Permit `r� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2013-00288
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2013
TIGARD Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 350
Project: Williston Finacial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Access control system for TI
Contractor: PROTEC INC Owner: PACIFIC REALTY ASSOCIATES
720 NE FLANDERS ST ATTN: N PIVEN
PORTLAND, OR 97232-2763 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-235-4000 PHONE:
FAX: 503-235-0363
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/13/2013 $75.00
12%State Surcharge-Electrical 11/13/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 1 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 952-00 090. 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: Permittee Signature: -/,G/e`7 0'"
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.
NO1)-07-2013 16 24 PROTEC INC P.01/03
Electrical Permit Application RWCIIIE
deeiv ,/�it i3 , PermitNo.; LiQ oi3 oaApe
City of Tigard Date/By:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other Perid �3 �/
Phone: 503.71$2439 Fax: 503.598.1960 NOV 7 2013 Dete/B : m I , 1 I'I 1 Inspection Line: 503.639.4175 Date Ready/By:
1A r; gI See pogo 2 for
Internet www.rigard-cr.sov CITY�TI ' a , Ncu fied/Mcthod. Supplemental�� Inf
ormation
..-
.1 ry,,. ,., :-".:.:4i.: -,� 'G, t , 1i 7,';� '''''''717-f,01I.111 F.,11'�i9$;tl' 1 dl Eli „i 1 J 1i ,ilf..111_, , '6,.
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4I t f f h.[: r y I l-0,t1t......e�,i_jr t:c. ifLLfiL_.i d..l lu f�l�.l.l, }?kl i`x:f,.i�_.i-...,- '_ ..i.c.1..,}
a�J?. _,tC i _��._I:fici,: yl� uL .n,m, 1 (submit sets of plans w/hems checked below)',
Please check all that apply( Tc
❑New construction ®Add'Itlon/altcration/feplacemcnt ❑Service or feeder 400,amps or more ❑Building over three stnrie
❑Demolition ❑Other where the available fault current ❑Marinas and boatyards.
{ +a_, . ) ' _7. T r: V r , ` --:-'1''15"�' rr
i 1 ' ir r , ` , " t f y p , l 1 U� exceeds 10,000 amps at 150 volts or Q Floating buildings.
. 1 1 t,,,- i : I ` ., ;; :i+!__._ .'1 t, , . -- J-°... , .__ f. !5L.a.r.,
less to ground,or exceeds 14,000 ❑Commercial.use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other ingallations. buildings.
CI Multi-family ['Master builder 12 Other: ❑F1f°Pump. ❑Installtrliun of 150[:VA or
u, ; A, rd Cm{f ,j,..1 D Emergency system. larger separately derived system,
',I , r,? LI' r ..ii ),§,i5-. ;�ai•i� liW;,ti_Ynta�{ '''ii tT ttth ' Y i'Llii-t:�-�i,1 ❑Additionofnewrmotorloadof E.A,, ,.E,, "1.2. ..I41• 1001-1P or mote. occupancy.
Job no_:998 Job site address:12909 SW 6S11'Pkwy ❑Six or more residential units. ❑Recreational vehicle parks.
1:1 Health-care facilities. 0 Supply voltage for more than
City/State/ZIP:Tigard,OR 9722:3 — — — ❑Hzeardous locations. 600 volts nominal.
Suitc/bldg./apt. .:350 Project name:Williston Financial ❑Service or feeder 600 amps or more
•TiT7 LL ,cos , I s.':': +rr ,'1 Wt '7 li�'n
..i.A•Id +tee R._ii xl�4jJ.c:hlin 11,:>11.,� ta' •�,{r ikt..i.,...1.n.4.n...�.. .':,t:.t�f:}'4-.
Cross street/dir ns to job site:SW Hampton bescdprian Qty- Nee Tnmt •
Y, ` New residential single-or multi-family dwelling unit.
