Permit (124) -
4.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t a COMMUNITY DEVELOPMENT Permit#: ELR2017-00060
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/03/2017
T t c_..x F,,C� g Parcel: 2S111ACO2901
Jurisdiction: Tigard
Site address: 9500 SW MURDOCK ST
Project: TTSD-Templeton Elem 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
'j\ 4
/4issued By: �e 1 ✓2 � %tom'as Permittee Signature: e141
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 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.
r i CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
PI al COMMUNITY DEVELOPMENT Permit#: ELR2017-00060
13125 SW Hall Blvd.,Ti Date Issued: 04/03/2017
T4C;Akt, and OR 97223 503.718.2439 9
Parcel: 2S111ACO2901
Jurisdiction: Tigard
Site address: 9500 SW MURDOCK ST
Project: TTSD-Templeton Elem 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: ,/ c 7 ,rj Permittee Signature: 5z r /c-,keet-74i
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.
°Eletitrical Permit Application RECTIVED R.Oi l l(•I, I,S1,ONLY
City ofTigard Received 3//i,/17 ��/7_C Z,
1:11111 _ g y fi Permit#:
' 13125 SW Hall Blvd.,Tigard,OR 97223 MAR 14 20 i7 DateB
II. Plan Review
Related Permit#: ,•40// 4,aG35
Phone: 503.718.2439 Fax: 503.598.1960
DateBy:
Inspection Line: 503.639.4175 / +., TIGARD Read DateB orris:
FIt'ARi7 V� 1 t9� Y Y SeePage2for
Internet www.tigard-or.gov Notified/Method
Supplemental Information
Please check all that apply(submit 2 sets of plans w/items checked):
0 New construction 1:/ Addition/alteration/replacement
0 Demolition ❑Other ❑Service or feeder 400 amps or more ❑Building over three stories.
_
.,, f "u � ,_ xceedst10,000 am s att150 volts or Marina anddi yards.
�.,, p ❑Floating buildin s.
0 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi family 0 Master builder 0 Other: Fires fall°the`instauations. Installation
' . �a� pump. ❑Installation of 150 KVA or
::. "' ... ,,; ,,, ' 11T 1 ga Tii° Oto` �/ ` ❑Emergency system. larger separately derived
Job#: 107844 Job site address: 9500 SW MURDOCK ST ❑100H oo ofore motor load of system.
100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP: TIGARD, OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: USD-Templeton Elem 0 Hazardous locations. ❑Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site:
Description I Qty. Each l 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
i; , " „ IC31�1 ) Ea.add'l 500 sq,ft.or portion 33.92 1
�, ` = Limited energy," � residential 75.00 2
Upgrade Fire Alarm Monitoring (with above sq.ft.)
aboveft.) 75.00
Limited energy,multi family
residentialsq. 2
(withbo
. ...:',:`:(:Q.!°; i ••.i. ` V` .;;
Renewable Energy ❑ 2
Services or feeders installation,alteration,SeePage 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:( ) I 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
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 59.36 2 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54
2
. 't , 5Branch circuits—new alteration or extension,per panel
A.Fee for branch circuits with
Business name: Performance Systems Integration, LLC above service or feeder fee,
Contact name: Dan Schelhass each branch circuit 7.42 2
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 I Fax: :( 503)641 1464 Miscellaneous(service or feeder not included)
Each manufactured or modular
Email: Dan@psintegrated.com dwelling,service and/or feeder 67.84 2
Reconnect only
::: :- 4` .:*Q R.. .. . . . c .. ::: 67.84
2
�•-"" • ., - Pump or irrigation circle 67.84 2
Business name: Performance Systems Integration, LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy /
Address: 7324 SW Durham Road
panel,alteration,or extension. ee Page 2 2
City/State/ZIP: Portland, OR 97224 Each additional inspection over allowable in any of the above
Phone:( 503)641 2222 I Additional inspection(1 hr min) 66.25/hr
Fax( 503)641 1464 on Invests ati (1 hr min
Investigation ) 90.00/hr
Email: Dan@psintegrated.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 205924 I Electrical Lic.: CLE407 I Suprv.Lic.: 3172LEA specifically listed 'A hr min) , 90.00/hr
Suprv.Electrician signature,required: _ i ' ..>'f'?
Subtotal:
Print name:
William J. Driver, III: 1 LEA I Date: /17ei/C 0 Plan Review Required(25%of permit fee):
�/"/ State surcharge(12%of permit fee):
Authorized signature: Li TOTAL PERMIT FEE:
IPrint name: Dan Schelhass I This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
I:\BuildingTermits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 * Number of inspections allowed per permit.
440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2-Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
..... ..., .... „.:: ;:,. .,.s 9,. \\\�\\�. •?: Description \.... Qty. I Each I Total I *
$75.00 Renewable electrical energy systems:
Fee for all residential systems combined:
Check Type of Work Involved: 5 kva 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 lava over 25 7.42 3
El 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 a1� 90.00/hr
spec]]c 1\te
(%z hr mm
vra
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
L .Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ O• utdoor Landscape Lighting*
❑ P• rotective Signaling
❑ Other:
Total number of commercial systems: j_
*No licenses are required. Licenses are required for all
other installations
I:\Building\Permits\ELCPermitApp_ELR_ERE.doc Rev 06/17/2015