Permit 1111 II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2014 00025
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/29/2014
Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 410
Project: NWCUA Subdivision: VARNS ACRES Lot: 9
Project Description: Low voltage for fire alarm.
Contractor: FIRE PROTECTION SERVICES Owner: GK TRIANGLE CORPORATE PARK III L
5573 SW ARCTIC DRIVE BY THOMSON REUTERS INC
BEAVERTON, OR 97005 ATTN: MEGAN DOWLING
PO BOX 130174
CARLSBAD,CA 92013
PHONE: 503-590-3732 PHONE:
FAX: 503-628-6214
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/29/2014 $75.00
12%State Surcharge-Electrical 01/29/2014 $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: 1
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: 0 Total $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issu b'ect 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 ordance with'spproved 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 NTION: Oregon law re ' you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 th ugh OAR 952-001 90. y obtain a copy of the rules or direct questions to OUNC by calling 503 7 r .800 32.2344.
Issued : Permittee Signature:
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 ApplicatKCEIVED FOR OFFICE USE ONLY
City of Tigard Received Permit No
131zsrSW Hall lvd.,Tigard,OR 97i Date/By: ( a9 /I{ E 09,0 I 5r
III g 81 2 9 2014 Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.59 Date/By:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE WIRING DIVISION PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit/sets of plans w/items checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
El 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. ❑Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","I-2","1-3",
Job no.:2988 Job site address: 13221 SW 68th Parkway or more occupancy.
Six
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard Oregon 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:410 Project name: NWCUA ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 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'I 500 sq.ft.or portion 33.40 I
'Fax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
MOVE HORN STROBE FROM ABOVE CEILING IN OFFICE TO Limited energy,multi-family 75.00 2
CONFERANCE ROOM 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
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
ty relocation
Phone:( ) Fax:( ) 200 amps or less 66.85 l
201 amps to 400 amps 100.30 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 133.75 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. Branch circuits—new,alteration,or extension,Qer panel
Owner signature: Date: A.Fee for branch circuits with
E] APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: FIRE PROTECTION SERVICES, INC. B.Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: DAVID M.PHIPPS first branch circuit _
Each add'I branch circuit 6.65 2
Address: 5573 SW ARCTIC DRIVE Miscellaneous(service or feeder not included)
City/State/ZIP:BEAVERTON,OR 97005 Each manufactured or modular 90.90 2
dwelling,service and/or feeder
Phone:(503)590-3732 Fax: :(503)628-6214 Reconnect only 66.85 2
E-mail:phipps @fpsnw.com Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s)or limited-
Business name: FIRE PROTECTION SERVICES,INC. energy panel,alteration,or
extension.Describe: I Page 2 75.00 2
Address: 5573 SW ARCTIC DRIVE
City/State/ZIP:BEAVERTON,OR 97005 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone:(503)590-3732 Fax:(503)628-6214 Investigation per hour(1 hr min) 62.50
CCB Lic.: 154333 Electrical Lic.: 34 8CL Su rv.Lie.: 4120LEA Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: TSv'-K'
Print name: DAVID M.PHIPPS Date: 2/29/2014 Plan review(25°/a of permit fee): tt OQ
7v
State surcharge(12%of permit fee): /•�
Authorized signature: iy� TOTAL PERMIT FEE: Ql�a4
sf�� This permit application expires if a permit is not obtained within ISO
Print name: DAVID M.PHIPPS Date: 2/29./24/12 days after it has been accepted as complete.
• Number of inspections allowed per permit.
C\Building\Permits\ELC-PermitApp.doe 05/23/06 440.4615T(I t/05/COM/WEB