Permit ' °tom r a C IT Y �� ® ELECTRICAL RESTRICTED ENERGY PERMIT
M: x ". COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00159
TIG A 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/25/2007
PARCEL: 25101 DA -00100
SITE ADDRESS: 13010 SW 68TH PKWY ZONING: C -P
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 007 JURISDICTION: TIG
PROJECT: US BANK
Project Description: Security system.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL: X
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
PACIFIC NORTHWEST PROPERTIES PERFORMANCE SYSTEMS INTEGRATION
9665 SW ALLEN BLVD 7324 SW DURHAM RD.
BEAVERTON, OR 97005 PORTLAND, OR 97224
Phone: 503- 626 -3500 Contact #: PRI 503 -641 -2222
FAX 503 -641 -1464
FEES Reg #: ELE 34- 522CLE
LIC 150747
Description Date Amount
[ELPRMT] ELR Permit 5/25/2007 $75.00
[TAX] 8% State Surcha 5/25/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit , e sire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon la require. you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through •AR 952 - 101 - 0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. /
Issued By: �� Permittee Signature: , 1. V c ►�
v j ,
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.
Electrical Permit Applica FOR OFFICE USE ONLY
. +� Re ceived i
City of Tigard DateB : S a 5 O Permit No. � , DO ...
° 13125 SW Hall Blvd., Tigard, OR 97, ( A 5 ? U U / Plan Review
' C ` ' Phone: 503.639.4171 Fax: 503.5 Date/B : Other Permit:
T I G A R D Inspection Line: 503.639.4175 G , ; ,; - t ` `. J Date Ready/By: Juris: / 63 See Page 2 for
Internet: www.tigard- or.gov �" r ;; r>,> ,, , p f, Notified/Method: ' f Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® 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.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "l -3 ",
Job no.: 106082 Job site address: 13010 sw 68 t6 parkway 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: US Bancorp ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Add Security System. Limited energy, multi - family 75.00 2
tY Y stem. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Performance Systems Integration Corp. Signal p a nel t(s) or limited -
energy panel, alteration, or
Address: 7324 SW Durham Rd. extension. Describe: 1 Page 2 2
Security Panel.
City/State /ZIP: Portland, OR 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 641 -2222 Fax: (503) 6414464 Investigation per hour (1 hr min) 62.50
CCB Lic.: 150747 Electrical Lic.: Suprv. Lic.: 3456LEA Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required` Subtotal:
Print name: Scott Dulaney Data. 5/25/07 Plan review (25% of permit fee):
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE: W . 10
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615TQ1 /05 /COM/WEB
��N�~�� OF CITY ��*x� um�����m�*
BUILDING DIVISION PERMIT #: ELR3007'00169
13125 SW Hall Blvd., Tigard, OR A7223 . DATE ISSUED: 5V26/2007
Phone: (503) 639-4171 A
„„,„„,,4`
Inspection Requests (24 Hrs.): (503) 639-4175 J.
. INSPECTION WORKSHEET FOR DATE: 9/24/2007 TIME: 7:00AM PAGE: 5J
SITE ADDRESS 13010 SW68Tf1PKVVY CLASS OF WORK
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 007 TYPE OF USE:
PROJECT NAME: US BANK
DESCRIPTION: Security system.
OWNER: PACIFIC NORTHWEST PROPERTIES, PHONE #: 603526-550)
CONTRACTOR: PERFORMANCE SYSEMS INTEGRATION PHONE #: 503
Inspection Request Scheduled For: Date: 8y24/2007 Pour Time:
Code # Inspection Description on Contact # Message
199 Electrical final 503'959-6949 Y
Corrections/Comments/Instructions: -^-~----~-
jrN
\ \\\: i \ \ , \-`
i fy
PASS | I PARTIAL APPROVAL I CANCEL ri NO ACCESS
FAIL CALL FOR INSPECTION || ADDITIONAL FEES ASSESSED
�����
- Inspector: G -71 ,N . Date Phone #: (503) 718-