Permit IIIN =_ CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
`f, q
>s .. COMMUNITY DEVELOPMENT Permit #: ELR2010 00058
YT I GARB 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/07/2010
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 460
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: AM Trust North America
Project Description: Install (2) horn strobes, and (2) strobes to existing system.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 04/07/2010 $67.84
PORTLAND, OR 97224 12% State Surcharge - Electrical 04/07/2010 $8.14
PHONE: 503 - 624 -6300
Contractor:
STANLEY CONVERGENT SECURITY
SOLUTIONS INC
15495 SW SEQUOIA PKWY STE 100
PHONE: 503 - 968 -3353
FAX: 503- 968 -3398
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: Y
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332 2344.
Issued By: @--,3,k_,, �� vl i, Perm ittee 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' 't I. kpp Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 i a
k 14. i 4a , " - FOR OFFICE USE ONLY
City of Tigard By , : , Received
Permit No.:
t P2 I Q'
III
. ° 1 3125 SW Hall Blvd., Ti ard, OR 97223 / ' ' 1 - ^ - Date /By: Q
g Plan Review I. ' Phone: 503.639.4171 Fax: 503.598.1960 ,„^ Date /By: Other Permit:
T I G A RD Inspection Line: 503.639.4175 CL r , ( ti':,' .`. A.+ . N Date Ready /By: Juris: H See Page 2 for
Internet: www.tigard - or.gov 6U11 D... J .V3; iO1'i Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
—
[=1 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
El A Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: 12909 SW 68 PARKWAY #460 l OOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: PORTLAND, OREGON 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: AMTRUST NORTH AMERICA ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. ] Total 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
INSTALL TWO (2) HORN STROBE AND TWO STROBES TO EXISTING FIRE Limited energy, multi - family 75.00 2
SYSTEM BOOSTER residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: PACIFIC REALITY ASSOCIATES 601 amps to 1,000 amps 240.60 2
Address: 15350 SW SEQUOIA PARKWAY Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: PORTLAND, OREGON 97224 relocation
Phone: (503)624 -6300 Fax: (503)624 -7755 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 133.75 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 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 6.65 2
each branch circuit
Business name: STANLEY SECURITY SOLUTIONS B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: GARY TAUSCHER first branch circuit ,
Each add'I branch circuit 6.65 2
Address: 15495 SW SEQUOIA PARKWAY Miscellaneous (service or feeder not included)
City/State /ZIP: PORTLAND, OREGON 97224 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (503) 968 -3355 Fax: : (503) 968 -3398 Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: STANLEY SECURITY SOLUTIONS energy panel, alteration, or
extension. Describe: Page 2 2
Address: 15495 SW SEQUOIA PARKWAY
City/State /ZIP: PORTLAND, OREGON 97224 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 968 -3355 Fax: (503) 968 -3398 Investigation per hour (I hr min) 62.50
CCB Lic.: 161567 Electrical Lic.: 37 -1054C Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: } _ ..S'_ -- Subtotal:
Plan review (25% of permit fee):
Print name: STEVE MOREHOUSE Date: 4/6/10
State surcharge (12% of permit fee):
Authorized signature:
TOTAL PERMIT FEE: 7 5 . q 8
. This permit application expires if a permit is not obtained within 180
Print name: STEVE SNYDER Date: 4/6/10 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1: \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORKONLY: - 771
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
CO MMERCIAL: 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
❑ 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
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 03/23/06