Permit }
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00426
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/16/2007
PARCEL: 25101 DA -00100
SITE ADDRESS: 13010 SW 68TH PKWY 140 ZONING: C -
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 007 JURISDICTION: TIG
PROJECT: PACIFIC SOURCE HEALTH
Project Description: Installation of low voltage for fire alarm.
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: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SCHNITZER INVESTMENT CORP PERFORMANCE SYSTEMS INTEGRATION
PO BOX 10047 7324 SW DURHAM RD.
PORTLAND, OR 97296 PORTLAND, OR 97224
Phone: Contact #: PRI 503 -641 -2222
FAX 503 - 641 -1464
Reg #: ELE 34- 522CLE
FEES LIC 150747
Description Date Amount
[ELPRMT] ELR Permit 11/16/2007 $75.00
[TAX] 8% State Surcha 11/16/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Co•e, State o OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This pe mit will expir - if w. • not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon aw requires , o . o fol „ w rules adopted by the Oregon
Utility Notification Center. T • e rules are set forth in OAR 952 - 001 -0010 throug OAR 952 -111 .100. ou may obtain copies of these
rules or -ct question • •/ -t 503.246.6699 or 1.800.332.2344.
Issu . d By: l� ��/ � Permittee Signature:
OWNER INSTALLATION ONLY 6,„1/4
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 Application FOR OFFICE USE ONL
, - :..:. ' "" City of Tigard DateB / 0 Permit No.: / _ / I �
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
1111
1i Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T 1 Cl A It 1) Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: i C Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction g[ 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
❑ 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: / 350 S �r4 1,,, Six or or more. occupancy.
__ • / ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: / ❑ Health -care facilities. ❑ Supply voltage for more than
(l / �� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: / lt'/ Project nameT+G A . 0)(42-a.— ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. l 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'I 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.)
Limited energy, multi - family 75.00 2
6] 11 , � ge 4-t1412.44... 5 residential (with above sq. ft.)
`' % Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: t( j f 0 1 ` _ i J J £ ( • ` 7 j. J 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 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: /� _ 1,,'F/I+, -tom 57,, , �i1Z/ . B. Fee for branch circuits
�Gfl
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address:
A.v_A is 'S t Z
1524 5 G/> r/?7 Each add'I branch circuit 6.65 2
��� p Miscellaneous (service or feeder not included)
City /State /ZIP :� z / 72 2 % Each manufactured or modular 90.90 2
,/ , dwelling, service and/or feeder
Phone: 6 ) 1„4/._ z Z 2. 2 Fax : : ( $3) 447' J96 Y Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: �,. _ _J Signal energy panel, or limited -
C j . "", { 1/(� p alteration, or
Address: extepio scrj A' / Page 2 2
City/State /ZIP: Each additional inspection ctti onover allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: /5074 Electrical L .: 3 22. el- Suprv. Lic.: 5¢6 Le* Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
�' Date: / Plan review (25% of permit fee):
Print name:
5�f / / u J,� /fil State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
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.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(1I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information :4
•
LIMITED ENERGY PERMIT FEES:
r 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:
r COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
O . Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
93 Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical •
❑ Nurse Calls •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other •
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007 -00426
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/16/2007
Phone: (503) 639 -4171 Apr
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/21/2007 TIME: 7 :03AM PAGE: 52
SITE ADDRESS: 13010 SW 68TH PKWY 14 {3 CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE F'ARK LOT #: 007 TYPE OF USE:
PROJECT NAME: PACIFIC SOURCE HEALTH
DESCRIPTION: Installation of low voltage for fire alarm.
OWNER: SCHNITZER INVESTMENT CORP, PHONE #:
CONTRACTOR: PERFORMANCE SYSTEMS INTEGRATION PHONE #: 503 - CA1 - 2222
Inspection Request Scheduled For: Date: 12/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
136 Low voltage 062024 -01 503849-4772 N
‘0'� �r-j� *L.
Correctio s /Comments /Instructions:
FL P ' b t 1
etc A t`n Aee ttAsV'AL.. Q
_______________/' `ri‘a___•Aspsz.:1 V
1 \/C' ---)
y: PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
` ❑FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: S 1A Date: Phone #: (503) 718 -2b•
CITY OF TIGARD
BUILDING DIVISION -- PERMIT #: ELR2007-00426
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/16/20307
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/14/2007 TIME: 7:01AM PAGE: 61
SITE ADDRESS: 13010 SW 613TH PKWY 140 CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 007 TYPE OF USE:
PROJECT NAME: PACIFIC SOURCE HEALTH
DESCRIPTION: Installation of low voltage for fire alarm.
OWNER: SCHNITZER INVESTMENT CORP, PHONE #:
CONTRACTOR: PERFORMANCE SYSTEMS INTEGRATION PHONE #: 503-641 -2222
Inspection Request Scheduled For: Date: 12/14/2007 Pour Time:
Code # Inspection Description - •nfirn_# Contact # Message
135 Low voltage 061506-01 503.84R-4772 Y
Corrections /Comments /Instructions:
co s pL'� c�' oto w ALI Qt.) E AP
•
- r a__1\)fp4
Q Pe i %+1 ci t1/4N EL •
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL SCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � N v Date: I 2--' fl - Q) Phone #: (503) 718- ✓"ti0°
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: El 82007 -00426
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11116/2007
Phone: (503) 639 -4171 Ar»m
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/312007 TIME: 7 :Q0AM PAGE: 63
•
SITE ADDRESS: 13010 SW 68TH PKWY 140 CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 007 TYPE OF USE:
PROJECT NAME: PACIFIC SOURCE HEALTH
DESCRIPTION: Ir,siallation of low voltage for fire alarm.
OWNER: SCHNITZER INVESTMENT CORP, PHONE #:
CONTRACTOR: PERFORMANCE SYSTEMS INTEGRATION PHONE #: 503 - 641 -2222
Inspection Request Scheduled For: Date: 12/3/ ?007 Pour Time:
Code # Inspection Description onfirm # Contact # Message
135 Low voltage 060542 -01 503 - 849 -4772 N
Corrections /Comments/ Instructions:
•
_`, PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G` ' N d8 Dater' p21bl0 1 Phone #: (503) 718 - 2 -"14A