Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a.. COMMUNITY DEVELOPMENT Permit #: ELR2009 -00161
T ( AR O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/16/2009
Parcel: 2S113AD01900
Jurisdiction: Tigard
Site address: 16640 SW 72ND AVE B10
Subdivision: OREGON BUSINESS PARK 1 Lot: 9
Project: Veris Industries
Project Description: Update existing access control and intrusion system.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Restricted Energy Permit 06/16/2009 $75.00
#300 12% State Surcharge - Electrical 06 /16/2009 $9.00
PHONE:
•
Contractor:
STANLEY SECURITY
15495 SW SEQUOIA PKWY #100
PORTLAND, OR 97224
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: N
HVAC: N Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: Y
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. All work will
be done in accordance with approved plans. is permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTE. . = • law requires y'' to • o, the rules adopted by the Oregon Utility Notificatio Center. Those rules are set forth in OAR
952 -001 -1.10 through OA" 95 ; 01 -0100. m obta'n = of of the rules or direct questions to oUNC by call' :246,6699 or 1.800.332.2344. ��
Issu = • By: »���. - `� �� � I / - • Permittee Sign re: l � ��
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:
2 CONTRACTOR INS LLATION 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.
I ; _ • , Jun. 12. 2009 9:43AM No. 4329 P. 2
Electrical Permit Applic t)ippf , -- �j` l °..' j - �� F(NZ(lI'FICE USE O,NLV
City of Tigard 1 Rcoeived /_ /2 d9 , ,X Permit No.: gh/1, eerf - /4/
I N
• 13125 SW Hall Blvd., Tigard, OR QQ77?�?�tZt Plan Review
Phone: 503.639.4171 Fax: 503.58BI196t 20 Date /fly: Other Permit:
T I % A R D inspection Line: 503.639.4175 Date Ready /By: _Jv,,/C%
r � ' El See Page 2 for
Internet: www.tigard- or.gov f` t \t I" • • ` Notiflcd/Mcthod: _/ 000000 GOO 000A0Ofo
minim
_a t t � � ryC�� i ._ ...
t 21f`l T,..,tr,. - -- _. .v- - - - ° tl.{ Ri3f.alh,.+t�HSr - ......_ .._� .- ::: -, ,� , n. a 3 lh . .. dr711]ItliEicABO ,. r ..,...- Ela) ti - ig= .M
❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 seu of plans w /items checked below):
EJ Demolition Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories,
where the available fault current ❑ Marinas and boatyards.
-�* W � = -- .= = ::• - = te
- - � ,�� c ti t �s 1 I � �y { � s r=j- � `s' - � - - t, exceeds 10,000 amps at 150 volts or ❑Floating buildings.
. �1 �1111l111gitt i� -- ,z;;•5;; 3'S fli 1 asgrai mie.•- -•--- .- --= - - - -• -, .111`iutignin t il.at,: enti li i i1 :01ii Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling mmcrcial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family / ❑'aster builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
1 — — vvu r , , q , s , �_._ .::__ ,,�.._ ,,, _, }Sn ❑ Emergency system larger separately derived system,
_ �11i11S�131111�ff�>i3 -:-�'. ��::: —._. _. t - _ .. ....._ �� isltff�ll�; iiliilli: �- h1 *tl}�'1 {I'=3;� {I�I�C111�11it ❑ Addition Of new motor load of ❑ •'A" "£,• "t_, ut_g
Job no.: 35oS5 4I it7W"Ie+ S R/ Job site address: (( 4/P A , ` � 100HP or more. occupancy.
❑ 't/ ❑ Six or more residential ututs. Recreational vehicle parks.
City/State/ZIP: d R. "� Z 7 1 0 H .•care facilities.
s. ❑ Supply voltage for more than
"^� ❑ Hazardous locdons. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: V Q (2. fs IiCS1 eC �0 Str%!ce or feeder 600 arms or more.
