Permit (73) RECEIVED
City of Tigard 0 COMMUNITY DEVELOPMENT DEPARTMENT
'lt MAY 162018
' li Request for Permit Action
CITY OF TIGARD
T 1 c,A R n 13125 SW Hall Blvd. •Tigard,Oregon 97223 • 503-718-2439 • ‘v vw.ti4*, 1- > . v }
DIVISION
TO: CITY OF TIGARD
Building Division I o 1
13125 SW Hall Blvd.,Tigard,OR 97223 / � —
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov /�i ,S7
1
FROM: ❑ Owner 0 Applicant ❑ Contractor ❑ City Staff
Check(1)one
REFUND OR Name:
INVOICE TO: (Business or Individual) Performance System Integration LLC
Mailing Address: 7324 SW Durham Rd
City/State/Zip: Portland, Or 97224
Phone No.: 503-641-2222
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
Q CANCEL/VOID PERMIT APPLICATION.
x❑❑' REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
REMOVE/REPLACE CONTRACTOR ON PERMIT(do not cancel permit).
Permit#: ELR2017-00151
Site Address or Parcel#: 9378 SW Mandamus Ct
Project Name: Ashbrook Apartments
Subdivision Name: Ashbrook Farm Lot#: 25
l
EXPLANATION: This permit was requested to change out the FACP dialer with an AES
Radio. The signal strengh was not'adequit and monitoring was not changed to the Radio Technology.
ZSignature: �._ Date: 05/16/18
Print Name: Bill Driver
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of
• Any fee which was erroneously paid or collected,
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service,
3. Please allow 3-4 weeks for processing refund requests. /3, cr.)7S.c'z? — (vC�r
•ere — 7 ,20 ._ - /,efC
„le) /t' ,teO
FOR OFFICE USE ONLY
Route to Sys Admin: Date B .. Route to Records: Date4d B lit4
Refund Processed: Date Ade
,y By e' Invoice Processed: Date By
Permit Canceled: Dated /tf/ By s% arcel Tag Added: Date By
l:\Building\Forms\RegPcrmitAction_923144oe
11111 . q
TIGARD
City of Tigard
6/1/2018
Performance System Integration LLC
7324 SW Durham Rd
Portland, OR 97224
Re: Permit No. ELR2017-00151
Dear Applicant:
The City of Tigard has canceled the above referenced permit(s) and encloses a refund for the
following:
Site Address: 9378 SW Mandamus Ct
Project Name: Ashbrook Apartments
Job No.: N/A
Refund Method: r Check#228669 in the amount of$67.20.
❑ Credit card"return"receipt in the amount of$ .
Note: Please allow 2-5 days for this refund transaction to be
credited to your account by the company that issued your card.
❑ Trust account"deposit"receipt in the amount of$ .
Comment(s): Per applicant's request as signal strength was not adequate so monitoring
was not changed on radio technology. Refund 80% of permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
if ,
Dianna Howse
Building Division Services Supervisor
Enc.
1
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'! Permit#: ELR2017 00151
�� ' COMMUNITY DEVELOPMENT
13125 SW Hall Blvd.,Ti Date Issued: 08/16/2017
T[f �LE.T and OR 97223 503.718.2439 9
Parcel: 1 S 135ACO2500
Jurisdiction: Tigard
Site address: 9378 SW MANDAMUS CT
Project: Longstaff Apartments Sales Office Addition Subdivision: ASHBROOK FARM Lot: 25
Project Description: Low voltage wiring for AES radio installation.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: MACH 1 GE-ASHBROOK LLC
7324 SW DURHAM RD 851 SW 6TH AVE#1500
PORTLAND, OR 97224 PORTLAND, OR 97204
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/16/2017 $75.00
12%State Surcharge-Electrical 08/16/2017 $9.00
Type of Use:
Class of Work:
Total Number of Systems:
Audio&Stereo: Boiler Controls:
CCTV: Clock Systems:
Data&Telecommunications: Fire Alarm:
HVAC: Instrumentation:
Intercom/Paging: Landscape/Irrigation:
Landscape Lighting: Medical:
Nurse Calls: Protective Signal:
Security Alarm: 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 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.
