Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
'� COMMUNITY DEVELOPMENT Permit #: ELR2011 -00008
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/11/2011
Parcel: 2S113AB00101
Jurisdiction: TIGARD
Site address: 16101 SW 72ND AVE 130
Project: Siemens Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: Fire alarm.
Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS INI 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 01/11/2011 $75.00
12% State Surcharge - Electrical 01/11/2011 $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 suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent- • Those rules are set forth in OAR
952- 001 -0010 through 0 : 2- 001 -0090. Yo •• _ - - - =•py of the • •r direct questions to OUNC by calling 503.232.1 • : or 1.800. .. .
Issued By: .. _��': �+ l' Permittee Signature: _ i
AV
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 FOR OFFICE USE ONLY
Rece ived Permit No.: �� y s �j
City of Tigard / `lNO
IN tY g - q �,� DateBY: / � // / ��l �.4R SDI i
° 13125 SW Hall Blvd., Tigard, OR 97223 , ''i 1 „ Plan Review I / p r
a a n r� C�C)0. 65
Phone: 503.639.4171 Fax: 503.598_4 X 60 Date/By: Other Permit: 1 1
_ • Date Ready /By: Juris: El See Page 2 for
T[GARD Inspection Line: 503.639 r �� +,+
Internet: www.tigard- or.gov " t ,�` �! Notified/Method:� Supplemental information
";, ,'TYPE OF WORKa('Y , ': .'° . t` PLAN REVIEW ',(.
III New construction ®Addition /alteration /rep
t. are ietlt;�``j��}},
d'• n x� Please check all that apply (submit 2 sets of plans w /items checked below):
s acel
�n El Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other: '. r( � where the available fault current El Marinas and boatyards.
' ' = CA T E G O RX 'OF C ONSTCI'I asw� N ;;'" ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
�... � • - t
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- 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
❑ Emergency system. larger separately derived system_
B'
' JO SITE INFORMATION AND °LOCATION Addition of new motor load of ❑ "A ", "E ", "l -2 ", "I -3 ",
Job no.: Job site address: 16101 SW 72" AVE, SUITE 130 I00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP:. PORTLAND, OREGON 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: SIEMENS REAL ESTATE ❑ Service or feeder 600 amps or more.
'
> ` . FEE SCHEDULE ..
Cross street/directions to job site: , Description I Qty. I Fee. I 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'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: .
Limited energy, residential .
2
: ;DESCRIPTION OF' WORK.: , ,',' ' ,, ' " "" (with above sq. ft.) 75.00
INSTALL FOUR HORN STROBES 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
# ` 201 amps to 400 amps 106.85 2
"; � 'PROPERTYO . ; . _. " . , .. ❑ .TENANT. " t ' "
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
above service or feeder fee,
" ®- APPLICANT x " y i=i ~CONTACT PERSON , ` each branch circuit 6.65 2 •
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
x
-" Sign or outline lighting 53.40 2
- °CONTRACTOR, ' - g � t � g
Signal circuit(s) or limited .
Business name: STANLEY SECURITY SOLUTIONS energy panel, alteration, or •
extension. Describe: ( Page 2 75 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
CCB Lic.: 161567 Electrical Lic.: 37- 054C Suprv. Lic.: Industrial plant per hour 73.75
w ; :'ELECTRICAL,PERMIT" FEES: " .
:
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee):
Print name: STEVE MOREHOUSE Date: 01/11/2011 0 5'
- State surcharge (12% /o of permit fee): ,
Authorized signature: I, ■ . ��� TOTAL PERMIT FEE: s co--
This permit application expires if a permit is not obtained within 180
Print name: GARY TAUSCHE Date: 01/11/2011 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\Building \Permits \ELC- PermitApp. doe 05/23/06 440- 4615T(11/05/COM /WEB
•