Permit CITY OF TIGARD 4 ELECTRICAL RESTRICTED ENERGY PERMIT
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• - COMMUNITY DEVELOPMENT Permit #: ELR2011 -00123
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/31/2011
Parcel: 1 S136CD00401
Jurisdiction: TIGARD
Site address: 8020 SW PFAFFLE ST, STE# 100
Project: H & S Holdings Subdivision: CITY BIBLE CHURCH Lot:
Project Description: Low voltage for alarm system. 7/5/11, reprint permit to add suites 100 & 200.
Contractor: HSI SECURITY SYSTEMS INC Owner: PFAFFLE OFFICE, LLC
3424 NE 35TH AVE PCCC LLC
PORTLAND, OR 97212 915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: 503 - 287 -4604 PHONE:
FAX: 503 - 287 -1345
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/31/2011 $75.00
12% State Surcharge - Electrical 05/31/2011 $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: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
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 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: 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.
,, CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00123
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/31/2011
Parcel: 1 S136CD00401
Jurisdiction: TIGARD
Site address: 8020 SW PFAFFLE ST
Project: H & S Holdings Subdivision: CITY BIBLE CHURCH Lot:
Project Description: Low voltage for alarm system.
Contractor: HSI SECURITY SYSTEMS INC Owner: PFAFFLE OFFICE, LLC
3424 NE 35TH AVE PCCC LLC
PORTLAND, OR 97212 915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: 503 - 287 -4604 PHONE:
FAX: 503 - 287 -1345
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/31/2011 $75.00
12% State Surcharge - Electrical 05/31/2011 $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: N
HVAC: N Instrumentation: N
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: Y
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
This permit is • subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don. accordance wi - . • •roved plans This permit will expire if work is not started within 180 days of issues -, or if w•- is suspended for more the 180
days ATTENTION: Oregon law eq ' -s y• to ollow the rules adopted by the Oregon Utility Notific- '.n C: ter. /' o e rules ape fort •AR
95 001 -0010 through OAR 952 -001 -.:.0. YouA• . • :in a copy of the rules or direct questions to OUNC by calk • • 50 • '• . j 1 :8,332.2
I ued By: L / Perm ittee Signature: A ► L
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 may -
City of Tigard DateB a �� �tX�! Permit No.: id , 5
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
.
Phone:• 503.718.2439 Fax: 503.598.1960 Date /B : Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard- or.gov Notified /Method: Supplemental Information
i sa > TYi'E OF WORK ' ; ` P AN REVIEW*
E 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.
a� Y $ RU , , 1
< ; ::7'4":71:.1.7:',:': " :'° .', CATEGOROF_ 0*$1 0..$17_ " ^` E P ..' ` I- ' 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
* 4 : - r e . - t: r El Emergency system. larger separately derived system.
e S . ) & 1 # r ,
JO B I
STE W A LOC CI . ` Wig , 1 El Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ",
Job no.: 19533 Job site address: 8020 SW Pfaffle I OOHP or more, occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: qG ❑ Service or feeder 600 amps or more.
D� (it.l : a"`•_ 1:: -, : ar. :.. „ s ° :EEE;SCIIEDU ; 7 _ . (' `g ''rr.;;- , -...,'
Cross Street/direCtions t0 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 168.54 4
Ea add'I 500 sq.. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
t9 T ' e ,�s” (with above sq. ft.) 75.00 2
4 > ; ., :� s . r ' �,.. • DE QF . # W ORK; . ° . - t . N a;.` . r ; ( q
Limited energy, multi - family 75.00 2
Alarm System residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
' � - _ a - 201 amps to 400 amps 133 2
: ' f? „ ® OW1 , , i r r „ ` .. . 4 ' 0 „ TENA ,,t s,*, s " 'i P p
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2,
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: • relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
• 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 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
:kV, ® = APPLICANTS a ` `, ® CONTACT PERSON °e a " R each branch service or f ceder fee, 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: - Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
Y dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67 84 2
Pump or irrigation circle 67:84 2
- E-mail:
3�, : .: q . ,� , ;, ' `> ; _ ; . . , , - CONTR�A'CTOR 1& ' ;. °-i Vii i � � z *- . ° Sign or outline lighting 67.84 2
�� =_. - e '1. w a � °� �€ >..,'r �� f � �'t Signal circuit(s) orlimited - energy �f �
Business name: HSI Security Systems, Inc. panel, alteration, or extension. l Page 2 r 2
Each additional inspection over allowable in any of the above
Address: 3424 NE 35 Ave.
Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Portland, OR 97212 Investigation (1 hr min) 66.25/ hr
Phone: (503) 287 - 4604 Fax: (503) 287 - 1345 Industrial plant (1 hr min) 78.18/ hr
CCB Lic.: 42140 6 Electrica • ic.: 55C I � 15
�II Suprv/ e78JLE Inspections for which no fee is 90.00 / hr
or /J s specifically listed (%z hr min)
Suprv. Electrician signature, require. /�� a k;, t, �„ I' ELECTRIC 'ALA =PERM LEES`., d" " ,
Subtotal: 75°°
Print name: William • - 11 ate: 5 - 29 - 11
Plan review (25% of permit fee):
Authorized signatu , . � State surcharge (12% of permit fee): .9.0e
TOTAL PERMIT FEE: 84.00
Print name: Barney O'Donnell' . Date: 5-29-11 •
I:\Building\Pennits\ELC- PermitApp doc 07/01/10 440- 4615T(11 /05 /COM/WEB _ -
Electrical Permit Application - City of Tigard
- Page - 2 Suppleiriental Information
LIMITED ENERGY PERMIT FEES:
•
SIDENTAL;V:*iq ONLYi =:, ZT L ?;
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems* •
❑ Other:
;10011 1:M RCIAL'I WO= P_OT:*_ Y '" ., 7 rd :`
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
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
• 0 'Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
® Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- Permi1App doc 07/01/10