Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
;
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00092
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2011
Parcel: 25101 DC00200
Jurisdiction: Tigard
Site address: 13535 SW 72ND AVE 165
Project: Workflow One Subdivision: 72ND AVE OFFICE BUILDING Lot: 0
Project Description: Fire Alarm.
Contractor: FIRE PROTECTION SERVICES Owner: PNWP LLC #2
18270 SW MOUNTAIN HOME RD BY PACIFIC NW PROP LTD PTNSP
SHERWOOD, OR 97140 PO BOX 2206
BEAVERTON, OR 97075
PHONE: 503 - 590 -3732 PHONE:
FAX: 503 - 628 -6214
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/20/2011 $75.00
12% State Surcharge - Electrical 04/20/2011 $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. You may obta • - • • �_, - • -s • ect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ = Permittee 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.
Apr 18 2011 3:44PM Fire Protection Services 503 828 -5214 p.1
Electrical Permit ApR l 1 V ED l'ORR 01:F1( 1: USE ()NIA
City of Tigard Recci,ed , - � / Permit No ^ s
13125 SW Hall Blvd., Tigard,OR 97223 APR 19 2011 Date/13 : _ . ` ��
l i,�W,;, Plan Review - -
Phone: 503. 639.4171 Fax: 503.598.1960 �'h;lh 1 '`' Date/By Other Permit Q149 � f _ dL .Yi3
D ate Read /B .
Inspection Line: 503.639.4175 C ' 1 runs - ® `
CITY Or� Y Y - Page 2 Internet: www.ci.tigard.or.us , Notified/Method;
Supplemental Information
• a t I •P
:„ °PE - WOR10
❑ New construction ® Addition /alteration /replacement Please check all that apply:
❑ Demolition Other: ❑Service over 225 amps, comm'I :Hazardous location
❑Service over 320 amps- rating ❑ Buildng over 10,000 sq. ft.,
E1IOB. OF *,,
a....::.M.. ` .:. :. . . . •: , 7' , .: :i: :: ; 1: of 1 -and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building ID System over 600 volts nominal units in one structure
❑ Multi family ❑ Master builder ❑ Other:
❑Building over three stones :Weeders, 400 amps or more
Occupant load over 99 persons CI Manufactured structures or
Nit, i JOB -SITE .' oiiii ATION AND LOC 11OT� ❑Egress /lighting plan RV park
Job no.: 2700 Job site address: 13535 SW 72nd ❑Health -care facility ❑ other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: Tigard, Or The above are not licable to temporary porary consVuction service.
Suite/bldg. /apt. no.: 165 i Project name: Workflow F ; :;
Description I Qty. Pee. [ Total 1 `'
Cross street/directions to job site: SW Cherry Drive New residential single -or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no
Limited energy, residential 75.00 2
i Limited energy, non - residential 75.00 2
PI St ii
� n . J'I i�b' KKR � : :
" Eac manufactured of modular '
Remove and replace horn strobe per Ti dwelling, service and/or feeder 90.90 2
q ��
Services
or less feeders installation, alteration, and/or relocation 2
� t � � 20 0
PRO,OTEItt"Y OWNER ... _ }51 NT amps to amps 106.85 2
.N
e an a 'o
200
l 40
-:a, ... ... . ..,... ',< .,.. ,. ,. 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: relocation
( ) 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 600 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
; [ ..�1Fi,L.7C 1_ C OIyT A C ' ft pst . A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address:
_ each branch circuit 46.85 2
Each add'I branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 53.40 2
( ) Fax: ( ) Sign or outline lighting 53.40 2
E -mail
eo ? -;� Signal limited-
al circuits) or li ted-
'
kUNTRCx_t : energy panel, alteration, or
M ss'S extens Describe: 1 Page 2 7s, a 2
Business name: Fire Protection Services Inc
Address: 18270 SW Mpuntain Home Rd Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Sherwood Or,97140 Investigation per hour(1 in Iran) 62.50 '
Phone: (503) 590 -3732 Fax: (503) 628 -6214 Industrial plant per hour 73.75
, EL'ECTRi 1:4 ( ll t
CCB Lie.: 154333 Electrical Lic.: 34- 488CEP Suprv. Lie.: 4120LEA Subtotal 7 se", ,.
Suprv. Electrician signature, required: Plan review (25% of permit fee) ca-
......._74.79. State surcharge (�°/ of permit fee)
Print name . � 7 Date: 4 /18/2011 q .
l t l ` J t 1/ TOT > L RMIT FEE `R LI, Z/ td
Authorized Signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: r ` c y n & Tito yy ' Date: 4/18/2011 • Fee methodology set by Tri County Building Industry Service Board
•• Number of inspections per permit allowed .
is lnuilding \PermirsELC- PermitApp. doe 17103 440 4615T(I0(OVCOM/WEB
Apr 18 2011 3:44PM Fire Protection Services 503 628-6214 p.2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
0410risr1iAL WORK CoNI;4:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
O Audio and Stereo Systems*
LI Burglar Alarm
▪ Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
O Vacuum Systems*
O Other:
,Ar4
Fee for each commercial system S75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
E Audio and Stereo Systems
Boiler Controls
E Clock Systems
E Data Telecommunication Installation
lEj Fire Alarm Installation
LI HVAC
O Instrumentation
O Intercom and Paging Systems
O Landscape Irrigation Control*
11 Medical
O Nurse Calls
O Outdoor Landscape Lighting*
O Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
OfluildingTenniueELC-PermitApp clec 340U3