Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'> COMMUNITY DEVELOPMENT Permit#: ELR2017-00105
•, 11 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/30/2017
t - • Parcel: 2S113AB00500
Jurisdiction: Tigard
Site address: 16083 SW UPPER BOONES FERRY RD
Project: G&S FC LLC Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37
Project Description: Fire alarm system.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: G&S FC LLC
7324 SW DURHAM RD 16083 SW UPPER BOONES FERRY RD,
PORTLAND, OR 97224 STE
TIGARD, OR 97224
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/30/2017 $75.00
12%State Surcharge-Electrical 05/30/2017 $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: 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 foil. •- rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You in a<•• of -rules or direct questions to OUNC by calling 503.232.1987 or 1.800.33 44. _ >(1
Issued By: i7 i�?P��s-- rmittee 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.
-,.A 1.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received t permit#: ' n
lig - �� 13125 SW Hall Blvd.,Tigard,OR 972 plan RevtewJ ////7 51_,e42.0
21 7 to
of 3
Phone: 503.718.2439 Fax: 503.598. Iy DateBy: Related Permit#: Fpooj 7—GL.Y)6 .
Inspection Line: 503.639.41751 DV Ready Date/By: Juris: El SeePage 2 for
TI G A R D Internet: www.tigard-or.gov �\H\{ 11
Q Notified/Method: Supplemental Information
TYPE OF WORK of 1 `' �+ ri� PLAN REVIEW
❑New construction ®Addition/alteratiot� ye®,N`7 Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition ❑Other: 50� \��\`V�`v''' 0 Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUC 11ON exceeds 10,000 amps at 150 volts or El Floating buildings.
0 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: El Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION El Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#:346584 Job site address: 16083 SW Upper Boones Ferry RD loose or more. ❑"A","E","t-z","t-3",
City/State/ZIP:Tigard,Oregon 97224 CI Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:Bldg"B" Project name: Fanno Creek El Hazardous locations. El Supply voltage for more than
0 Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Qty. I Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
Wiring for New AES Radio (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
[} PROPERTY OWNER Renewable Energy ID See Page 2
TENANT 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
0
APPLICANT 0 CONTACT PERSON 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,
7A2 2
each branch circuit
Contact name:Dan Schelhaas B.Fee for branch circuits without
serAddress:7324 SW Durham Rd branchce i feederstfee,first 56.18 2
branch circuit
City/State/ZIP:Portland,Oregon 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
Email:Dan@psintegrated.com dwelling,service and/or feeder
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 Rd Signal circuit(s)or limited-energy ee Page 2 75-e--' 2
panel,alteration,or extension.
City/State/ZIP:Portland,Oregon 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
Email:Dan@psintegrated.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 205924 Electrical Lic.: CLE407 Suprv.Lic.: 3172LEA specifically listed(%hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ 7 Subtotal: -75-1432-
Print
Jj`F3t-
Print name: Wiliam Driver III Date: 5/8/17 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): t),
Authorized ,_ atur.� TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Dan Schelhaas Date: 5/8/17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
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- s
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
I *
Fee for all residential systems combined: $75.00 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:
n B• urglar 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
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ V• acuum 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 min)
COMMERCIAL WORK ONLY: ELEt;17tICCAL PERMIT FEES
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
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ P• rotective Signaling
❑ Other:
Total number of commercial systems:
*No licenses are required. Licenses are required for all
other installations
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