Permit ill 4' CITY OF TIGAR ELECTRICAL RESTRICTED ENERGY PERMIT
. : _ ,. COMMUNITY DEVELOPMENT Permit #: ELR2011 -00254
13125 SW Hall Blvd Tigard OR 97223 503 Date Issued: 12/22/2011
T� Parcel: 2S112DC00100
Jurisdiction: Tigard
Site address: 15605 SW 72ND AVE
Project: Consumer Cellular Subdivision:HERN PACIFIC TIGARD INDUSTRIAL Lot: 1 -2
Project Description: Low voltage for fire alarm
Contractor: STANLEY SECURITY SOLUTIONS INC Owner: PACTRUST
15495 SW SEQUOIA PKWY #100 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 PORTLAND, OR 97224
PHONE: 503 - 968 -3353 PHONE: 503 - 624 -6300
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/22/2011 $75.00
12% State Surcharge - Electrical 12/22/2011 $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 ordance wi approved plans. This permit will expire if work is not started within 180 days of issuance, or if ork is suspended for more the 180
days. AT NTION: Oregon law ir you to follow the rules adopted by the Oregon Utility Notification Center Those rul set forth in OAR
952 -001- 010 through OAR 952-1:1-00s I. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.198 0 1.800 .2344.
1
I
Issu d 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.
Electrical Permit Applicatio E C , - FO OFFI O NLY
City of Tigard DEC 2011 Received /R /v?' /A - ' 1 Permit No : eG l..., s
13125 SW Hall Blvd., Tigard, OR 97223 v��q Plan Review
'> Phone: 503.639.4171 Fax: 503.598. OF TIGARD Date/By:
Permit:
TI GARD Inspection Line: 503.639.4175 Date Read /B tuns: El See Page 2 for
. Internet: www.tigard- or.gov BUILDING DIVISION Notified/Method: Supplemental Information
. A" .. Pte . A t, £ . .'. AWZ OF WORK i'' .M v ' .4 :* 4 ` PLANS EV %
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
s ., . where the available fault current ❑ Marinas and boatyards.
* , GATEGORA OF CbNSTRt, T I ' �
� ;,,� � , ��. � a ,,,,,��� � ;: •_ b�,��° � exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1- and 2 - family dwelling ® Commercial /industrial ❑ Accessory building less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
�� �� ' ° "� ❑ Emergency system. larger separately derived s
{ ' LJOB SIT :44i5R fATION' AN OCATION ' '' } - g Y Y g P y system.
y
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 15605 SW 72 AVE 100HPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: PORTLAND, OREGON 97224 ❑Health -care f acilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite /bldg. /apt. no.: Project name: CONSUMER CELLULAR ❑ Service or feeder 600 amps or more.
Cross street /directions to job site: OREGON BUSINESS PARK III -0E SCHEDULE'
Description [ 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 I
r -�� ,. 5 - ,. _ : -- ; -.>- , r , . - ,r/ / Limited energy, residential 75.00 2
dm .F, _ ` :: tan , c11IPT D fallfefk v> " > . F � ` 4` (with above sq. ft.)
REMOVE AND REPLACEMENT AFA PANEL AND EQ. INSTALL SMOKE Limited energy, multi - family 75.00 2
DETECTORS residential (with above sq. ft.)
FOR ELEVATOR CONTROL. INSTALL STORBES AND HORN /STROBES Services or feeders installation, alteration, and /or relocation
PER DRAWINGS 200 amps or less 80.30 2
i. d fi ` �a T u-� Vim, €
®�P OW1 R ® . 1?ENAN ,. 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
201 amps to 400 amps 100.30 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 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: • Date: A. Fee for branch circuits with
1 � ®�APIANT•, y GONTACTPERSO above service or feeder fee, 6.65 2
> each branch circuit
Business name: STANLEY SECURITY SOLUTIONS B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: GARY TAUSCHER 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
yid , y . ` .�.. CON RAC oR ' --v,,,. a 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 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 Li .: 37 -1054C Suprv. Lic.: Industrial plant per hour 73.75
' M ` ELTEMI:itatett YIIT_ FEES'"'' "" ; `h'"
Suprv. Electrician signature, required: Subtotal: -75.
Print name: STEVE MOR OUSE Date: 12/20/2011 Plan review (25% of permit fee):
. State surcharge (12% of permit fee): v
Authorized signature: (ICU IV.) ` � 1---.,, TOTAL PERMIT FEE: , $
co
This permit application expires if a permit is not obtained within 180
Print name: GARY TAUSCHER Date: 12/20/2011 days after it has been accepted as complete.
I: \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
NESIDWTIAL AW ONLY_, ,' ; i ,:
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: -
•
„ COff,RTERCIA 67W LY $
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. \Building\Permits \ELC- PermitApp doc 03/23/06