Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
o : - COMMUNITY DEVELOPMENT Permit #: ELR2012 -00143
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/12/2012
Parcel: 2S113AB01201
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 120 •
Project: Phoenix Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 30
Project Description: Low voltage for fire alarm
Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS IN Owner: PACIFIC REALTY ASSOCIATES LP
15495 SW SEQUOIA PKWY SUITE 100 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 968 -3353 PHONE:
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/12/2012 $75.00
12% State Surcharge - Electrical 07/12/2012 $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 a 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. A NTION: Oregon law quires ou to follow the rules adopted by the Oregon Utility Notification C� =y� =r. Those rules are set ,forth in OAR
952 -001 010 thr ugh OAR 952- 1 -00 . ou may obtain a copy of the rules or direct questions to OUNC by calling 503.2 / :NOJLA/t• or11.800..332.223444..
Issue . Y
Perm Signature: -4 -
OWN ER 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 Applicat' FOR OFFICE USE ONLY
( Received
City of Tigard DateB : J � Permit No.: Ewe o/ _ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C/OS ��� --440/0.2— ' C Phone: 503.639.4171 Fax: 503.5980 1 2 2012 Date/By: Other Permit:
T I G A It D Inspection Line: 503.639.4175 Date Ready/By: lulls: WI See Page 2 for
Internet: www.tigard-or.gov
CITY O Notified/Method: Supplemental Information
TYPE IM MO DIVISION PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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
❑ 1- 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A", "E", "l -2 ", "l -3 ",
Job no.: Job site address: 12909 SW 68 PARKWAY #120 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: PHOENIX SYSTEMS USA ❑ Service or feeder 600 amps or more.
FEE SCIIEDULE
Cross street/directions to job site: • Description P I 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
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
RELOCATE OR ADD ONE HORN TO SUITE 120 ON EXISTING AFA residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 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
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, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: STANLEY SECURITY SOLUTIONS B. Fee 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
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: STANLEY SECURITY SOLUTIONS CO
energy panel, alteration, or
Address: 15495 SW SEQUOIA PARKWAY extension. Describe: / Page 2 15 2
City/State /ZIP: PORTLAND, OREGON 97224 Each additional inspection over allowable in any of the above
Per
Phone: (503) 968 -3355 Fax: (503) 968 -3398 inspection 62.50
per hour (I hr min) 62.50
CCB Lic.: 161567 Electrical L .: 37 -1054C S Gic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: ' 74.4-.7 ' °d
Print name: STEVE MO' • OUSE Date: 7 /1 1Az_ Plan review (25% of permit fee):
State surcharge (12% of permit fee): Q,oO
Ir
Authorized signature: , UL etc TOTAL PERMIT FEE: gq, co
'--`� This permit application expires if a permit is not obtained within 180
Print name: GARY TAUSCHER Date: /A, 1 /(7._ days after it has been accepted as complete.
• Number of inspections allowed per permit.
l:\ Building 'Permits\ELC- PermitApp.doc 05/23/06 440-4615T(I1 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
El Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY: •
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
El Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC •
El Instrumentation •
❑ Intercom and Paging Systems •
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other '
Total number of commercial systems: •
*No licenses are required. Licenses are required
for all other installations '
I:\ Building \Permits\ELC -Per mitApp.doc 03/23/06