Permit M CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I COMMUNITY DEVELOPMENT . Permit #: ELR2010 -00268
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/22/2010
T IGARD Parcel: 1S134CC01700
Jurisdiction: Tigard
Site address: 12325 SW KATHERINE ST
Project: Mary Woodward Elementary Subdivision: Lot: 0
Project Description: Low voltage for fire alarm.
Contractor: PERFORMANCE SYSTEMS INTEGRATION CORP Owner: TIGARD - TUALATIN SCHOOL
7324 SW DURHAM RD DISTRICT #23J
PORTLAND, OR 97224 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503 - 641 -2222 PHONE:
FAX: 503 -641 -1464
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/03/2010 $75.00
12% State Surcharge - Electrical 12/03/2010 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit i .... • ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don - n accordance wi - 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 ITN epires to follow the rules adopted by the Oregon Utility Notification Center. Those rules are s -t forth in OAR
952-111-0010 through OAR 95 :01 -009' ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.197 or 1.::•• 32. 4'
Iss -d By: K.... Perm ittee Signature:
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 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 Application � � r 4 , FOR OFFI USE'
0
City of Tigard « Received _
1111 Date/13v: ' dI 1.f al_, it
'+ 13125 5� `Hall Bhd., Tigard. OR 97' u1 Review
0. .,i' . Phone: 503.6394171 Fax: 51);.595.19 ) ^ GC t�� n . \:
( v1) r P i<
TIC'.1 2.D Inspection Line: 501.639.4175 F. G H elves c2fr
Intcr.0 ww .ti nd of got ` v /�(' i \ � tiup mantel lnl ,rmatiun
t t � T . sry � r'm a > ✓ !' t 3,. 5� ' €„� a �,.. t u.+�., i r a ,.�k" �€fj r ,�7p - k
` a t , . _:.x.. t E..w s ,1 1 PF l)F N (7111 :4, � .. s S `� _ ..,''�. t x 5 a_ z a : , . , 31.4 f REM II_ W„ s * . , _ ., s. is l ,
❑ Nev construction Addition /ahcration /rep c tent 1 Icvse check ,III ohm apply (submit or plans ty(, eon henked below):
❑ Service ,,r feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where I e :iv: ruble G ennent ❑ Marinas and bo:lte:uds.
' '''e :7 ' t,,T al,Et OR'' Ol'A EONS I'RUC I IO ?' y ? C s , ,g5 t xceed, l I),n 8) IiI . al l Sn ,,,lls „r ❑ Flo huilchngs.
less to ground. or t v i ds 14.11151 ❑ Commercial -use agricultural
❑ i- and 2- family dwelling " Igl Commercial /industrial ❑ Accessory building amps for all other iostallati.ms. budding,
❑ Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
,� a • - ❑.F.rneruencv ystcm larger separately derived system.
'
` �-f ° '" ��t w € , LOB: Sl ;iii I FOiZ 1A71o�N •AND lj0(.11:10N c6 , § . , ,t: , : ,fi r
u. >. _ .. . . M. . o, . ,.,... - . s.l'. . e . ,, -1 ._ :, ❑ ti
Addi o f pleb un)1n 10,0 of ❑ A 1... .. p....
Job no.: 1a . iii 1 lob site address:123Z� SW teat; rl s 1 IQ(1111' or mare. occupancy.
vv l�t1A �C. A� i ❑ Sir or more residential units. ID Ri•crreational vehicle parks.
City/Slate /ZIP: 'j"• (flick D R o ni ❑ ❑ Health-care ti facilities. ❑ Supple > nhact t ■) more than
v Hazardous locations. 000 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Solis or feeder 6(10 nips or more.
