Permit 1 1111- CITY OF TIC�ARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2011
Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 300
Project: Pacific Realty Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project Description: Fire alarm installation. Relocate (4) horn strobes and install (2) strobes to existing system.
Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS IN Owner: PACIFIC REALTY ASSOCIATES
15495 SW SEQUOIA PKWY STE 100 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 PORTLAND, OR 97224
PHONE: 503 - 968 -3353 PHONE 503 - 624 -6300
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/18/2011 $75.00
12% State Surcharge - Electrical 01/18/2011 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N 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 sus.ended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those . es a - set forth in OAR
952- 001 -0010 through OAR 9 2 0011 You . ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1* ; i or 1.80!. 32.2344.
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Issued By: / 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.
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Electrical Permit Application i iit.....vLfilifL - FOR OFFICE USEONLY .
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. . .
. City of Tigard JAN 1 8 2011 D R e e e e , B i v e d 45 re imm Pennit No.: 63-2 -gc 2 0// — G
, . .. 13125 SW Hall Blvd., Tigard, OR 97223
I N Plan Revie
. .
'., - .• Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TI' ther Permi/99_520/./ —0,00D7
TIGARD VID Date/By:
Inspection Line: 503.639.4175 ' Date Ready/By: Juris. 63 See Page 2 for
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' • Internet: WWW.tigard BUILDING DIVISIO IN
\„ otified/Method: Supplemental Information
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l.....--...- -,-: 1, -...::: - ."l1X--.414.".2i.-:: . 'll:A.W ..717-l-Wr . - r'' - • -^" ., , 1, ; 1 -' , .: , -- " ''- i.-
0 New construction El Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over,three stories.
0 Demolition ['Other: where the available fault current 0 Marinas and boatyards.
,;r 040Ri f :' 31"::.i:'... -,i'''' exceeds 10,000 amps at 150 volts or 0 Floating buildings .
less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling 1E) Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder El Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB Is..iii„,......otemxiitisv,;,, LOCATION ,,, ,,,, ,,,, ;,!,,, ,: 4, , :,,,: 4 , El Emergency system. larger separately derived system.
Job'no.: ' Job site address: 15350 SW SEQUOIA PARKWAY 100HP or more. occupancy.
0 Six or more residential units. . 0 Recreational vehicle parks.
City/State/ZIP: PORTLAND, OREGON 97224 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 300 Project name: PACTRUST 0 Service or feeder 600 amps or more.
lze q.gt$:Mfiak'f- •
Cross street/directions to job site: Description I Qty. I Fee. j, Total I *
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'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: Limited energy, residential
k';=2::: :i'V'iiiStiiie - 1 ' 724 ' - ' (with above sq. fl.) 75.00 2
REMOVE ANDRELOCATE FOUR HORN STORBES INSTALL TWO STORBE Limited energy, multi-family
75.00 2
- TO EXISTING FIRE SYSTEM . residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
i OWNER :,
PROPERTY :- .-,:tm 1: t ' „.:1 -, ,:-,:' ': ' "'",:.'' ,f61:Ac :,.ig
iW, ,-: ....,:,--.,,, 201 amps to 400 amps 106.85 2
e., - 4 "::,,.' , A' . = ■- , ' ' = '' ' ' . V - ;''L . ." -...:; . Y-1 ,'",,`'...!;-,
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 10 400 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, 1 er panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee,
st::A 1 ' : t: *'-':":::‘.;..-7..tno..,N4o,:J4,-#§0N each 6.65 2
h 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 addl branch circuit 6.65
.
Address: 15495 SW SEQUOIA PARKWAY Miscellaneous (service or feeder not included) • 2
City/State/ZIP: PORTLAND, OREGON 97224 Each manufactured or modular
90.90 2
' dwelling, service and/or feeder
Phone: (503) 968-3355 of / • Fax: : (503) 968-3398 Reconnect only 66.85 2
E-mail: . Pump or irrigation circle • 53.40 2
133, '=', JZ; , , " `,1" ,',,. '„, •: 'T. =:::: Li^:7 . Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: STANLEy1SECURITY 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 (1 hr min) • 62.50
Industrial plant per hour 73.75.
CCB Lie.: 161567 Electrical Lic.: 37- Suprv. Lie.:
f . yi ',,ri,;'';. f. :' " C. c:AT: RIvirrj:;Kg$7
Suprv. Electrician signature, required: ;Pr Subtotal: 75 e - r )
or Plan review (25% of permit fee):
Print name: STEVE MO 'MOUSE Date: 01/13/2011 •
( Th State surcharge (12% of permit fee): ''. o--) WY TOTAL PERMIT FEE:
Authorized signature: A ' ( .C.A/ . 0.---V This permit application expires if a permit is not obtained within 180
Print name: GARY TAUS HER Date: 01/13/2011 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:03uilding \Permits \ ELC-PermitApp.doc 05/23/06 440-4615T(11/05/COM/WEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems •
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
❑ Instrumentation •
n Intercom and Paging Systems
❑ Landscape. Irrigation Control*
n Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
• ❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \B uildingPermits \ELC- PermitApp.doc 03/23/06