Permit (236) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 00258
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2012
Parcel: 2S115BA02500
Jurisdiction: Tigard
Site address: 16200 SW PACIFIC HWY S
Project: Gentle Dental Subdivision: 2004 -015 PARTITION PLAT Lot: 1
Project Description: (1) low voltage for protective signaling for TI
Contractor: STANLEY SECURITY SOLUTIONS INC Owner: SN PROPERTIES PARTNERSHIP
15495 SW SEQUOIA PKWY SUITE 100 1121 SW SALMON ST
PORTLAND, OR 97224 PORTLAND, OR 97205
PHONE: 503 - 968 -3353 PHONE:
FAX: 503 - 968 -3398
FEES
Description Date Amount
•
Specifics: Restricted Energy Permit 11/19/2012 $75.00
12% State Surcharge - Electrical 11/19/2012 $9.00
Type of Use: COM
•
Class of Work: ALT
•
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
•
Nurse Calls: N Protective Signal: - y
Security Alarm: N Other: • N
•
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 riles 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..2 0.
or 1.800.332.2344: n
Issued By: rl
Permittee Signature: Z � �'_ -1 .I4T'//t
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
RECEIVE , FOR OFFICE USE ONLY
CI of Tigard i�� Received Permit �l !
`J g Date/By: l I I I q 110? 5 P it N gill �- (��dJ
INI q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C . ' Phone: 503.718.2439 Fax: 503.598.1960 NOV 1 5 2012 Date/By: Other Permit: 8 f ,2 0.- wD"7f
1' I G A 1t D Inspection Line: 503.639.4175 Date Ready/By: 1 El See Page 2 for
Internet: www.tigard - or.gov CITY (* TIGARD Notified/Method: <P Supplemental Information
TYPE OF WdMUILDINIJ DIVISION PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ 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
❑ 1- 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: 5004650 Job site address: 16200 SW PACIFIC HWY SUITE #S IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD OREGON 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: S Project name: GENTLE DENTAL ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total r •
. New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
INSTALL INTRUSION SYSTEM residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: •
601 amps to 1,000 amps 301.04 2
•
Address: Over 1,000 amps or volts 552.26 2
Cit /State /ZIP: • Temporary services or feeders installation, alteration, and /or
Y 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
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ® CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: STANLEY SECURITY SOLUTIONS B. Fee for branch circuits without •
service or feeder fee, first 56.18 2
Contact name: STEVE MOREHOUSE e # 60-'7/ ; k477 branch circuit
Each add'I branch circuit 7.42 2
Address: 15495 SW SEQUOIA PKWY #100 Miscellaneous (service or feeder not included)
City/State/ZIP: PORTLAND, OREGON 97224 Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
Phone: (503) 9683300 Fax: : (503) 9683398 _ Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: steve.snyder @sbdinc.com
Sign or outline lighting 67.84 2
CONTRACTOR • Signal circuit(s) or limited- energy
Business name: ABOVE panel, alteration, or extension. X Page 2 I 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City /State /ZIP: Industrial plant (I hr min) 78.18/ hr
Phone: ( ) _ \y,3( Fax: ( ) ,1 0 Inspections for which no fee is 90.00 / hr
�t!` specifically listed (/2 hr min)
CCB Lic.: 161567 (9 Electrical Lic.: Suprv. Lic.: 37 -1054 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: 75.00
Plan review (25% of permit fee):
Print name: STEVE M OUSE Date: 11 -07 -12 State surcharge (12% of permit fee): 9.00
` TOTAL PERMIT FEE: 84.00
Authorized signature: i ' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: STEVE MOREHOUSE Date: 11 -07 -12
• Number of inspections allowed per permit.
1: iBuilding \Permits\ELC- PermitApp.doc 07/01/10 440 -4615T(t I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ B urglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ V acuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
ID C lock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
• ❑ 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'ELC- PermitApp.doc 07/01/10