M4Y ®Q) 47A � Pi/. A M - M
sod", wtt 4 . r ' S 4 1? i 1 ;S(.HI T a gp-t 5 ;ws , _ .4
Cross street /directions to job site: St) Wiw4d A iit K�'°° rip„ I Qtr. I rev. I Twat I
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,001) fi.orless 168.54 4
Ea. add'] 500 sq. ft. or portion 33.92 1
Tax /
map parcel n0
17 Limited energy. residential
n.:-, - it Us`"n.t , 1 ` .. 1)I; fION O ,`N a
.(OtRiy..d . „ > a" `
-n •; `s (with above ft.) 67.84
A Limited energy. multi family 67.1;4 2
Fa Q 1 ld residential (with above sy. II.)
Services or feeders installation, alteration, and/or relocation
200 amps Or less I 11)0.71) no 2
7 „ ' D PR0PERTI «)WNLR ; " ' D ENAN 1 rK. p> P
"� r a t " - T � -sk`. "' .. 201 alt 10 400 ; rl , 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1.000 amps 301.04 2
Address: Over 1.000 amps or volts 5522(i 2
' Temporary services or feeders installation, alteration, and /or
City /Stale /ZIP: relocation
Phone: ( ) Fax ) ) 2011 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
intended for sale, lease, rent. or exchange, according to ORS 447, 449. 670, and 701. 401 amps to 599 amps 168.54
Branch circuits - new, alteration, or extension, per panel
. Owner signature: Date: A. Fee for branch circuits n'it1,
Fri
` qPPI 1( ' ` s i {�1 .1�`I f RSU\t' t ' above service or /'ceder fee. 7.4? 2
.. ..s_._ra=. u _.,.. ...._ each branch circuit
Business Italic': B. Pee for branch circuits grit /rout
�tRFt?fMnr.+� /Sth \5 service or feeder 6'e. first 56.Ik
Contact name: 'j' , �( branch circuit
�.t D HN 6`'1 ZL4lE Cf Each add'/ branch circuit 7.4 a
Address: •3 22{ S"W b,;24rtwr ?..,,,L. Miscellaneous (service or feeder not included)
Each manufactured or modular
City /Slate /ZiP: phaa i'tr ,, tj /OR / 91-2:2.4- dwelling. service and /or feeder 67.84 2
Reconnect only 67.84 2
Phone: (Sty3) Coe.(l - 222 "7__ Fax: : ( Sv3 1 0..0._ l
Pump or irrigation circle 67.54 _
E _ or outline lighting 67.84 2
r 5 4 ,xf, y ". 1 .t5�' , Cr 3 'Fq� 3° Sign o '
t,, , ,
,,�+ aC � Y .iz,.�� r �,� , r; �-¢�y� � x , r�;: „ ,,�,,, .. ,� , �,,,4�„ Signal crrcurti.l of limited- cuelgr 73-41Y- Business I.......: panel. alieraiion, or extension. / ''
Page
c2GD� Mn sy S; aMS Each additional inspection over allowable in any of the above
Address: .71 2. S�AJ u J12.HnoA KA . Additional inspection 11 hr min/ 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /S tate /ZIP: o RT L.{) w1), 7 o/ (1122_4
Industrial plant (I hr min) 78.18/ hr
Phone: ( . s03 i (Ai _222 Fax: I5 as) (;q k_ (4 6 --- Inspections for which no fee is 90.1 1 hr
specifi all hued (1/2 to min)
CCB Lie.: ISp}H7 Electrical Lie.: 3`i- 522_G.E1 Suprv. Lie.: LEq 38 ,
73 ,,,>:x.: y .� f El7✓C'h7t1, ,` P"ljEb ,: i.'Y r
Suprv. Electrician signature, required: y �� �� �r` Subtotal:
�i�l� Plan review (257; of permit 1cc):
Print name: s.OHn1 t i CHE �' Date: 12 (i - 03 __ 2 t o State surcharge (12% of permit tee):
�� TOTAL_ PERMIT FEE: 751/ r
Authorized signature: This permit application expires if a permit is not obtained within ISO
days alter it has been accepted as complete.
Print name: Date. . Number of inspections allowed per permit. ,
I:A Building VI'enniisVELC- PenniIApp.dnr 10/01/1)9 .1411- 41,I5Tr I I /115ICOp1/Willt