Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2017-00057
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/03/2017
T I +'R- Parcel: 2S103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: TTSD-Fowler Middle Subdivision: None Lot: None
Project Description: Fire alarm system.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: TIGARD-TUALATIN SCHOOL DISTRICT
7324 SW DURHAM RD BY MAPLETHORPE, BONITA
PORTLAND, OR 97224 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/03/2017 $75.00
12%State Surcharge-Electrical 04/03/2017 $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: 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: Permittee Signature: SnCr— ,oyph?Fuc'1
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.
ie , t
Electrical Permit Applicatiol):, i 3\1 FOR OFricE usl;ONLY
Received // Q�'/,f� ��
City of Tigard ?nii DateB : 3 !l 7 Permit#: 2/_/L i ' 0 b
13125 SW Hall Blvd.,Tigard,OR 97223 1ts� 1 plan Review �j ����
' I Phone: 503.718.2439 Fax: 503.598.1960 sr Date/B : Related Permit#: t l
Inspection Line: 503.639.4175 Co'y i"f 1 rt s€ L a Ready Date/By: Sufis: Ea See Page 2 for
11 L'AR I. Internet www tlgard or gov Supplemental Information
. �,_` :� T Ql8 4' ,.,..,-. n< .„ice IWvirW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stones.
where the available fault current ❑Marinas and boatyards.
C 'I' �1(? tx r ►N
°' "7.««•14117; exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family ❑Master builder ❑Other: 0 Fireum
p p. ❑Installation of 150 KVA or
,.; i y Q 0 Emergency system. larger separately derived
ID Addition of new motor load of system.
Job#: 107844 Job site address: 10865 SW WALNUT ST 100HP or more. ❑"A","E","1-2",°`1-3'
City/State/ZIP: TIGARD, OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: TTSD- Fowler Middle 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
.w ;..5 . .fit i ra n,
Description I Qty. Each ) Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot 4: Includes attached garage.
1,
sq.ft.or
168.54 4
0
0
ss
Tax map/parcel 4:
Ea 0 dd't 500 sq.ft le
.a portion 33.92 1
or poto
D cgjrrt011T O1 A.. .. a Limited energy,residential75.00 2
Upgrade Fire Alarm Monitoring (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
t Renewable Energy ❑ See Page 2
0 PRr l�tl�t ,'' _." t,..."", --- • Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
, S Branch circuits—new,alteration,or extension,per panel
`�"' � A.Fee for branch circuits with
Business name: Performance Systems Integration, LLC above service or feeder fee, 7.42 2
each branch circuit
Contact name: Dan Schelhass B.Fee for branch circuits without
service or feeder fee,first
Address: 7324 SW Durham Road branch circuit 56.18 2
City/State/ZIP: Portland, OR 97224
Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503)641 2222 Fax: :( 503)641 1464 Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Dan@psintegrated.com Reconnectonl 6784 2
1CTL 14 y
67.84 2
Business name: Performance Systems Integration, LLC Sign or outline lighting 67.84 2
Address: 7324 SW Durham Road Signalnel,alteration,t(s)or limited-energyxens . Pee Page 2 ) 2
panel, or extension. Y''
City/State/ZIP: Portland, OR 97224 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( 503)641 2222 Fax:( 503)641 1464 Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email: Dan@psintegrated.com Inspections for which no fee is
specifically listed /z hr mm) 90.00/hr
CCB Lic.: 205924 Electrical Lic.: CLE407 Suprv.Lic.: 3172LEA C4ffu
Suprv.Electrician signature,required: Subtotal:
Print name: William J. Driver, III: EA Date:�4/tI/� 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: 44/ `'-` TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Dan Schelhass Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:nuilding\Permits\ELC PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
R$" . ‘T _' ...i .. s . z
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 lova or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with 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
❑ Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
� a � pec y\ste hr (... �� 4`
smin)
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
Fire Alarm Installation
F
tHVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
E Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: i
*No licenses are required. Licenses are required for all
other installations
I:ABuilding\PermitsTLC_PermitApp_ELR_ERE.doc Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10865 SW WALNUT ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2017-00057
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
1
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• COMMUNITY DEVELOPMENT Permit#: ELR2017-00057
r 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/03/2017
T(.:: �[.C� 9
Parcel: 2S103AA00101
Jurisdiction: Tigard
Site address: 10865 SW WALNUT ST
Project: TTSD-Fowler Middle Subdivision: None Lot: None
Project Description: Fire alarm system.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: TIGARD-TUALATIN SCHOOL DISTRICT
7324 SW DURHAM RD BY MAPLETHORPE, BONITA
PORTLAND, OR 97224 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 04/03/2017 $75.00
Type of Use: COM 12%State Surcharge-Electrical 04/03/2017 $9.00
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: 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 952-001.0080 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: jZ YstPermittee Signature: JSP 4lt /?vei"�j'el'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 503.539.4175 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.