Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
r Permit #: ELR2011 -00233
4 :::" - COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/18/2011
TIGARD 13125 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 320
Project: Professional Eye Care Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: Fire alarm.
Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS INi Owner: PACIFIC REALTY ASSOCIATES
15495 SW SEQUOIA PKWY STE 100 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 968 -3353 PHONE: 503 - 624 -6300
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/18/2011 $75.00
12% State Surcharge - Electrical 11/18/2011 $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 suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Genii'. Tho = rue 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 4:7 or 1.::'.332.234 , .
i
Issued By: dl' 4 L .. � _ 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.
... ... . .: . . . ..
Electrical Permit Application .-_—__ ..._..L.F.0112i0FIFICE-USE-ONLY .
City of Tigard
V53) Received , i
Permit No.: " i
. dt... 1 .....c
q 13125 SW Hall Blvd., Tigard, OR ,,,,, ci..,
Ipl Date/B : 1 VI IF=
Plan Review
I I : Phone: 503.639.4171 Fax: 503.5ak,' .0 Other Permit: E- P5 d... I ( 33
Date/By:
Inspection Line: 503.639.4175 Date Ready/By: Rifts: IZI See Page 2 for
,
TIGARD rgov 0 .° . 1.%'\\
NV‘A Notified/Method: L- Supplemental Information
Internet: www.tigard-o
,
;'. ;: -7 •:. , ;' 7 .i ,-( i i i 7.4i*S M ii: VAP , 41. 4 .' 1- *WYPE-'01V, - ,W0‘160V i ' *' ':, ''':z..,:-.1ik , nREIEW..
O New construction 0 Addition/alterat%101,\%Pnent Please check all that apply (submit 2 sets of plans whtems checked below):
D Demolition • ID Other: .i).) D Service or feeder 400 amps or more 12 Building over three stories.
where the available fault current ID Marinas and boatyards.
'-areditifoAaiWg'iiitrefibir':*'..:!''.'t,'%.:K4r, exceeds 10,000 amps at 150 volts or 0 Floating buildings.
•"."'.A"' ':: I less to ground, or exceeds 14,000 D Commercial-use agricultural
O 1- and 2-family dwelling [Z1 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder D Other: 0 Fire pump. 12 Installation of 75 KVA or
0 Emergency system. larger separately derived system.
fti-titi :': - '' 1
. 2 , • .1i.:K:t -: 14* 0 Addition of new motor load of
100HP or more. occupancy.
Job no.: 1 Job site address: 15350 SW SEQUOIA PARKWAY
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: PORTLAND, OREGON 97224 0 Health-care facilities. El Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no320 Project name: PACTRUS91 ,.,.. ., D Service or feeder 600 amps or more.
/WI '''' "'''
*k r Liks: /.,. h•: ...1---,.:,-- 2..i*:*47,- 51
Cross street/directions to job site: _)/e..) Description I Qw. 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. addi 500 sq. ft. or portion 33.40 1
'Tax map/parcel no Limited energy, residential
W417 . ';';'•4400, :"1"MR: (with above sq. ft.) 75.00 2
REMOVE ANDRELOCATE TWO HORN STORBES INSTALL THREE Limited energy, multi-family
75.00 2
STROBE AND ONE STROBE residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
TO EXISTING FIRE SYSTEM 200 amps or less 80.30 2
r .. guf .6c:,,°!.t7 4,4!,; 201 amps to 400 amps 106.85 2
.,.:.-i:. : 4..1 '':'', ,A, 4.-4. ...,v., ^e',ATL, ^., 4- 4: , -,'%W , M,;„ ,.,ift . 4PatZ.
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 I 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
:.3: 54,074#11q g Yi*K r 4.4. 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 name7e*Itri7CrSerirR e,I.S * i' first branch circuit
Each addl 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)-%8 33Z - 6310 Fax: : (503) 968-3398 Reconnect only 66.85 2
Pump or irrigation circle 53.40 2
E dC-' iii.ra, 4,-- 1-7, a. ./.7.o •
niMiteAfat':7:iairk-itdttOV4VrOV*44'AMZiiilt Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: STANLEY SECURITY SOLUTIONS energy panel, alteration, or .
extension. Describe: 1 Page 2 - 6 - 7 - 2-- - % 2
Address: 15495 SW SEQUOIA PARKWAY
Each additional inspection over allowable in any of the above
City/State/ZIP: PORTLAND, OREGON 97224
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.: 7-I054C 7 ikSuprv. Lie.:
MS.Wn:gg.tijKlargWORE
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of permit fee): ---
Print name: STEVE MO 0 OUSE Date: 11/7/2011 State surcharge (12% of permit fee):
TOTAL PERMIT FEE: ll,
Authorized signature: fr I L, ri I A r>n e
This permit application expires if a permit is not obtained within 180
Print name: GARY TAUSCHER Date: 11/07/2011 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \Building \Permits \ELC-PermitApp.doc 05/23/06 440-4615TO 1/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RE:sl ENTIAL W iK ONtI.Y k
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:
41 ',WW-CCWWQRICO-VOVZOK1Stil 7 .1V1
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. \BuildingWermits\ELC- PermitApp. doe 03/23/06