Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00184
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/14/2010
Parcel: 2S 112 DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 290
Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project: Fairway America
Project Description: Low voltage for fire alarm.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Restricted Energy Permit 09/14/2010 $75.00
PORTLAND, OR 97224 12% State Surcharge - Electrical 09/14/2010 $9.00
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 $84.00
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 ork is suspended for more the 180
days. ATTEN • •. • e • law re• • es you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -00 • through OAR 95 0 • • 100. Yo- obtain a copy of the rules or direct questions to OUNC by calling 503.246.6. • • .800.332. .
0 /
Issue. By: ( Permittee Signature: x / r „�_ s it •
OWNER INSTALLATION ONLY / G
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 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 Applicati �` FOR OFFICE USE ONLY
City of Tig R ECE1 VED DateBy: / /y /� I Permit No.: £ �/e �
71 ° 131 S W Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598. l �� P 1 4 O, O Date/By: Other Permit:
T I G A li D Inspection Line: 503.639.4175 Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE oifft G 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 6650 SW REDWOOD LN I00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 290 Project name: FAIRWAY AMERICA ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 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 THREE HORN STROBES ON EXISTING FIRE SYSTEM Limited energy, multi - family 75.00 2
residential (with above sq. 6.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: PACIFIC REALITY ASSOSCIATES 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 15350 SW SEQUOIA PARKWAY Over 1,000 amps or volts 454.65 2
City/State /ZIP: PORTLAND, OR 97224 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)624 - 6300 Fax: (503)624 - 7755 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: STANLEY SECURITY SOLUTIONS B. Fee for branch circuits
Contact name: GARY TAUSCHER without service or feeder fee 46.85 2
first branch circuit
Address: 15495 SW SEQUOIA PARKWAY, SUITE 100 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: PORTLAND, OR 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
Business name: STANLEY SECURITY SOLUTIONS Signal circuit(s) or limited-
energy panel, alteration, or
Address: 15495 SW SEQUOIA PARKWAY, SUITE 100 extension. Describe: i Page 2 ]s me) 2
City/State /ZIP: PORTLAND, OR 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 (1 hr min) 62.50
CCB Lic.: 161567 Electrical Lic.: 37 -1054 Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 7', • r"
Print name: STEVE MOREHOUSE Date: 09/14/2010 Plan review (25% of permit fee): —6:4
State surcharge (12% of permit fee): Q' .00
Authorized signature: TOTAL PERMIT FEE: 0 0
This permit application expires if a permit is not obt within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building\ Permits \ELC•PermitApp.doc 05/23/06 440-461 5T( 11 /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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum 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
❑ 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