Includes attached garage. �___
Subdivision: Lot no.: - 1,000 sq.ft.or teas 1685 - 4 4
£a.ride 500 sq.ft.or portion 33.92 I
-Tax map/parcel no.: Limited energy.residential 75.00 2
L r 1 L l }wqs ' 1 ,� 'F t t ! - Z t i � � " G'�)
•i�,1 �� �:� � r,,r, 1 �, + a l ,1{ �; Cn t ,,, �_` � ��� i,� �, (with above sq.ft)
..Lt_±r..i.t�.L•-1IL..-1,'ILt..., f'�..._I�'ii:.:ri::l._..:,i _.,.,... ...t,_ ...i.._w a__� .. . .! . .-1:Lna.iu E'u Limited energy,multi-family
residential(with above sq.tl.) 75.OU 2
Install access control system --
:Renewable iiiiii y`I a: ,I. :.1. 1�::15ee 1Ptii ir2•:.,....i..• w•
Services or feeders installationialterution.and/or relocation
11 L c L , r 9 , ;., , tF Y'^t't a' 200 amps or less 100.70 2-
I:; fs r.-, .- , i.,1�:1 fa` ti 2y c `� :h': .. ... . ,' u . . :._` ./ �A.:L 3+�I 2
�, . ..t.:_L .: .; : . ..}. ..±:.c.a_I. n .4... _L:=s 1 201 amps to 400 amps 133.56
Name: 401 amps to 600 amps 200.34
Address: 601 amps to 1,000 amps 301.04 2
-•• Over 1.000 amps or volts 552.26 2
L'iry/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) I Fax:( ) -
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701, 401 amps to 599 am 168 y -
Owner signature: Date: Branch circuits-new,alteration.or extension,per panel
�r t,' qr,1 ,w-yi f '11 +r�r l'i r4}�77yy ill , '» i ti 5�'t!f'r a'Ir11 A.Fee for branch circuits with
il(111•,_ r„ .�c'i�`� ,-,,,fr} J :'I �.f;l.l..`�., I�. ..._ -r i�1N. c :,.I 3n nh l•
I��ai�.!;���t.u,.1,..:.... .,rl�}-..._La_ ...���_----�. - ,,„ , ...,t...,.__�t� r above service or feeder ice,
• 7.42 2
Business name:Protec Inc each brunch circuit__,_-
- . - B.Fee for branch circuits without
Contact name:Heather Hill service or feeder fee,first 56.18 2
- ------ branch circuit
Address:720 NE Flanders St Each add'I branch circuit 7.42 _ _ 2
..Cit /Slate/ZIP:Portland,OR 97232 Miscellaneous(service or feeder not included)
y Each manufactured or modular
67.84
Phone:(503)235-4000 Fax::(503)235-0363 dwelling service and/or feeder - I
Reconnect only 67.84 - _
E-mail:heatherh tprotecsecurity.com Pump or irrigation circle 67.84 2
fl" 11 0.,,I.r F ri , Ji ,rr 1 . I -1,,���T x i F : , S 1 v y.�J" 1 tr FIr ;ic 2
3 1q-ILILin-i_,.,.,:,,,=E;-.;1-:.,',,,;':-_:::: a!,.,a:,Li, :�.,.?r' 1 U,+th,:�?,•,L,_ --: .—.,:1..:I!....( :.:r.t t.t.11..__LL�.111 sign or outline lighting 67.84 1
Business name:Protec Inc Signal circuit(s)or limited-energy 1 Sec 1 w
panel.alteration.or extension. Page 2 2
Address:720 NE Flanders St Each additional inspection over allowable in any of the above
- Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Portland,OR 97231 Investigation(1 hr min) 6625/hr
Phone:(503)235-4000 Fax:(503)235-03 Industrial plant(1 hr min) 78.18/hr
7 / Inspections for which no tee is 90 pp/hr
CCB Lie.; 55414 q//CJ//5Electrical Lic.: 34-215CL 4u ry Lic.:IQ2 3�kw s taficall listed 14 br min
^,1111.lu i Slot r 1 '!,.Tree'I-'IrlFkl 7.?!.: Y'f J ' :C��.:11.�1 L I 1^
Suprv. Electrician signature,require Subtotal: 75.00
Print name: Jack Chilson Date://., 7_/3 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 9.00 j
Authorized signature: ,/ 'TOTAL PERMIT FEE: 84.00 ./
This permit application expires If a permit Is not obtained within 180
Print name: Heather Hill Date: 11/7/13 days after It has been accepted as complete.
• Number of inspections allowed per permit.
l' LilldIng\Prnniro\l.C_PennhApp_tI.R_tiat::,doc Key n5/2i/2013 440-4615TnI1/05/COM/WEO
NOV-07-2013 16 26 PROTEC INC P.02/03
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees: 5,
S '7 r- ��v i'i 1- U r�r.'trE�I tar . ', 1 i.4�:1� :rj,t i�?'vS; C"''. itry�l, .4icrry1rm ;1T PL .�!.pJU]IfL l.r .rr•�k1' mm.�Ci.
,-0 tAo ,n011ril,;�l,,,,rE��.a��':^� �,),,.,.,I�. �_.�...��.._^.�. � t r � ,r�r;�i1� ��� I�,i{r�; ,r�>;�E4]�u� I.i���, ���,ro ,uA
nnerlptlon I Om Fee I Tam for all residential systems combined $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or lens 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25kva 200,34 2
Wind generatio stems in excess of 25 kva:
❑ Burglar Alarm 25,01 to 50 kva 301.04 2
Garage Door Opener* 50.01 to 100 kva 55226❑
>100 kva(fee in accordance with 552.26 2
OAR 918-309-0040)
❑ Heating, Ventilation and Air Conditioning solar generation systems in excess of 25 kva:
System* — +'
Each additional kva over 25 7.42 3
7 V• acuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El O• ther: Each additional inspection is 66.25/hr
charged at an hour) I hr min —„
Inspections for which no fee is II 90,00/hr
�1 7 s• ifcall listed(Ys hr min)
V.01 N` i� U Y/ v .£ ....it .k'......31�I, It- t,'
�f .5 (�I 1 ti�,1Ly�i�� yd V f u i ! :_._ iu . 'a i.i .�.s _:..
Fee for each commercial system $75.00 Subtotal;
(SEE OAR 918-309-0000) Plan review.if required(25%of permit fee); -
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE;
This permit application expires;Ca permit is not obtained within 180
❑ Audio and Stereo Systems days titter it has Imo accepted as complete.
• Number of inspections Allowed per permit.
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
H HVAC
7 Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
O Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
• Other Access Control System
Total number of commercial systems: I
*No licenses are required. Licenses are required
for all other installations
1:\nuildingPPermits1.ELC_Per App_E R ERE.doc Rev 05/21/2011