Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00079
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2012
Parcel: 2S113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE 200
Project: Perlo Constrution Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: TI
Contractor: STANLEY SECURITY SOLUTIONS INC Owner: PACIFIC REALTY ASSOCIATES LP
15495 SW SEQUOIA PKWY #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 04/25 /2012 $75.00
12% State Surcharge - Electrical 04 /25/2012 $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: N
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: Y Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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This perm' issued su • to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance with = •proved •lens. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day . ATTENTIO : Oregon la -quir you to follow the rules adopted by the Oregon Utility Notification Center. Those rules a ; set forth in OAR
95 - 001 - 0010th gh OAR 952-%1 -0090. A • • obtain a copy of the ru es or direct questions to OUNC by calling 503.2 % 1987 or 1.800.332.23' .
ssued By: —� Permittee Signature:
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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.
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Electrical Permit Application FOR OFFICE USE ONLY
City Tigard O`
of Ti and Received h / � I J permit No.: /����� •�i
Date /Bv:
Er
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date /By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑ Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
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. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ",' I -3 ",
Job no.: L. j 9 a y ' l Job site address: (( OS Sw 7Z NA sneeer 100HP or more. occupancy.
0 Six or more residential units. ❑ Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
City/State /ZIP: Dp �� � V e 7 7 2 2 600 volts nominal.
`` Y ❑ H azard ou s locations.
Suite/bldg. /apt. no.: Project name: Fi (41, (1, N s o C T Rit et ta u ❑ Service or feeder 600 amps or more.
Fie ` ^"i FEE SCHEDULE
Cross street/directions to job site: Description r 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 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Tl AL4— T.A.i- p - '�L�/ .40A) CPNWI residential (with above sq. ft.)
�`' �^ Services or feeders installation, alteration, and/or relocation
g C(Q F / 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Y relocation
Phone: ( ) 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
IX APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: S j A,Ozy Secii S 14414/ ' B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: STt ve. /1440._ L. s e branch circuit
Each add'I branch circuit 7.42 2
Address: ' s y 9 5 6 Se pt,,tal. 4- platy ir/OO Miscellaneous (service or feeder not included)
City /State /ZIP: ._ T 2 LC� Each manufactured or modular
r LetAk V 1 nn ` — Q ! 7 dwelling, service and/or feeder 67.84 2
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Phone: ( S03) Ci6 i. 3 35 3 Fax: : ( � 96r; r; 3/ q Reconnect only 67.84 2
E -mail: S yd.e(t`Q s B INC • CO M
Pump or irrigation lig lighting 67.84 2
St W � • Sign or outline lighting 67.84 2
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CONTRACTOR Signal circuit(s) or limited- energy
Business name: AMC panel, alteration, or extension. I Page 2 T5� 2
SAM Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City /State/ZIP: Investigation (I hr min) 66.25/ hr
! i Industrial plant (I hr min) 78.18 / hr
Phone: ( ) 1179// Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed ('/z hr min)
CCB Lie.: 5 rElectrical Lie.: ,4.4 /0 /?t .t Suprv. Lie.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:
7/i // y Subtotal:
Plan review (25% of permit fee):
Print name:
Date: State surcharge (12% of permit fee): 9 °U
t TOTAL PERMIT FEE: �
Authorized signature: .,, t This permit application expires if a permit is not obtained within 180
( days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I Building \Permits \ ELC- Permit App doc 07/01 /10 440- 4615T(11 OS (OM WEB