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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 1 11- - COMMUNITY DEVELOPMENT Permit #: ELR2009 -00144 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/01/2009 Parcel: 2S101 CB00500 Jurisdiction: TIGARD Site address: 12670 SW Hall BLVD Subdivision: Lot: 0 Project: Apex Industries Project Description: Add /alter existing fire alarm system. Owner: FEES TCTPI LLC Description Date Amount 25977 SW CANYON CREEK RD #J Restricted Energy Permit 06/01/2009 $75.00 WILSONVILLE, OR 97070 12% State Surcharge - Restricted Energy 06/01/2009 $9.00 PHONE: Contractor: ACTION TECHNOLOGY SYSTEMS 835 SE 17TH AVE PORTLAND, OR 97214 PHONE: 503 - 231 -1992 FAX: 503 - 231 -1402 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 Total $84.00 Intercom /Paging: N Landscape /Irrigation: N Required Items and Reports (Conditions) Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: N Other Desc: 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 wit 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 e set forth in OAR 952 - 001 -0010 through O • R 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calli '. 503.2461 6or 1.800.332.23 rr j Issued By: III �' . . - I I Permittee Signature: _ . 1 11 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 an inspection that business day. 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 , , I ' ' " ' FO OFFICE USE ONLY ' Received City of Tigard Date/B Permit No.: fit; Iii 601 It " 13125 SW Fla!! Blvd., Tigard, OR 97223 JUN 0 1 2009 g Plan Review Other Permit: ' /' Pho ne: 503.639.4171 Fax: 503.598.196 1 `7 TIGARD BUILDING DIVISION Inspection Line: 503.639.4175 C Date /By: CITY OF TIGARD Date Ready /By. RI See Page 2 for Internet: www.tigard or.gov Notified/Method: � Supplemental Information TYPE OF - WORK ` ,, PLAN REVIEW Please check all that apply (submit 2 sets of plans se /items checked below): 1=1 New construction ® Addition /alteration /replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. . 'CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 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 pomp. ❑ Installation of 75 KVA or ' JOB'r SIT -INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. - _ CI Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ", Job no.: 16187 Job site address: 12670 SW Hall Blvd 100HP 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: Apex Industries ❑ Service or feeder 600 amps or more. .=: ., • ' -.FE SCHEDULE - - Cross street/directions to job site: Description . ' I Qty. . 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'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 - :' ' ' DESCRIPTION OF, WORK . ' • . (with above sq. ft.) Additions/improvements to fire alarms stem Limited energy, multi family 75.00 2 P Y residential (with above sq. ft.) Services or feeders installation, alteration, and /or relocation 200 amps or less 80.30 2 - ❑ : PROPERT ' 'OWNER - -, ❑' TENANT - 201 amps to 400 amps 106.85 2 Name: 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 City/State /ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: Date: Branch circuits - new, alteration, or extension, per panel A. Fee for branch circuits with ' ❑' APE,LI CANT:'." _ • ' ❑ ".CONTACT 'PERSON.- - ' above service or feeder fee, each branch circuit 6.65 2 Business name: B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 first branch circuit Address: Each add'! branch circuit 6.65 2 .. Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and /or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 .. - ,,: - • -- CONTRACTOR' ' - - ' - . _- Sign or outline lighting 53.40 2 Business name: Action Technology Systems LLC Signal circuit(s) or limited - energy panel, alteration, or Address: 835 SE 17 Avenue extension. Describe: I Page 2 75 co 2 City /State /ZIP: Portland, OR 97214 Each additional inspection over allowable in any of the above Per Phone: (503) 231 - 1992 Fax: (503) 231 - 1402 inspection 62.50 ga Investigation per hour (I hr min) 62.50 CCB Lic.: 157630 Electrical Lie.: 5-n (EA Suprv. Lie.: Industrial plant per hour 73.75 C 2• ELECTRICAL PERMIT FEES ' _ . - . 76,00 Suprv. Electrician signature, required: � / Subtotal: �,00 Print name: S el, (© ice Nb Date: C � — 1-01 Plan review (25% of permit fee): I�t� / l State surcharge (12% of permit fee): q OD Authorized signature: 7 ' �Z iier/ TOTAL PERMIT FEE: , Print name: V I �> �,. r !! --// This permit application expires if a permit is not obtained within 180 �s u� � ��,�y�r`/ Date: �� ■ I 07 days after it has been accepted as complete. * Number of inspections allowed per permit. I \Building\Permits\ELC- PermitApp doc 05/23/06 440- 4615T(l 1/05 /COM/WEB O Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL,WORK ONLY 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: COMMERCIAL.WORKONLY: 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 \ Building \Permits\ELC- PermitApp.doc 03/23/06