Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2011
• Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 180
Project: VersaLogic Corp. Subdivision: Lot: 0
Project Description: (1) alarm system
Contractor: PHILLIPS ELECTRONICS Owner: PACIFIC REALTY ASSOCIATES
3247 NW 29TH AVE 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97210 PORTLAND, OR 97224
PHONE: 503 - 222 -5083 PHONE: 503 - 624 -6300
FAX: 503 - 227 -4992
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/19/2011 $75.00
12% State Surcharge - Electrical 01/19/2011 $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 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. 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 law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through OAR 952-001-0090. - � i Youu may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: l'ee �(/ S e----- PermitteeSignature: 0 /975,4 / C 77("/
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 FOR OFFICE USE ONLY
n Ecfi r c Alk4 9 D R ic .
ig SW T gard, OR 972131
3
' - I . Phone: 503.639.4171 Fax: 503.596
III // A A r Permit No.:67X.2
DPIaatneiBReyv: Other Permit: iew/ /9
4175 639
Inspection Line: 503
p.. Date Ready/By:
TIGARD Ins 30 1 '°11\ , , 6 rup See Pa 2 Supplemental Information Internet: formation
rnet: www.tigard-or.gov Notified/Method:
,S. 0
0 New construction tgAddition/alteratiouatatraffieWv Please check all that apply (submit 2 sets of plans w/items checked below):
Pu El Service or feeder 400 amps or more 0 Building over three stories.
P Demolition 1=1 Other: where the available fault current El Marinas and boatyards.
`YttiqZ7VRTETi1dit AMO'r;,Wil&fYeilik,WRISAMAnia exceeds 10,000 amps at 150 volts or 0 Floating buildings.
IPI:' - ''' , '' 1 ' ,, : , t7II,,i. ,-,, <",",:': -.., less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling VI Commercial/industrial 111 Accessory building amps for all other installations. buildings.
E Multi-family 0 Master builder ['Other: CI Fire pump. 0 Installation of 75 KVA or
iiiie -, ,, ,,v,',,, VailiWA.Ai,-:,' 7-W IETR 0 Emergency system' larger separately derived system.
'! ' ' -T.":::N ,, , , :31% ,, ,FV El Addition of new motor load of El A "1-2" "1-3",
100HP or more. occupancy.
Job no.: Job site address: ii- 5. S eat uo i 0•..•
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Pe El g • 4 di s Health-care facilities. 0 Supply voltage for more than
- _,..11. a 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Igo Project name: V ersa. L 0:c core 0 Service or feeder 600 amps or more.
8
' '
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
;Vfgeffitiiir Anr4AIM (with above sq. ft.) 67.84 2
Limited energy, multi-family
67.84 2
A•., Voli-aie_ A lcurw. Svsfekt- residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
leMilialiltOcy POrl ,g: 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
. ,•• Z:',.. .'Aq!illAt;i:51114340-:AIY- Over 1,000 amps or volts 552.26 2
1 V. ,,Ztl.. -_,'' 0-j. Temporary services or feeders installation, alteration, and/or
. 1 .7 ; ea'te/Z Mit 1
b.94)hi .... .v,..,&.r.m.:7. relocation
Phone: ( .' ' -,.)- - Fax: ( ) 200 amps or less 59.36 1
r
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
651Per : r1r* N9-5:;:' ,,, t :' e0Retifik§braing above service or feeder fee,
742 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: / first branch circuit 56.18 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State/ZIP: . Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) • Fax: : ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
;.ii , „73;; ; ZP:-=faiiiiiiiiiiii i iiiiiiiiiiiiiii i ikiii0 Sign or outline lighting 67.84 2
Signal circuit(s) or limited- -
Business name:4fasier dba Phillips Electronics . .
energy panel, alteration, or -0°
Address: 3247 NW 29th Avenue extension. Describe: Page 2 95 1 2
City/State/ZIP: Portland OR 97210 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 222 . Fax: (503) 22 4992
i CCB
Lie.: 125364 l iojnittlectrical Lie.: 2621 C ' Supry Lic.: ipti 3 Lep .
Investigation per hour (1 hr min) 66.25
_
Industrial plant per hour 78.18
• l r;Y•:'1,A tiMITMCS10,Vica;,:.i:W
Suprv. Electrician signature, required: Subtotal: - 76700
Print name: e -14 S Olt Date: 1. 2 I Plan review (25% of permit fee): _
State surcharge (12% of permit fee): q 00
Authorized signature: TOTAL PERMIT FEE: '
This permit application expires if a permit is not obtaihed within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1: \ Building \Permits \ELC-PermitApp.doe 10/01/09 440-4615TO 1/05/COM/WEB
Electrical Permit Application - City of Tigard .
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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: •
COMMER .
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
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control* •
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
A r Protective Signaling
— tther
'otal number of commercial systems:
licenses are required. Licenses are required
�l other installations
•
•tS\ ELC- PcrtnilApp.doc 07/01/10