Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2021-00087
T I(;A li D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8l17/2021
Parcel: 2S104AB04700
Jurisdiction: Tigard
Site address: 13401 SW BENISH ST
Project: Our Redeemer Lutheran Church Subdivision: None Lot: None
Project Description: Replace existing fire alarm control panel.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: OUR REDEEMER LUTHERAN CHURCH
7324 SW DURHAM ROAD 13401 SW BENISH ST
PORTLAND, OR 97224 TIGARD, OR 97223
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/17/2021 $75.00
12%State Surcharge-Electrical 08/17/2021 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 1
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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/.k, low the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through O•y:52-001-r r90. You may obt�ai cop f the s or direct questions to OUNC by calling 503.232.1987 or��/1.8"""00..332.2344.--
Issued By: _I/./�/ _ Permittee Signature: St
/ 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 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 Aupilko iECEIVED FOR OFFICE USE ONLY
City of Tigard Daceved ?� /� '0a Permit l�r tQ Z,24 _ 00043 7
11 • 13125 SW Hall Blvd.,Tigard,OR 97223 AUG 1 3 2021 Date/By:n ��
S an Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit#
T I G A R n Inspection Line: 503.639.4175 LITY OF TIGARLi Ready Date/By: luris ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method /7 .S/ < Supplemental Information
I L I I L • >7 wmiLf.ror%r—vf•r
TYP t3F WO' PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/rleins checked):
O Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition El Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and2-family dwellingCommercial/industrial less to ground,or exceeds 14,000 ❑Commercial-usea cultural
❑ Accessory building g
amps for all other installations. buildings.
❑ Multi-family ❑ Master builder 0 Other: ❑Fire pump. ❑Installation of 150 KVA or
: JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
Jolt#: Job site address: 0 Addition of new motor load of system.
10993513401 SW Benish St 100HPormore. ❑"A","E", 1-z","l-3",
occupancy.
0 Six or more residential units.
City/State/ZIP: Tigard OR 972230 Recreational vehicle arks.
❑Health-care facilities. p
Suite/bldg./apt.#: I Project name: Our Redeemer Church ❑Hazardous locations. ❑Supply voltage for snore than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:SW 133rd Ave FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Replace existing fire alarm control panel. (with abovesq.ft.) 7500 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy El See Page 2
0 PROPERTY OWNER ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation: This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
XI APPLICANT I RI CONTACT PERSON allt. Branch circuits-new,alteration,or extension, l er panel
A.Fee for branch circuits with
Business name: Performance Systems Integration above service or feeder fee, 7.42 2
each branch circuit
Contact name: Michael Baker B.Fee for branch circuits without
Address: 7324 SW Durham Rd see
ircu der fee,ti stuit 56.18 2
City/State/ZIP: Portland OR 97224 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503) 713-9856 Fax: :(503) 641-1464 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: michael.baker@psintegrated.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name: Performance Systems Integration Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address: 7324 SW Durham Rd MI See Page 2 1 2
panel,alteration,or extension.
City/State/ZIP: Portland OR 97224 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( ) 503-641-2222 Fax:( )503-641-1464 Investigation(1 hr min) 90.00/hr
Email:michael.baker@psintegrated.com Industrial plant(Ihrmin) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 227526 Electrical e.:CLE569 Suprv.Lic.: 429LEA specifically listed(IA hrmin)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 731 d-'7)
Print name:Michael Baker Date:8-11-2021 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9.0-
Authorized signature: TOTAL PERMIT FEE: ey cr.,
This permit application expires if a permit is not obtained within 180
Print name:Michael Baker Date:8-11-2021 days after it has been accepted as complete.
' Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(I I/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. Each I Tolal I *
Fee for all residential systems combined: 575.00 Renewable electrical energy systems:
5 kva or less 100.70 2
Check Type of Work Involved:
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n B• urglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n G• arage Door Opener* >]00 kva(fee in accordance
552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
n Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 90 00/hr
specifically listed(V hr min)
COMMERCIAL WORK ONLY: ELECT
RICAL PERMIT FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: S75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
X[ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
1:1Building\Permits/ELC Permit App.ELR_ERE.doc Rev 06/17/2015