:a::=_: W z _ - " -_ ;d uly, ' 41 .; � i,', ?I�?;i 110j1=t1' iii if 11:-W
Cross street/directions to job site: Description — - Qrv. Pee. i Total "•
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: i Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no ": Ea. add'I 500 sq. ft. or portion 33.40 1
W i 4 " •t " t' n r ___— _ . -•- _ - � Limited energy, residential
II _.___ ss .- t t; t 3_ • -;r te -2 --m -__ • (with above R. ft. ) 75.00 2
,..;�:�5,+r+ji • i [4 � ,� _ i s� F,'i�,7rq 1Si1���� ! l�i ;*t':7'r-- --•-- ---- '-`= "= =a• =•= -._.._ ( a9
— Limited energy, multi- family
v oli rE ►cT't.elri '/ ss coAr ► Y- Z'NrPusroA) residential (with above sq. ft.)
75.00 2
�7 Services or feeders installation, alteration, and/or relocation
+ {t1 + }t �cr��� - }�1H'�.[������I ;.` _ �,p }) { +� +} tt {`{ _ _ 200 amps or less 80.30
2
2
��11 1�11lflS = •:s919J_W'rsK a• - s:—r�- rat !I�Y "]I .l[n i —T r -- 20 i to 400 s 106.8
.. _ .�. � '._tom ::�.��'' - , 4 ..-
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 arms 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
rdocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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 ettenslon, er panel
Owner signature: bate: A. Fee for branch circuits with
j j p( ry( • ig` == 3;11I11 ,,•sic'_ �u kr11II1I11II11I11I)f11H� .. i `_— 9 - .. each babove serviceioor t eder fee, 6.65 2
Business name: r ANki[ 5' c t i a if B. Fee for branch circuits
wirhout service or feeder fee,
Contact name: r
ss a i2 J S it y d first branch circuit 46.85 2
Each add'l branch circuit 6.65 2
Address:
r sHq 5 s' (A) Se 9ti 01\4 ma /
Miscellaneous (service or feeder not included)
/y
City /StateJZIP: , 0 972 Each manufactured or modular 90.90 2
1 � dwelling, service and/or feeder
Phone: ( ) 0 , , 00 F ax:: (j3) f q b fs' 33 ? ' g Reconnect only 66,85 2
E -mail: Pump or irrigation circle 53.40 2
__ =_:_ _ -_ :- _ ND . ::=TE = ^. is r:X11; f111I11#Iilllilli �ttl<tttr; = g
"_ -- ••z- - -� - - -- �'---- ••-- °- --- �� Sign or outlineli nn 53.40 2
Business name: HSM Electronic Protection Services (HSM Security) Signal circuit(s) or Limited
energy panel, alteration, Or
Address: 15495 SW Sequoia Parkway Ste. µ100 extension, Describe 1 Page 2 75.00 2
City /State/ZIP: Portland, OR 97224 Each additional Inspection over allowable In any of the above
Per inspection 62.50
Phone: (503) 968 -3353 I Fax: (503) 968 -3398 Investigation per hour (1 hr min) 62.50
CCB Lic.: 161567 I Electrical Lic.: 37 -1054 1 Suprv. Lie.: 941LEA Industrial plant per hour 73.75
ail} 1111111illtllllilll1111g11i 11 diNi 'r ;M:= ,Ml if1!111 RR
Suprv. Electrician signature, required: '—.,.a. Subtotal: 875,00
P
Plan review (25% of permit fee):
rint name: Steve Morehouse Date:
� /" State surcharge (8% of permit fee): m q.�_
Authorized signature: TOTAL PERMIT FEE: ,yy.uu Q .r v —
This permit -�.
application expires If a permit is not obtained within t80
Print name: Ere. e�
�� � � Date: � �y J f days after it has be aCCeptld At complete.
I ' Number 0t inspection; allowed parr permit.
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