Permit (121) Al li.
INCITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a COMMUNITY DEVELOPMENT Permit#: ELR2017-00055
13125 SW Hall Blvd.,Tigard OR 97223 503.718,2439 Date Issued: 04/03/2017
Parcel: 2S 102BC08700
Jurisdiction: Tigard
Site address: 12855 SW GRANT AVE
Project: TTSD-Charles F Tigard Subdivision: None Lot: None
Project Description: Fire alarm system.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: TIGARD-TUALATIN SCHOOL
7324 SW DURHAM RD DISTRICT 23J
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 952-001-0090. 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: 4/4 — ` rel, Permittee Signature: 4c.r Ortt h ld�
OWNER INSTALLATION ONLY 'J
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 603.639.4176 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.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2017-00055
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/03/2017
[ � 41�' 9 Parcel: 28102BC08700
Jurisdiction: Tigard
Site address: 12855 SW GRANT AVE
Project: TTSD-Charles F Tigard Subdivision: None Lot: None
Project Description: Fire alarm system.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: TIGARD-TUALATIN SCHOOL
7324 SW DURHAM RD DISTRICT 23J
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 . /4 _ 13g2ArAirkGfak _ Permittee 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.
Electrical Permit Application Pali oFFic•I: list,:QNIAX
toR147017
City of Tigard ,d! ,1. C-J Date/Bea /I Permit#:�%f�tleiCG/ `COO 5 —
13125 SW Hall Blvd.,Tigard,OR 97223 e 1,,c , ( ^�l
" Phone: 503.718.2439 Fax: 503.598.19611x, ; Related Permit#: ✓W
Inspection Line: 503.639.4175 Ready Date/By: Juris: !a See Page 2 for
llis Rfl Internet: www.tlgard-or.gov Notified/Method: Supplemental Information
LI New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Demolition 1=1 Other: _ where❑Service or feeder 400 amps or more ❑Building over three stories.
current El
tk' 1 Vc xceedthe
10 000 am fault
oats or Fl ating bul d n boatyards.
s.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑Multi-family ❑Master builder ❑Other: 0 amps pump.for ll other installations. Ibnstallation 150 KVA
4 \1' (� 11� j, *�i 'S�"�" 1 ❑Eme gensystem. larger separately derived
or
❑Addition of new motor load of system.
Job#: 107844 Job site address: 12855 SW GRANT AVE 100HP or more. ❑"A","E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP: TIGARD, OR 97223
0 Health-care facilities. ❑Recreational vehicle pazks.
Suite/bldg./apt.#: Project name: TTSD-Charles F Tigard ❑Hazardous locations. El Supply voltage for more than
❑Service or feeder 600 amps or more 600 volts nominal.
Cross street/directions to job site: -
Description 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'l 500 sq.ft.or portion 33.92 1
1 ;" Ql�l
>�.. :. � ..I ,,,ti.: :��N ,,��� uiai.... 727,. Limited energy,residential
(with above sq.ft.) 75.00 2
Upgrade Fire Alarm Monitoring
Limited ener
gy,multi-family 75.00 2
residential(with above sq.ft.)
❑,� t ne2
""" \ " t'""" �" Services orwable feedersEnergy installation,alteration,❑ SeePage 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
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
ti..
� ��, ,'-:,,i4.;,,
"� 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,
each branch circuit 7.42 2
Contact name: Dan Schelhass B.Fee for branch circuits without
Address: 7324 SW Durham Road service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP: Portland, OR 97224 Each add'l branch circuit 7.42 2
Phone:( 503)641 2222 Fax: : Miscellaneous(service or feeder not included)
( 50641 1464 Each manufactured or modular
Email: Dan@psintegrated.com
dwelling,service and/or feeder 67.84 2
Reconnect only 67.84 2
''' ;.`v " " f 1:4tL ., Pump or irrigation circle 67.84 2
Business name: Performance Systems Integration, LLC Sign or outline lighting 67.84 2
Address: 7324 SW Durham Road Signal circuit(s)or limited-energy
panel,alteration,or extension. xi See Page 2 / 2
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
Email: Dan@psintegrated.com Industrial plant(1h=min) 78.18/hr
Inspections for which no fee is
90.00/hr
CCB Lic.:205924 Electrical Lic.: CLE407 Suprv.Lic.: 3172LEA specifically iE O listed
.hr mm)
Suprv.Electrician signature,required:
, ,..
Subtotal:
Print name: William J. Driver, III: 3172LEA Date: /442 , 0 Plan Review Required(25%of permit fee):
Authorized signature: 4, � f State surcharge(12%of permit fee):
�J,/ r4- TOTAL PERMIT FEE: 1
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..Building\Permits\E•LC_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:
"' - Description I Qty. I Each I Total I "
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
50.01 to 100 kva 552.26 2
❑ 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
❑ 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
spect tc a listed
hr mM)
,c441 .4 . Cii-Ntk:,;lt:k27Vltt:51; , C
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
LI 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