Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111 COMMUNITY DEVELOPMENT Permit #: ELR2011 00236
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2011
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 350
Project: Williston Financial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: Fire alarm system. 11/17/11, reprinted permit for address correction.
•
Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS IN1 Owner: PACIFIC REALTY ASSOCIATES
15495 SW SEQUOIA PKWY STE 100 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 968 -3353 PHONE:
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/16/2011 $75.00
12% State Surcharge - Electrical 11/16/2011 $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 Center. Those rules are set forth in OAR
952- 001 -0010 through OA; • - 001 -0090. You may obtain a copy • e ru es o,direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
-
Issued By: Permittee Signature: 1/4. Ye... - 1 2--
7
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.
v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Y COMMUNITY DEVELOPMENT Permit #: ELR2011 -00236
T "IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2011
Parcel: 2S 101 AD03200
pyV Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY
Project: Williston Financial Group Subdivision: WEST PORTLAND HEIGHTS Lot: 9 -25, PT
Project Description: Fire alarm system.
Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS IN1 Owner: PACIFIC REALTY ASSOCIATES
15495 SW SEQUOIA PKWY STE 100 ATTN: N PIVEN
PORTLAND, OR 97224 15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: 503 - 968 -3353 PHONE:
FAX: 503 - 968 -3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/16/2011 $75.00
12% State Surcharge - Electrical 11/16/2011 $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 a I 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 • 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 r - set forth in OAR
952- 001 -0010 through OAR 952 - 001 -0090. Y•u - • : - •= - • • of the uestions to OUNC by calling 503.232.19:f or 1.800. .2344. • Issued By �'�� •er -- ature.:_
Mid I
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 � � . FokOFFIcE.UsE
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a r " `RI eived � p �,` N l
City of Tigard Date /B /1 C,6, /ii Permi J Eif`4 I UaD3l(J(J
q 13125 SW Hall Blvd., Tigard, OR 97223 NOV 16 201 { Plan Review
11 ; Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit: Fp 1 _,...6 (.;q-
TI G A RD Inspection Line: 503.639 CTY OF �l� ate Read /B Juris: ® See Page 2 for
Internet: www.tigard- or.goV �I I `' ° "� ' Notified Method: 'Ji (p Supplemental Information
riiIll rill\ In i r°'.t
{ ax �a '11�: x � � =�..ar�ao- :ire�s rte; � � � g
_-11 t $ . w g 4 I'YPE. OF °WORK I . , j .� , R �, A �' . ,
. ., PLAN REY �lj ,°
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
. � - where the available fault current ❑ Marinas and boatyards.
x , �r- ,,,, s t , 4 ,. EG . CON , § TRUCTI ,i , � ., : 4' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
amps for all other installations. buildings.
❑ Multi- family ❑ Master builder .: 1a, Other: Fire pump. Installation of 75 KVA or
" `.'� .mw.e. ' . � JOB; §X F.6RM TI i AND` ❑ TION�° anal ID Fire
.a:' ❑ ❑ Emergency system. larger separately derived system.
nz;�wx a�i'v., e;ca:A° -?. �...,z...t Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 12909 SW 68 PARKWAY 50 IOOHP or more. occupancy.
City/State/ZIP: PORTLAND, OREGON 97224 ❑ Six or more residential units. ❑ Recreational vehicle parks.
y , ❑ Health -care facilities. ❑ Supply voltage for more than
12 Hazardous locations 600 volts nominal.
Suite /bldg. /apt. no.: Project name: WILLISTON FINANCIAL ❑ Service or feeder 600 amps or more
Cross street/directions to job site: ' DV:FEE ,SCAEDULE'N r e ,�,,,
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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
s r - ,P; Limited energy, esidential
. , DES F WURK gY 75.00 2
5n $ %x (with above sq. ft.)
ADD TWO HORN /STROBES AND FOUR STROBES TO SUITE 350 TO NEW Limited energy, multi - family
EXPANDER residential (with above sq. ft.) 75.00 2
REWIRE EXISTING TRHIR FLOOR HORN STROBES TO NEW THIRD Services or feeders installation, alteration, and /or relocation
FLOOR BOOSTER 200 amps or less 80.30 2
PROPERTY OER '� „`. TENANT, �$ y 4 201 amp 106.85 2
to 400 amps
. r i9 km.'£- . :4'- e 1 e x; : 11 ; : 1 11 1 : m a° ^'S �a.'= _ »`
Name: PACIFIC REALITY ASSOCIATES 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
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
L :$4314, ►► °1APPLICANT rA' a, ®C NTCTI?ERSON; above service or feeder fee, 6.65 2
a ° � 0 - each branch circuit
Business name: STANLEY SECURITY SOLUTIONS B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: GARY TAUSCHER -e/i ell S �°r�. I ' first branch circuit
Address: 15495 SW SEQUOIA ARKWAY , Each add'1 branch circuit 6.65 2
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. -3353 G2y- j U ,'ax:: (503) 968 -3398 Reconnect only 66.85 2
Pump or irrigation circle 53.40 2
E- mail:
de"- .),,s 115 /9•► +Rtvf i 0 - U'4Y)
. .41111 p '2* C 7 3 1` ` ' ) Sign l outline lighting 53.40 2
Si circuit(s) or limited -
Business name: STANLEY SECURITY SOLUTIONS energy panel, alteration, or
extension. Describe: 1 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 Lie.: 161567 Electrical Lie.: 37 -1054C Suprv. Lie.: Industrial plant per hour 73.75
a..aTRICx1L PERMIT F O...„ .0:4
Suprv. Electrician signature, required: Subtotal: 7
Plan review (25% of permit fee):
Print name: STEVE MOREHOUSE Date: State surcharge (12% of permit fee): .241--
Authorized signature: TOTAL PERMIT FEE: v2r
This permit application expires if a permit is not obtained within 180
Print name: GARY TAUSCHER • Date: days after it has been accepted as complete.
1•\Building\Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I 1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
VRAESI DI TIAL D KIONLY _ A , ` ,
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:
COMERCIALWOARK®NLY s a , ' x
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 \BuildingPermits\ELC- PermitApp doc 03/23/06