)7714
Issued By: C> ,
Permittee letkattin
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 FOR OFFICE lSE ONLY
City of Tigard ? lei Vis. Permit# i -y
lig - '► 13125 SW Hall Blvd.,Tigard,OR 97223 / '`"
•an eview
Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Related Permit#: r
Inspection Line: 503.639.4175 y lv? t T" 3��
T I G A R D r eady DMetho Juris: ® See Page 2 for
Internet: www.tigard-or.gov J U 6 2 U 1]�Iotified/Method:7/1 0 ''
Q Supplemental Information
'I 'E QI:WORK ter iGAttp PLAN REVIEW
❑New construction ®Addition/alteration/repla Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: UILO1IS G DIVISION 0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current ❑Marinas and boatyards.
" ,CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 D Commercial-use agricultural
❑Multi-family ❑Master builder amps for all other installations. buildings.
❑Other: , ❑Fire pump. 0 Installation of 150 KVA or
OB SITE INJ'oI TIO 'AND LOCATION 0 Emergency system. larger separately derived
Job#: Job site address:9378 SW Mandamus Ct ❑Addition of new motor load of system.
10OHP or more. ❑"A","E","i-2","1-3",
O Six or more residential units. occupancy.
City/State/ZIP:Tigard,Oregon 97223
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: 61 h B'�- 0 Hazardous locations. 0 Supply voltage for more than
J`�""�✓ ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
E
SCHEDULE '
Description ...I Qty. I ...Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION Ot WORK Limited energy,residential
Low Voltage Wiring for AES radio Installation (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
( Pi E}PERTY owN R 0 TENANT: Renewable Energy ❑ See Page 2
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
City/State/ZIP:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
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
►l APPLICANT I 0 CONTACT PERSON Branch circuits-c new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Performance Systems Integration LLC above service or feeder fee,
each branch circuit 7.42 2
Contact name:Dan Schelhaas B.Fee for branch circuits without
Address:7324 SW Durham Rd service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Portland,Oregon 97224 Each add'l branch circuit 7.42 2
Phone:(503)641-2222Miscellaneous(service or feeder not included)
Fax: :(503)641-1464 Each manufactured or modular
Email:dan@psintegrated.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Performance Systems Integration LLC Sign or outline lighting 67.84 2
Address:7324 SW Durham Rda 2 Signal circuit(s)orlimited-energy 0See Page �.7
panel,alteration,or extension. g /5' 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Portland,Oregon 97224
Additional inspection(1 hr min) 66.25/hr
Phone:(503)641-2222 Fax:(503)641-1464 /0/1/p.o Investigation(1 hr min) 90.00/hr
Email:dan@psintegrated.com (. /. /,� Industrial plant(1 hr min) 78.18/hr
A (� Inspections for which no fee is
CCB Lic.: 205924 Electrical Lic.: CLE407 _ Suprv. ic.: 4062LEA specifically listed('/2 hr min) 90.00/hr
ELECTRCAL PERMIT FEES 'Suprv.Electrician signature,required: , � �� i, ..-.-<...
Subtotal: '7$ ---
00—
Print name: Michael Brooks Date: 6/28/17 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): f q c�
Authorized sig -c------- -- TOTAL PERMIT FEE: ` �
This permit application expires if a permit is not obtained within 180
Print name: Dan Schelhaas Date: 6/28/17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-46I5T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY FEE SCHEDULE
DescrFee for all residential systems combined: $75.00 ion I Qty. I Each I Total
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n 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
50.01 to 100 kva 552.26 2
n Garage Door Opener* >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
n 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
specifically listed(Y.hr mm)
COMMERCIAL WORK ONLY:
ELECTRICAL PERMIT FEES
SubtotalEnteron Page 1):
Fee for each commercial system: $75.00
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
® Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n 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
I:\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 06/17/2015