Permit -` - CITY OF TIGARD / 3 • , ELECTRICAL RESTRICTED ENERGY PERMIT
a
l iki
a COMMUNITY DEVELOPMENT Permit ti: ELR2012 00252
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2012
Parcel: 2S110DC00500
Jurisdiction: TIGARD
Site address: 11455 SW SUMMERFIELD DR
Project: Schwindt Medical Office Subdivision: WILLOW- BROOK -FARM Lot: 17
Project Description: (1) low voltage for intrusion security devices installation 12/3/12 REPRINT to correct ASI information
Contractor: SONITROL PACIFIC Owner: CDBK PROPERTIES LLC
8220 N INTERSTATE AVE 11565 SW DURHAM RD BLDG F 100
PORTLAND, OR 97217 TIGARD, OR 97224
PHONE: 503 - 223 -5822 PHONE:
FAX: 503 - 973 -7773
FEES
Description. Date Amount
Specifics:, Restricted Energy Permit 11/08/2012 $75.00
12% State Surcharge - Electrical 11/08/2012 $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)
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 OAR 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ,efdlaelelf Lttitt Permittee Signature: D/L /9-P6 T V L1
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.
•
n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
- COMMUNITY DEVELOPMENT Permit #: ELR2012 -00252
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2012
Parcel: 2S110DC00500
Jurisdiction: TIGARD
Site address: 11455 SW SUMMERFIELD DR
Project: Schwindt Medical Office Subdivision: WILLOW- BROOK -FARM Lot: 17
Project Description: (1) low voltage for intrusion security devices installation
•
• Contractor: SONITROL PACIFIC Owner: CDBK PROPERTIES LLC
r,.
8220 N INTERSTATE AVE 11565 SW DURHAM RD BLDG F 100,
PORTLAND, OR 97217 TIGARD, OR 97224
PHONE: 503 - 223 -5822 PHONE:
• FAX: 503 - 973 -7773
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/08/2012 $75.00
.12% State Surcharge - Electrical 11/08/2012 $9.00
Type of Use: COM
Class of Work: FND . •
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: r 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)
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 OAR 952 - 001 -0090. You may obtain a of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. f
Issued By: ,l/ O�i'l.�(R/1 Permittee Signature: d � �`fl i- � �/r��^-'
I 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.
•
•
Nov. 7. 2012 5:26PM Sound Security Inc. No.2468 P. 2
Electrical Permit Application FOR OFFICE USE O N L Y
■
City of Tigard R«ei LE (8- 1 �.� , eApu -00 1
. PIa nRe � v 13125 SW Hall Blvd., Tigard, OR 9 RECEI Plan Review
,
Phone: 503.718.A39 Fax: 503.598.1960 Daied3y- Other Permit:
I l ' 11: l)
Internet: Inspection Line: 503.639.4175 NOV 0 8 2012 Dale Rmd lath: i Id Sec Page 2 for
vwvw.ligard or.gov Notified/Method: �+�'�/ (� T�� 'I/ Supplemental information
!
w ° _ TXPLi�OF,iity- till t v` I ll>lA -; . : PLAN REP.I W'
I ° M1 Please all rhat apply (s ubmit 2 sets of plans w /items checked below):
[� New construction ®Addition/altc� t P
❑ SeMceorfeeder400ampsormore ❑Buading over three stories.
ID Demolition ❑ Other:
where the available fault current Q Marinas and boatyards.
i''= " �' �''• ' exceeds 10.000 am at 150 volts or 1] Float buildings.
�:.; i. .. :: •, ::.-' , �CA�GOR7C ;OF :. : CONSTI�UC,1701 V; - . :.;,_ !
- > >� B gs.
less to ground, or exceeds 14.000 0 Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder [i Other: ❑ Fire pump. ❑ installation of 75 KVA or
A 0 Emergency system. larger separately derived system.
