Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
"'� tt . COMMUNITY DEVELOPMENT Permit #: ELR2011 -00149
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/28/2011
Parcel: 2S 113AB00600
Jurisdiction: TIGARD
Site address: 16160 SW UPPER BOONES FERRY RD
Project: Dow Agrosciences Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Fire alarm system.
Contractor: SUPPRESSION SYSTEMS INC Owner: PACIFIC REALTY ASSOCIATES
4417 PACIFIC HWY EAST 15350 SW SEQUOIA PKWY #300
TACOMA, WA 98424 PORTLAND, OR 97224
PHONE: 253 - 926 -3300 PHONE: 503 - 624 -6300
FAX: 253 - 926 -3306
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/28/2011 $75.00
12% State Surcharge - Electrical 06/28/2011 $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 0' : '52 -001 -0090. You may . • :' ►="" o• of the rules or . : t questions to OUNC by calling 503.232.1987 r 1.800.332.2344.
Issued By: //0 iJ �'_ _s! _ Permittee Signature:
...A ...----
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.
Electric-al Application l Permit Applicati
Z % FOR OFFICE USE ONLY
City of Tigard n e !L' Re cete/B ived Permit No.:
: '
a 13125 SW Hall Blvd., Tigard, OR 97223 c lan Review
Y �' �� Lr✓ L •.L
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Phone: 503.718.2439 Fax 503.598.1960 DateJBy Other Permit: / , /,„` y
Inspection Line: 503.639.4175
` IG A R l? �� Date Ready/By: Y= H See Page 2 for
Internet. www tigard -or gov q r S ` Notified/Method: Supplemental Information
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ie li '.A\ Please check all that apply (su sets o l aps w /items c hecked below
❑ New construction �� n below):
Addition / alterati n/
❑ Demolition ❑ Other r ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
: k V „ 3 ..,._ ?, , _ t s; era 7 ', , � __ ,, -. exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
'Ir Commercial/industrial /industrial it Accessory building less to gr all of or exceeds 14,000 ❑ commercial use agricultural
❑ 1- and 2- family dwelling
amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
a . . i ', l . t 1 *, 5 ❑ Emezgeacy system larger separately derived system.
s,= 1- / - e - -_ . . a ,. _ f - 4 _ _ ”, "1 -2 ", `1 -3 ",
❑ Addition of new motor load of ❑ `A ", 'B
Job no.: I \ \ Job site address: 1 ( 1 (,,"] � ` �P+ `- 10011P °r more. occupancy.
�+ L. � \..1.J � 0rA rC. ❑ Six or more residential units. ❑ Recreational vehicle parks
City /State/ZIP: T `c 2 c ...2 .... Q eA4 ❑ alth -care facilities. ❑ Supply voltage for more than
1 S - r> , ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: I Project name: yy�� — c _ ❑ Service or feeder 600 amps or more
v - (J� . X _ `4. .C.25 . r x,
Cross street/directions to job site: e Iz ~ ' -' ;
» I Qty. I Fee I w raal _. 1 _ * ..
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: ' Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
F w tM 75.00 2
, N f s� _ 1 , .; : i y [ 4 ., n_.,a s.F=_ � (with above sq. ft.)
1 Limite energy, m - famil 75.00 2
�� � .V �� 'tom C C .fieccatt. (..5 C, - �G r\ C-v1 L; �T resid enti al ( err ins ti
Servlcea or feedersII sq- ation, alteration, and/or relocation
,. 0 — S • e■ S '-- C-.tM ' 200 amps or less 100.70 2
4 W: .R.- W �± � * 201 amps to 400 amps 133.56 2
Name: 1fr. IN /' 401 amps to 600 amps 200.34 2
S .& 601 amps to 1,000 amps 301.04 2
Address: 1 L (ot) . u9pGZ i3 ts ' e Q (Lk, 1 '1�a7 Over 1,000 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
T %a > c o �Z relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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
f f 3 . i a �, - �� " z above serv or feeder fee,
> ip �. _- _ b 7.42 2
_ _� <. _ each branch circuit
� ��s` i c-���� 1>�� B. Fee for branch circuits without
Business name: v
service or feeder fee, first
Contact name: ` , •11,%11::1,, C'7 c_ • , SL branch circuit 56.18 2
Address: f 1 u t n v � cf Z.V W Each add'I branch circuit 7.42 2
`lC-G i '_ ��\_.t Miscellaneous (service or feeder not included)
City /State/71P: - y ( -,..e. ' - A 4 a u lli and/or modular
67.84 2
Phone (Z.c , SID U Fax:: ( G "Z1,• 330Cp Reconnect only 67.84 2
�
Pump or irrigation circle 67.84 2
FiL r`Lc" \ 12,'52, s 0'64 •
Sign or outline lighting 67.84 2
.,. a„ ff , S i, 'r ,, �,K.,�:l_`— , _ _ „mss, ,- Signal circuit(s) or limited e nergy
Business name: � � INS ` panel, alteration, or extension. I Page 2 75;75, 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) [ 66.25/ hr
City /State/ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ br
Phone: ( ) Fax: ( ) Inspections for which no fee is txll 1>r
_,/\ s ificall listed V2 hr mm
CCB Lic.: G?. --1 ` Electrical Lic.: 1 oyS uprv. Lic. S L Gig i y t .. 3 a �](T' , ' ' a
Suprv. Electrician signature, required: _q / Subtotal:
K� r Plan review (25% of permit fee):
'I
Print name: , �`[+JyC_
(� Date: a L, lo(,{ I 1 \ State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature:
J 1
This permit application expires if a permit is not obtained within 180
Print name: ` ` ! Date: ' f da after it has been accepted p
as com lete.
ems-\, ���� �� �( I Z � , � J� 1 I _
ElectiiCal Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for All residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
Fl Vacuum Systems*
❑ Other:
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 •
n Data Telecommunication Installation
ire Alarm Installation I,T LC'V ■GAn c C--43 rt 4L 4 e k L4 ^ ri cz q-
HVAC l• �
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other ' 1 5 Total number of commercial systems: v`
*No licenses are required. Licenses are required
for all other installations