Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00138
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/16/2011
Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 250
Project: Spec Space Subdivision: TIGARD TRIANGLE CENTER Lot:
Project Description: Fire alarm system.
Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS IM Owner: PACIFIC REALTY ASSOCIATES
15495 SW SEQUOIA PKWY STE 100 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 968 -3353 PHONE: 503 - 624 -6300
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/16/2011 $75.00
12% State Surcharge - Electrical 06/16/2011 $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 k is suspended for more the 180
days. ATTENTIP •re•.• law requires you to follow the rules adopted by the Oregon Utility Notification Center. T ose rules t forth in OAR
952 - 001 -0010 rough OAR 95 001-0 Yoo may obtain a copy of the rules or direct questions to OUNC by.calling 503.232.1 or .800.3 . 44.
Issued By: _ f 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.
ter.
R a r• -
Electrical Permit Application ��� ; , - FOR OFFICE USE ONLY .
City Tigard Received Per No.. C of T and ` -
tY g DateB : t! /s i f; 0 I
13125 SW Hall Blvd., Tigard, OR 97223 , 1 ^' 1 t \ Plan Review
. 6' 2(J Phone: 503.639.4171 Fax: 503.598.1960 ,Ulv Date /By: Other Permit. Supplemental ' ) O// 73
TIGARD
Internet: www.ti Inspection Line: 503.639.4175 , , i...,, Date Ready /By: inns. . u H See Page 2 for
and -or. o v C4� l'"''' l , Notified /Method. C[
€ g Q^ ii Information
12': mgr° a � ' z � � r r, � � �,
';, .1 J '�CYPE Ok :44 " 1 1 * °. tai r:4Wi PLAN�RFVIEW` � N e t
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
t � �CATE ORY O CONSTRUCT O V `` ;� exceeds 10,000 amps at 150 volts or El Floating buildings.
'*.'' i �� "'°` `' 4 ` k "'"�'' `"t`""�''"' �' "` " :611 '"`�`�' " „ "``' „.J. t. `` 24:.,e ` f " 1 less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I - and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
A, c n. ,, , r, ° % ❑ Emergency system larger separately derived system.
1 ,. OB IT'E i , AN LOCATIO110
�'�." rr"�. _ s^. ��° n�ct.�.w �� m��r�e.a� D � «ew... a �aa.. � .` °� , ,e# >a- :.:,,`t El Addition of new motor load of ❑ • A „ E x• 1_2 „ • 1 3
Job no.: Job site address: 12909 SW 68 PARKWAY #250 100HP or more. occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks.
City /State /ZIP: PORTLAND, OREGON 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: SPEC WORK ❑ Service or feeder 600 amps or more.
C .sj_. °.! Ja ' :, : .. ".�CESGLIEDI7LEs . . � " . ti =x :
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 145.15 4
Tax map /parcel no.: Ea. add'! 500 sq. ft. or portion 33.40 . 1
Limited energy, residential
�, a„
75.00 2
t, , e t l i �" , DES ..RTPTION OF WORK a, W4, , U,, (with above sq. ft.)
Limited energy, multi- family 75.00 2
ADD FOUR HORN /STROBES SUITE 250 TO EXISTING EXPANDER residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less . 80.30 2
f ""� ® µ PROPR
ETY OOWNER TENANT To t .
- ,.��� �� .� � „�, �� � x � � �� , �r -,. �, �, 201 amps to 400 amps 106.85 2
Name: PACIFIC REALITY ASSOCIATES 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 15350 SW SEQUOIA PARKWAY Over 1,000 amps or volts 454.65 2
City/State /ZIP: PORTLAND, OREGON 97224 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503)624 -6300 Fax: (503)624 -7755 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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
lit*A41$174 PRI IGAN ' ; ii: = ®000NTAC'I' PPRSON �,'° g above service or feeder fee, 6.65 2
each branch circuit
Business name: STANLEY SECURITY SOLUTIONS B. Fee for branch circuits
Contact name: GARY TAUSCHER without service or feeder fee, 46.85 2
first branch circuit 0
Address: 15495 SW SEQUOIA PARKWAY Each add'( branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: PORTLAND, OREGON 97224 Each manufactured or modular 90.90 2
503 968 -3355 Fax: (503) 968 -3398 Reconnect
dwelling, t on y and /or feeder
Phone:
( ) ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
7 q a ; ,." CONTRACTOR A4 `, a --itim Sign or outline lighting 53.40 2
Business name: STANLEY SECURITY SOLUTIONS Signal p a nel t(s) or limited -
energy panel, alteration, or
Address: 15495 SW SEQUOIA PARKWAY extension. Describe: l Page 2 7S 2
City /State /ZIP: PORTLAND, OREGON 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 968 -3355 Fax: (503) 968 -3398
Investigation per hour (1 hr min) 62.50
CCB Lie.: 161567 Electrical Lic.: 37 -1054C Suprv. Lie.: Industrial plant per hour 73.75
°„ ELEC'i?RI.CAL k "ER81, OWES 'VW: it
Suprv. Electrician signature, required: �( Subtotal:,
1(6 ' ` ��� �/� Plan review (25% of permit fee): ��
Print name: STEVE MOREHOUSE Date: State surcharge (12% of permit fee): �,�'
Authorized signature: &a,..., TOTAL PERMIT FEE: 5 t. t
Print name: STEVE SNYDER Date: �� / t This permit application expires if a permit is not obtained within 180
V days after it has been accepted as complete.
* Number of inspections allowed per pennit.
(:\Building \Permits \ELC -Perm it App.doc 05/23/06 440- 46t5T(t l /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
OSIUENTfIAI ; W(JRgia, Y
-� .�. ,� - -4 •�
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
"COIVIIVIERCIAI.� ORK ONLY , f
Fee for each commercial $75.00 •
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
Fl Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n M edical
n N • urse Calls
n O utdoor Landscape Lighting*
n P • rotective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I. \Building\Permits \ELC- PermitApp doc 03/23/06