump, 0 Installation of 75 KVA or
t l ry /r +;r, I7 ��g!� !$ a a t+ns a t �rr�y t r yng' , Enter gcrrcy system. largo separately derived system.
�� N4`�Yf�`'K�i1' + i' rgiV ,1.44 . 1ai+Y,n'! I KA. 1 t(ttu' vl t S hF t •' • rrc 1'9 .. 4 'W L i; 0 Addit of now motor load of ❑ `•A" "E' ") "1 -
Job no,: 83 -26845 Job site address: 6830 SW Atlanta St IOOHPor more. occupancy.
___ a Si,, or mote residential units. ❑ Raeroatienai vehicle parks.
City/State/ZIP: Tigard OR 97223 0 Health -care Facilities. C] Stpply voltage for more than
._ ._ __ 0 Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: erD Project name: Tillamook County Creamery 0 Service or feeder 600 amps or more.
CrossstrtcVdirectians job site: — .. — ._�. - - -. ;i ap '',, 1 .w4t � � '�,;�i ,F.w i 4 '_ t's'.I�'; t sir
si e: t> t r rt rand
`' New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot Ito.: 1,000 sq. ft. or toss .r. 168,54 4
fax map/parcel no.: H Ea. add'l 500 sq, 0, or portion 33.92 t
):' 'r ." i r fi .�.1 wR %1.) a ,! 7'n 1 dt wi h nbo sg ft.) sal � 75.00 2
r H Li n
' , i it i a , 4 �7idr .,tr.' �1�� t ,, 14t,, ':t1 :t • , •__ _.
Limited energy, multi - family 751J0 2
Low voltage burglar alarm r with above . 0.,
- - ... _ ._ _ Services or feeders Installation alteration, and /or relocation
200 amps or less 11111 100.70 El
3 ; ,a :: 7 llr x 1 5 f 9 "� 1,. }.snit. !� r
+ 1" 201 amps to 400 amps - 133.56
.g ttvi . U ro+aw.p ,,r1 t ,ra. 'f r ',, ,; A -'•' �" k' ,''?.. :` 1 L ' >� s P
Name: Tillamook County Creamery Association 401 amps to 600 an7ps 200.34 ^ U
- k C .., — 601 amps to l ,000 amps MI 301.04 El
Address: 6830 SW Atlanta St Over 1,000 amps or volts 552.26 El
` '" ` " — Temporary services or feeders instatlation, alteration, and/or
City /State /ZIP: Tigard, OR 97223 relocation
Phone: (503)619 -4223 lax: ( ) 200 amps or less MI 59.36 — IDI
Owner Installation: Phis installation is being made on property that I own which is not 201 amps to 400 amps 125 08 _
intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701. T 401 antes to 599 amp 168.54 0
Branch circuits.- new or extension
Owner signature Date; „ � p. Fee branch ciutdts wrrh I
���r � r q{� ��t yp °+ , ' t P,, .� ,* above service or feeder fee.
;9i+t � 1 7 f .�'� � :� i t ' '1 ' �.LVl36i.�k :.!:,.'� )t '`t') Jc� l�la< " l: each branch circuit 7A2
1 m v, 0 6 7. z eta 1 O OW I , ,x 611
Il
Business name: B, Foe for branch circuits without II service or feeder fee, first 56.18
Contact name: branch circuit
-- -- -- ••- •- •--, -- ° µ Each add'I branch circuit __ _7.42
Address: Miacellane (ser vice or feeder not included
a ZIP: wel _ , � _ "- �._ dwelling, nonu Of modular " 67,84
(.Ity /5uIt0 /ZIP: dwelling, service and/or feeder
Phone: ( ) k Eul; ; ( ) R ecmmcct only 67.84
--� - -- Pump or irrigation circle 67,84 El
E -mail: Sign a outline lighting NM 67 ggi
` �x I t'� i L YN `•t t r .+; w a , + r • .....
' r' Egli(:, ft,' fh.vt,! �5 t1ttU ",v!k�l° d) frt.�3Eia�'SB,wb'�i's ;`\!31MET a(, . ' i."! �S"' rx i' Signalcircuit(s) eergy
Business name: ADS' LLC panel, iteration, or extension.____ ," 1 _ Pag. 7S'0 2",
_ - .. Each additional inspection over allowable in an of the above
Address: 2815 SW 153 DR Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Beaverton OR 9700 _ W- Investigation (t hr min) N 66.25 / hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 469 -7241 _ [Fax: (503) 469 - 7128 „ -- Inspections tar which no tee is 90.00 / hr II - s, cilicall listed 'h hr min
C'CB Lie.: 196360 '3 r
Electrical Lie.: CUD 17 Suprv. Lic, 4252I,1� . .. � fi),e.1S1,P:P"r1'�':471 n�` MITT,
Spry. Electric:lan signature, required: : - i Subtotal: 75.00
Spry. ,•• - - -- —.- - �_ . ` � �_ _�T Plan review (25 %of permit fee):
Print name: Eric Willard ...
- Date: 10/ 112' Suite surcharge (12% of pemtil fee): 9.00
— TOTAL PERMIT FEE: -- 84.00
Authorized signature: This permit application expires if a permit is not obtained within 18i)
- � N 111 'T T I ^ TJale; ��" — days after It has been accepted as complete.
Print name;
Nmnbcr of inspections allowed per permit.
I:t ouitainstPermist [LC•PermitApp,due 01101/10 440.46131(1 1105/CO,MAYl;a
10/02/12 10:32PH HP LASERJET FAX p.02
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES: e
'`,'ifAI ,Tk ^t ta: rR ",off" 0 :''` e�'it�,��', '.,; js ;,�IIt,i `+r4+7n
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.
�L of i tb '�i {� p X" s i`,r J��i P ' �1� ?,n l • ,f z
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ l=ire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
• Protective Signaling
❑ Other W ..__..
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
hf luildinetrmitsTLC4amitApp.doc O7!OUw