Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
``1 • COMMUNITY DEVELOPMENT Permit#: ELR2014-00279
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/11/2014
Parcel: 2S112DA00800
Jurisdiction: TIGARD
Site address: 15115 SW SEQUOIA PKWY 200
Project: Sumner College Subdivision: PACIFIC CORPORATE CENTER Lot: 2
Project Description: Fire alarm system.
Contractor: FIRE PROTECTION SERVICES Owner: PACIFIC REALTY ASSOCIATES LP
5573 SW ARCTIC DRIVE ATTN: N PIVEN
BEAVERTON, OR 97005 15350 SW SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-590-3732 PHONE:
FAX: 503-628-6214
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/02/2014 $75.00
12%State Surcharge-Electrical 12/02/2014 $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 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 952-001-0 090. You may obtain a c p direct questions to OUNC by calli . 9 1.8 .332.2344.
Issued By: PermitteeSignature: ✓`\
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 Application #26 FOR OFFICE. USE ONLY
j� Received
City of Tigard �>� \n, Date/B (� Permit No.: . 1
111111
• 13125 SW Hall Blvd.,Tigard,OR 971 G �,1 Plan Review
s Phone: 503.718.2439 Fax: 503.598. Date B : Ocher Permit y(/) e /:
TI t.AR[7 Inspection Line: 503.639.4175 Date Ready By: luris: ® See Page for
Internet: www.tigard-or.gov q 2014 Notified/Method: Supplemental Information
\
VI G
TYPE OF WORK ,: 1` n � PLAN REVIEW
❑New construction ®Addition/alteration/t /1 YICf1L T n Please check all that apply(submit 2 sets of plans w/items checked below):
,.,r 71`.,1S O! ❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CO1WRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
E l 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E "1-2","i-3",
Job no.: Job site address: 15350 SW Sequoia Parkway IOOHPormore. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: Portland,Oregon ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Sumner College ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description J P I Qty. I Fee. I Total I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot net.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00
Limited energy,multi-family 75.00
Install Low Voltage Fire Alarm System. residential(with above sg.ft.) _
Renewable Energy _ ❑ See Page 2 _
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
relocation
Phone:( ) 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 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: Fire Protection Services,Inc. each branch circuit
B.Fee for branch circuits without
Contact name:David Phipps service or feeder fee,first 56.18 2
branch circuit
Address:5573 SW Arctic Drive Each add'I branch circuit 7.42 2
City/State/ZIP:Beaverton,Oregon Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)590-3732 I Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:fire2112 @ymail.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Fire Protection Services,inc. Signal circuit(s)or limited-energy I See .-7 cam .
panel,alteration,or extension. Page 2 5/ 2
Address:5573 SW Arctic Drive Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Beaverton,Oregon Investigation(1 hr min) 66.25/hr
Phone:(503)590-3732 I Fax:( ) industrial plant(1 hr min) 78.18/hr
inspections for which no fee is
CCB Lic.: 154333 I Electrical Lic.: 34-4 u rv.Lic.: specifically hr
fically listed('/:hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 7s. —
Print name: David M Phipps Date: 12-2-2014 Plan review(25%of permit fee):
State surcharge(12%of permit fee): ef•
Authorized signature: TOTAL PERMIT FEE: t
-
This permit application expires if a permit is not obtained within 180
Print name: David M Phipps Date: 12-2-2014 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-4615T(1 I/OS/COM/WEB