Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
`_ COMMUNITY DEVELOPMENT Permit #: ELR2010 -00095
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/27/2010
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 200
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: CNA Insurance
Project Description: Low voltage for fire alarm.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 05/27/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 05/27/2010 $8.14
PHONE: 503 - 624 -6300
Contractor:
STANLEY CONVERGENT SECURITY
SOLUTIONS INC
15495 SW SEQUOIA PKWY STE 100
PHONE: 503 - 968 -3353
FAX: 503- 968 -3398
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: Y
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
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. At 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. ATTEN e • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0r r through OAR 9 :- -0110. .0 may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.23 4.
Issue By: _ /� L ∎ ∎∎ � = ' Permittee Signatu '� ! ' �arin "
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 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 Application (� �
� ,� 1 � � FOR OFFICE USE ONLY _ q
City of Tigard A`Q " /� Date/By: 5 alp m 1 Permit No e 94 /O -� ` S
1 ° 13125 SW Hall Blvd., Tigard, O 11`�h .,1,`�) Plan Review :J ,
1` DateBy: Other Permit: fAr�f D - WG 5 1
Phone: 503.639.4171 Fax: 503. x( 0:1 \`a
T I G A R D Inspection Line: 503.639.4175 �� 1� Date Ready /By: .,/ f �1 q _ ,I++ B( See Page 2 for
Internet: www.tigard- or.gov Notified Method: ,uP / �d 7�,� IYJ ( (% 4 Supplemental Information
TYPE OF WORK
.1* PLAN REVIEW
❑ New construction ® Addition /alteratid l ent Please check all that apply (submit 2 sets of plans w /items checked below):
4 � ❑ 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
❑ 1- 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 ", "1 -3 ",
Job no.: Job site address: 12909 SW 68 PARKWAY ./1,00 100HP or more. occupancy.
G ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 200 Project name: CNA INSURANCE ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total 1
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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
INSTALL SIX ADDITIONAL STROBES AND FIVE HORN STROBES ON Limited energy, multi - family 75.00 2
EXISTING FIRE residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
SYSTEM 200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: PACIFIC REALITY ASSOSCIATES 601 amps to 1,000 amps 240.60 2
Address: 15350 SW SEQUOIA PARKWAY Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: PORTLAND, OR 97224 relocation
Phone: (503)624 -6300 Fax: (503)624 -7755 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 133.75 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 ❑ CONTACT PERSON above service or feeder fee 6.65 2
each branch circuit
Business name: STANLEY SECURITY SOLUTIONS B. Fee for branch circuits
. without service or feeder fee, 46.85 2
Contact name: GARY TAUSCHER first branch circuit
Each add] branch circuit 6.65 2
Address: 15495 SW SEQUOIA PARKWAY, SUITE 100 Miscellaneous (service or feeder not included)
City/State /ZIP: PORTLAND, OR 97224 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 968 -3355 Fax: : (503) 968 -3398 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: STANLEY SECURITY SOLUTIONS energy panel, alteration, or
(f7
extension. Describe: I Page 2 47 S 2
Address: 15495 SW SEQUOIA PARKWAY, SUITE 100
City/State /ZIP: PORTLAND, OR 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 968 -3355 Fax: (503) 968 -3398 Investigation per hour (1 hr min) 62.50
p7 L, Industrial plant per hour 73.75
CCB Lic.: 161567 Electrical Lic.: 37- 1054C(/ Suprv. Lic.: !! ELECTRICAL PERMIT FEES !!
Suprv. Electrician signature, required: Subtotal: — &7. 3T ''
Plan review (25% of permit fee): _6"7"
Print name: STEVE MOREHO Date: 5/25/2010 State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 76 .9t
- �--- ! / r This permit application expires if a permit is not obtained within 180
Print name: - Date <� 4 days after it has been accepted as complete.
Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T( t I /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
`_ RES,IDENTIAL.WORR :QNLYc:.
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:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:U 3uildingWermits \ELC- PermitApp.doc 03/23/06