Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00137
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 140
Project: OMEP Subdivision: TIGARD TRIANGLE CENTER Lot:
Project Description: Fire alarm system.
Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS IN' 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 work is suspended for more the 180
days. ATTENTION' 0 n law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules - - set forth in OAR
952 - 001 -0010 throu OAR 9 - 001 -00 You may obtain a copy of the rules or direct questions to OUNC by calling 503.2•' -r 1.800.3 . 44.
Issued By: �/�ilL /I Permittee Signature: 7� _ t
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 Appl , N . :FO OFFICE U O NLY
CI Of Tigard y q Received Permit No.:
131 SW Hall Blvd., Tigard, OR 97223 1 ZO1 Date/By: f/ /677 EL. /[ (�i - 1 - 7
g Plan Review it
Perm: 1
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other l�Sp t 000 N ?)-
T:IGARD Inspection Line: 503.639.4175 CITY OF TIGA:RD Date Ready /By: .turfs: �± ® See Page 2 for
. Internet: www.tigard - or.gov BUILDING DIVISION Notified /Method: 776 Supplemental
' t a .. a 4 . c i ,e.aa + �m;,u^ �z.: s w'� a .. -� m ,:
e � Fm t4 4x .:. z 7 tPE OF W ORKo- d `-r1 .. 3 .. r ` x'a � t r PLAN REVIEW' -
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction E Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
°s t "• exceeds 10,000 amps at 150 volts or
'.°� CATEGORY OFD GONSTRUCTIONa �' P CI Floating buildings.
� xis `" " " ° " " " ` ' `° "° "- 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
eb ,, ,r - ,- r, � 1 .�_, . , , ❑ Emergency system larger separately derived system.
JOB SITE INEORMA�TION A Addition of new motor load of ❑ A", "E "1 -2 ", "1 -3',
Job no.: Job site address: 12909 SW 68 PARKWAY #140 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: PORTLAND, OREGON 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
•
Suite /bldg. /apt. no.: - Project name: OREGON MANUFACTURING ❑ Service or feeder 600 amps or more.
0„
Cross street /directions to job site: Description lQty. 1 Fee. 1 Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax niap /parcel no.: . Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential
,� �W� ORK �
k ; i . DESCRIPTION OFs'� � : g M °r �.�- (with above sq ft.) 75.00 2
Limited energy, multi- family 75.00 2
ADD TWO HORN /STROBES SUITE 140 TO EXISTING EXPANDER residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
It e 6 PROPEIWYY OWNER . s X _; , + . TENAN T r '" q ' x 201 amps to 400 amps 106.85 2
% axe .M
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, ter panel
Owner signature: . Date: A. Fee for branch circuits with
`i . ®SSAPPLIC , t e e`x tdON TACT PERSON 4 A above service or feeder fee, 6.65 2
each branch circuit
Business name: STANLEY SECURITY SOLUTIONS B. Fcc for branch circuits
Contact name: GARY TAUSCHER without service or feeder fee, 46.85 2
first branch circuit
Address: 15495 SW SEQUOIA PARKWAY Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: PORTLAND, OREGON 97224 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (503) 968 -3355 Fax: : (503) 968 -3398 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
°W . ; :ir Y``CONTR'ACTOR ,Iv:' f , Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: STANLEY SECURITY SOLUTIONS energy panel, alteration, or
Address: 15495 SW SEQUOIA PARKWAY extension. Describe: ( Page 2 '''6:,--""
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 Lie.: 37 -1054C Suprv. Lie.: Industrial plant per hour 73.75
.. 2 ;„ ;ELECTIt1C0 PER41kffiEES r .:
Suprv. Electrician signature, r e q u i r e d : S u b t o t a l : '•) —
Print name: STEVE MOREI - LOUSE Date: l II .QA tep/l I Plan review (25% of permit fee):
State surcharge (12% of permit fee): q.
Authorized signature: QQ�v��" TOTAL PERMIT FEE: r CO-.
This permit application expires if a permit is not obtained within 180
Print name: STEVE SNYDER Date: �() days after it has been accepted as complete.
* Number of inspections allowed per permit.
t.\ Building \Permits\ELC- PermitApp doc 05/23/06 440- 46t5T(t1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY � „7' R je ` L
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:
C.07gR RdIAL WOR .L ` " i "
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*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Buildmg\Permits\ELC- PermitApp doc 03/23/06