Permit 'o' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II
_ . ' & COMMUNITY DEVELOPMENT Permit #: ELR2012 -00019
13125 SW Ha ll Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2012
3 I�"irA -R, Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 380
Project: Pactrust Subdivision: 1996 -048 PARTITION PLAT Lot: 2
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 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 968 -3353 PHONE:
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/03/2012 $75.00
12% State Surcharge - Electrical 02/03/2012 $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. AT TION: Ore•: law = -uires you to follow the rules adopted by the Oregon Utility Notification Center. ose rule - e s- forth in OAR
952 -00 010 through OAR 95 I 1 -00.0. u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 • .800.33 44.
Iss d By: / / f � , Permittee Signature: -.411( �_
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 Application .
' - -- - -FOR OFFICE USE ONLY .
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a
City of Tigard II Received n _
,-:
q 13125 SW Hall Blvd., Tigard, OR Plan Review
.'1- 2E
I' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: •
li E1VED Date/B : "
d Permit No.:
Other Permit: 1
TIGARD FEB 2 2012
Inspection Line: 503.639.4175 Date Ready/By: Juris: Iii See Page 2 for
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„I Internet: www.tigard-or.gov Notified/Method: '14 Supplemental Information
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-K.7.,:8; t VtiV '', r' ;• Viji. Y.MN21:VV:A len WAViirVirWtT
El New construction El Addition/aanfrMil1aUtI4t1UN Please check all that apply (submit 2 sets of plans w/items checked below):
El Service or feeder 400 amps or more 0:Building over three stories
111 Demolition , . 0 Other: .
where the available fault current 0 Marinas and boatyards.
''',Qii-4t44,,*.A.„,_,„;;: feoWit•FreeTgf,irireiibV?;''>;:,if,;At"'VIVi'N exceeds 10,000 amps at 150 volts or 0 Floating buildings.
,__,' "":" ''' l '--- ' ' 3 :''' '"'"'-'''''"'irr''" '''" '-'''''' less to ground, or exceeds 14,000 0 Commercial-use agricultural
LJ 1- and 2-family dwelling 0 Commercial/industrial 111 Accessory building amps for all other installations. buildings. '
El Multi-family EJ Master builder 111 Other: 0 Fire pump. 0 Installation of 75 KVA or
-; g i,,,. 4 : ; ; ; ; ‹ ,; ;; ,,,,,,;;,,,; 0 Emergency system, larger separately derived system.
: 0 Addition of new motor load of 0 "A", "E", "1-2", "1-3",
;:ti:44;i4,41 .lg
' ' — ' — — sit ' ' ' ' ' . •
Job no.: Job site address: 15350 SW SEQUOIA PARKWAY 100HP or more. occupancy.
El Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: PORTLAND, OREGON 97224 El Health-care facilities. El Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 380 Project name: PACTRUST 0 Service or feeder 600 amps or more.
i' fizil
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 *
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: ' Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
.
Tax map/parcel no.: Limited energy, residential
75.00 2
.4VkiZbTS':qtrtO:&lbF,5:0aN;,g4a,,'Fi:::Xii L.,,4: (with above sq ft.)
Limited energy, multi-family
INSTALL ONE HORN /STORBE AND ONE STROBE TO EXISTING residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or. relocation
FIRE SYSTEM
200 amps or less 80.30 2
Pffiliiiii(TaTikr :Agit, P;RAVVElliilATNIV';:r4C44-s ,'' 201 amps to 400 amps 106.85 2
,,4 ,,,,,,,,,, -,,, ,,,, , :,,...,4.4
Name: PACIFIC REALITY ASSOCIATES 401 amps 10 600 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 10 400 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
'''''' '-''' ''
'..P'':174:1*2100AP11176*.,10!1413,44,1 &-;:,:.:-.?:e . , zo f. , ,., 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,
Contact name: GARY TAUSCHER • 46.85 2
first branch circuit
.-
Address: 15495 SW SEQUOIA PARKWAY Each addi 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
Kgrii7nte iIii]?.F f': NT*SPW.kriVi;:tlq;Catie.:!:ii 7.06.4105.`k Sign or outline lighting 53.40 2
Business name: STANLEY SECURITY SOLUTIONS Signal circuit(s) or limited-
energy panel, alteration, or
Address: 15495 SW SEQUOIA PARKWAY . extension. Describe: 1 Page 2 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 ic.: 37-1054C Suprv. Lic.: Industrial plant per hour 73.75
. faiitifietWROOlenkitC04.4.04ati:4W
Suprv. Electrician signature, required: Subtotal: - 7 3
- — . Plan review (2-5%-of permit .fee)?
Print hame: STEVE MO4: HOUSE Date: 02/1/2012
. .
Authorized signature: State surcharge (12% of permit fee):
ture: ‘,... L rd. ,--)
O TOTAL PERMIT FEE:
-41.- '
This permit application expires if a permit is not ob ained within 180
Print name: GARY TAUSCHER IF Date: 02/1/2012 days after it has been accepted as complete. .
. . . . * Number of inspections allowed per permit.
I: \Buildihg \ Permits \ ELC-Permit App.doc 05/23/06 • 440-4615T(1 I /05/COM/WEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
R aitiENTIOAK),RK O E,T , mq
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: •
; 4.70AI ®NEY,s , , ,
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
•
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
VI Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape' Irrigation Control*
n Medical •
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
•
UBuildingPermits \ELC- PermitApp.doc 03/23/06
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