Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 a - COMMUNITY DEVELOPMENT Permit #: ELR2012 -00275
Date Issued: 12/12/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S112AC01500
Jurisdiction: Tigard
Site address: 7319 SW KABLE LN 500
Project: Quality Custom Distribution Services Inc Subdivision: FANNO CREEK ACRE TRACTS Lot: 23, PT 2
Project Description: Low voltage for security system
Contractor: TYCO INTEGRATED SECURITY LLC Owner: PACIFIC REALTY ASSOCIATES
2815 SW 153RD DR ATTN: N PIVEN
BEAVERTON, OR 97006 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE. 503 - 469 -7206 PHONE:
FAX: 503 - 469 -7114
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/12/2012 $75.00
12% State Surcharge - Electrical 12/12/2012 $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 - • • t to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done accordance with a. • oved plans This permit will expire if work is not started within 180 days o - • • • -, or if work is suspended for more the 180
days TENTION: Oregon law - • • ou to follow the rules adopted by the Oregon . i;otification Center Those rules are set forth in OAR
952-011-0010 throu h OAR 952 . -0 90 ' o may obtain a copy of the rules or direct questions to Ot by calling • i ' or 1 800 332 2 , 4
4 Iss d By: / / Permittee Sign • - • i0 ,, ,040 - / �
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:
CONTRA R INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' ; � 1- Date:
` • • • ) E 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.
Electrical Permit Application
/e,4iS(
City of Tigard g O Date/By: /1...1> Permit N 24../24.4/2 — Ce `� �f S
• 13125 SW Hall Blvd_, Tigard, OR 97223 / Plan Phone: 503.718.2439 Fax: 503.598.1960 I Date/By Other Permit
Inspection Line: 503.639.4175 /J ,/ / ,j V I / / Date Ready/By: kris /2,20/...7.— D���
- (2
TIGARD
Internet www.tigard -otgov Notified/Method: I H S ee Page 2 for
Supplemental Information
TYPE OF WORE PLAN REVIEW
❑ New construction co Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
1:1 Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
building less to r all other a exceeds ons, ❑ Commercial axe agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory g amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency hem- agar separately derived system.
g / 0 Addition of new motor load of 0 "A ","E", "1- 2 ",`1_3 ",
Job no.: a 6 / g I Job site address: 73 / 9 J) �� /,,,. 100HP or more. occupancy.
❑Six or more residential omits ❑ Recreational vehicle parks.
City/State/LIP: TIGARD OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no. : 5 z 3 e3, I Project name: ,e/l &?, �„ ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Disoiptirr FEE SC
DULE • I Q n -I Fee. I 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
En. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
D ON OF WORK (with above sq. ft)
Limited energy, multi - family
�?��ei2 r residential (with above R) 75.00 2
Services o r feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 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 I
201 - amps to 400 amps 125.08 2
Owner installation: This installation is being made on property 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
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: / branch circuit
Each add'l branch circuit 7.42 [T
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each - manufactured or modula 67.84 2
g,
dwellin service and/or feeder _
Phone: m3 ) 705 , ? 3 Q 9 Fax:: ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuits) or limited-energy
Business name: TYCO INTEGRATED SECURITY _panel, alteration, or extension. l Page 2 75.00 2
Each additional inspection over allowable in any of the above
Address: 2815 SW 153 DR. Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 6625/ hr
City/State/ZIP: BEAVERTON OR 97006
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 469 - 7206 ax: (503) 469 - 7114 Inspections for which no fee is
specifically listed (54 hr min) 90.00 / hr
CCB Lic.: 197010 Electrical Lic.: Suprv. Lic.: 3976 EA ELECTRICAL PERMIT FEES
Subtotal: 75.00
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: DAVID TENDERELLA Date: /� State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: s days after it has been accepted as complete.
Number of inspections allowed per permit.
11Buitding\Permits C- PermitApp.doc 07 /01/10 440- 4615T(t1 /05 /COM/WEB -
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
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:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Oth„ /1: � //64-2/f
Total number . f commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \BuildingPeumnssELC- PamitApp.doc 07/01/10