• ,•- g ,. - • • . JOB _. lIVF012i�tA'I:IOIY, ' AN�_•: „, -._ �'.- ... :: ❑ Addition of mess motor load of ❑ "A ", "E ", "1 -2 ", "1.3 ", •
Job no.: P120149 Job site address: )14 Summerfield Drive lootlPormom. oeeupaney•
_ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97224 if 4'5 .5.
' .S ❑ Heatth•carofacilities. ❑ Supply voltage for morothan
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt.no.: Project name: Dr. Brandon Schwindt DMD ❑ service or feeder 600 amps ormore.
' YY _ - _ PEE: SC/1ED1/4 '
Cross street/directions to job site: Off Dnrhana Road Description I Qiy. 1 Pre I Teat I •
New residential single or multi-family dwelling unit,
Includes attached garage.
Subdivision: I Lot no.: 1,000 R or less 168.54 4
Fa. odd' 1 500 sq. R. or ponion 33.92 I
Tax nlap /parcel no.: Limited energy. residential
x .7 ' DESCkI O F WO RK • ' , ;.. ' (with above sq. R.) 75.00 2
Limited energy, multifamily
Installation of Intrusion security devices residential (with above sq. Il.) 75.00 2
Services or feeders Installation and /or relocation
200 amps or less 100-70 2
., f fl PROPERTY OWNEiit* s':•-` :I' � TENANT : 201 amps to 400 amps 133.56 2
Name;
401 snips 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
Temporary Services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Y Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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 j' h
. "` ;tx �. CANT' :. , . ••••• . I 'U COI![I'1 ::- .:
above bran feeder 7.42 2
s ApP1i1
- � C • each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Dr. Brandon Schwindt branch circuit
Each add'I branch circuit 7.42 2
- Address: 11565 SW Durham Rd Bldg F Ste 100 - Alisccllaneotts (service or feeder not included)
Ia e h manu or modular
City /State/ZIP: Tigard, OR 97224 _ duelling, service and/or feeder 67.84 2
Phone: (503) 650 - 2777 Fax: : ( ) Reconnect oniy 67.84 2
Pump or irrigation circle 67.84 2
E -mail: drbrandon.tlgard ®gmall.com
Sign or outline lighting 67.84 2
~..' ` . ' : ): ' :r Z . . CONTRACTOR - 'mss:_ _, ' ' , .:' .. ' :.. • -. Signal circuit(s) or limitedenergy 1
Business name: Sonitrol Pacific panel, alteration, or extension. Page 2 75.00 2
Each additional Inspection over allowable in any of the above
Address: 8220 N Interstate Ave Additional inspection (I hr min) 66.251 hr _
City/Slate /ZiP: Portland, OR 97217 Investigation (I hr min) 66.25/h
- industrial plant (I hr min) 78.18/hr
Phone: (S03) 223 - 5822 Fax: (503) 973 - 7773 Inspections for which no fee is 90.00 / hr
V specifically listed (15 hr min)
CCB Lic.: 53535 Electrical Lie.: 26370CLE Suprv. Lic.: 3567LEA �_ :7. :ELECrRICAL' rr.TEES .. '.: ,
/a� 1 I Ill Subtotal: 75.00
Suprv. Electrician signature, required: Pion review ( 25% o f pens t fee): --
Print name: Gordon Ducette Date: 11/7 /12 State surcharge (12% of permit fee): 9.00
TOTAL PERMIT FEE: 84.00
Authorized signature: • this permit application expires it a permit is not obtained within 180 �'
Date: 11/7/12 days after it has been accepted as complete.
Print name. Ann C. Moore • Number of inspections allowed per permit.
1: 1BuldingiPermii0lC- PermtIApp.doc OY/01/10 440.461ST(IraovcoN /Wna
Nov. 7. 2012 5:26PM Sound Security Inc. No. 2468 P. 3
, Electrical 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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
; '.COItiINiERCIAL WORD OI�I]LX,; `.,
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
0 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; 1
*No licenses are required. Licenses are required
for all other installations
1: 1Bu ildingTermitslELC- PennitApp.daa 07/01/10