Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' . :'- COMMUNITY DEVELOPMENT Permit #: ELR2011 -00107
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05!13/2011
Parcel: 2S 101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 500
Project: University of Phoenix Subdivision: TRIANGLE CORPORATE PARK Lot: 2
Project Description: Low voltage for intrusion /access control.
Contractor: STANLEY SECURITY SOLUTIONS INC Owner: GK TRIANGLE CORPORATE PARK III L
15495 SW SEQUOIA PKWY #100 BY THOMSON REUTERS INC
PORTLAND, OR 97224 ATTN: MEGAN DOWLING
CARLSBAD, CA 92013
PHONE: 503 - 968 -3353 PHONE:
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/13/2011 $75.00
12% State Surcharge - Electrical 05/13/2011 $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: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
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 • ' '52- 001 -0090. You m09 obtain a copy of the direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued 7 � 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.
May. 1 3. 2011 1:06PM • 666 P.
RECEIVED
•
. No. o 1
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Electrical Permit APplication - FoRA USE ONLY
City of Tigard MAY 1 3 2011
Blvd.,
" 13125 SW Hall Blvd., ,22j ,-
r
Phone 503.
; '. '.. : 503.71.8.2439 Fax:k51459MF64 Dateffly
7 IGARD Received'
Datelly: 0 / 3
Plan Review
E 1 Permit No
. Other Pennit:
' eikAa//-oolos7
TIGARD 1 ' 15 1=1100 Lille: 503 . 639 19VALDING DIVISION . Date Rearly/Ily; Julia:
Internet: www.ligard-or,gov . NolifiedNethod: LTitoSpeleenP6ta21 for
don .,
'...'" ":.'..... •:"..'. INFE::.6p . :...... . ::..., 7, : 7 .1 .. • ,. • .., 1 ''.''', ''',- ',' •.,... . -, :•- ': . ' ::..: : .. 1140 REVIEW . ' ''7. ": •:-:-.. •:''' •
n New construction 1r, . ddition/aiteration/rcplacement . Please check all that apply (ubmit a SCLS Of Pins wfilerns checked beow):
0 Service or feeder400 amps or more 0 Building over three stories.
,
111 Demolition • Other;
where Olt available fhult current 0 Marinas and boatyards.
exceeds to,odo arups at 150 Win or 0 Floming buildings.
less to ground, or escceds 14,000 0 Commercial.use agricultural
0 1- and 2-family dwelling Or Commercial/industrial 0 Accessory building amps loran other installations. buildings.
11 Multi-family MI Master builder 0 Other: 0 Fire pump. El Installation of 75 KVA or
larger separately derived system.
::.. . .,...: : - 0 Additio„ °New motor load of 0
Job no.: YIA5 Job site address: / 5 1 71- 10014P or more, occupancy.
A .. 1 4 A. kdt 0 Recreational vehicle parks.
-..
0 Sin or more residential units.
City/State/ZIP: l' . 6 6 4 3 - 7 2 2 3 0 Health-care facilities. ID Supply voltage for more than
El Hazardous locations. 600 volts nominal. •
Suite/bldg./apt. no.: 99 Project name: "/ / i ' a . . a g), , D Service or feeder 600a nips or more. . ... . ..
.4
/-*" •;. ig.:::.:;'2.',..•::'.':',..:.-YS.:fg.'jr43.tt::$0-g.f.)rit1:-]:::::::':::::...7..:7::::::::
Cross street/directions to job site;
nescripli.. I OW. I rte. U Tout
---• _
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision:
Lot no.: 1,000 sq. 11. or less . 168.54 4
Fa add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no-:
_
. . Limited energy, residential
75.00 2
. (with above sq. R.)
Limited energy, multi-family 75.00
2
A.. 11.- A-Ilut A) A C eel 5 CO ,t, residential Lidi&ove sq. ft,)
Services or feeders Installation, al ;
teraton, and/or relocation
200 amps or less 100.70 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 552.26 2
ren SerVices or feeders installation, alteration, and/or
City/State/ZIP:
• relo Cation
. ,
.
Phone: ( ) I Fax: ( ) . 200 amps or less 59.36 i
_
Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps 125.09 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 bnsnch circuits with '
04pii4ic: .:;:: e a a bo ch ve br s a e n r c v h ice ci o r : u r i c t eder fee.
7A2 2
Business name: B. Fee for branch circuits w/r/tour -
. service or feeder fee, fi
•
56.18 2
Contact name: ' branch circuit
Each add'ibranch circuit . 7,42 — 1 - 7
Address: .
)1iseellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP:
. dwelling, service and/or feeder 67.84 2
.
Reconnect only 67.84 2
Phone: ( ) Fax: : ( ) _
- Pump or Irrigation circle 67.84 2
E-mail:
.. Sign or outline fighting 67-84 2
•.:..•: 1. •: ,.- . ''.;":: .;.:;Y .;' .. CONTIFLNPT.alt '! : • ..:.-,.:;• ...: '...... . 7 :::. .:'... --.. . .. • • "Tiitene 1
Business name: S , t a . , panel, alteration, or extens i 2
ion. I Page 2 i ...,
_._../.. . J . . 5 Each additional inspection over allowable In any of tho above
Address: / 5 4,
" IA) . - .m idi 1,4„, a Ii r k. ' i • 0 Additional inspection (I hr mm) 6615/ hr
.._..._.
Im (1 hr nun) 66.25/ Isr
City/State/ZIP: GIVEA 97 W./ Industrial plant (1 hr min) 78.18/ hr
Phone: ( So3 ) ' - 5 3 s Fax: (5C) - („s--- 3.3 9 e s" Inspections for which no fee is
specifically listed (Yi. hr min) 90.00/ hr
COB Lc.: is s' -7 V t rectrical Lic.: _ e l -- Suprv. Lic.7 r... '.. : : . ELECUICAL:PgRitl'f..FEES . ' • • . : :. • ,.., ..:
Subtotal: '7
Suprv, Electrician signature, required:
Plan review (25% of permit fee):
Print name: 02.2._S- I Stole surcharge (12% of permit fee): 9,00
TOTAL PERMIT FEB: p .0
Authorized signature: f ao r
'1'1114 permit JinilileatiOn expir Ira permit it not obtained \ ilhin In
■ •
days :slur is has been accepted at comp
Print name: c Sr• - • „ . ,
-A Date: . 4 -( /
• thimber of inspections ,pllowed per permit.
11. • 4 d I : L.
On unclingW4r1t114\ELC•PemlitApp.doc 07/0 1/1 0
445.-161crilliActrAx myna
May. 13. 2011 1:07PM No, 0666 P. 2
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' Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
AESIDENTLAI:: \voRI ONLY:
Fee for a residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems`
❑ Burglar Alarm
❑ Garage Door Opener's
❑ Heating, Ventilation and Air Conditioning System'
❑ Vacuum Systems*
❑ Other:
C?vll?Ex���`wali� ONLY _ _,
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Boiler Controls
Cock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control"'
El Medical
❑ Nurse Czlls
❑ Outdoor Landscape Lighting*
VI „ Protective Signaling
Other
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
1:111ui1ding\PcrmitsTI C•Vermiinpp doc 07/01/10