Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. COMMUNITY DEVELOPMENT Permit #: ELR2012 -00012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2012
Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 105
Project: Cognex Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: Fire alarm system added to existing fire alarm panel.
Contractor: FIRE PROTECTION SERVICES Owner: JDS LLC
5573 SW ARCTIC DRIVE CRITERION CREEKVIEW LLC
BEAVERTON, OR 97005 ATTN JAMES A MEYER
PO BOX 6525
BEAVERTON, OR 97007
PHONE: 503 - 590 -3732 PHONE:
FAX: 503 - 628 -6214
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/19/2012 $75.00
12% State Surcharge - Electrical 01/19/2012 $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 OAR • 2- 001 -0090. You may obtain a co. - - - - - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: i 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.
Jan 18 2012 3:42PM FirePrete l ipervicesInc (503) G28 -8214
err' . p.l
Electrical Permit A llca , t 4 t14 t rl 1'11 r; 1 <.+NO l'
City of Tigard � '� Rte- 4c .! NI 13125 5W Hall etvd, Tigard, 0 972,23p� ^�� Ba°e� L7> 0 +
Plan :_view
Phone: 503,639.4171 Fax: 503,598.1 6 (,`t`CJ�(}\`
Dato: � rp e C°ri + '/�i) � r,II — �0l �
1 t t ' 1 t l Inspection Line, 503,439 4 ®` ) MIA - .11dy/By; 0 g Page 2 for
Internet, www,tigard- or.gov G\ ♦ `s� tiAl.,. etbod: SI Supplemental Information
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'Fl� u�: a��u � v4.ul.eyl IY,IY'37u., I �Y .,. J�eJM ei!.�ll(�JIyF1,111J)Ivl.l; v ti w n rw�P7Y�t ��1Ai111011t 1111 .. 4 '."'. r - ': 1.L,. , - .'�I'' !'16 ,:r rIl.l ".t n,n�7n A ur. C.4 0Au∎ 0 14uAW 14; ,i. ''7 k1 r e a._...
❑ New construction ►;/ Addition /alteration /replacement 'lease check = !that apply *broil a sets of plant w /items checked below):
❑ Service or feeder 400 amps or more ❑ $uilding aver three stories.
❑ Demolition ❑ Other where the available fault current ❑Marinas and boatyards.
?fl. iii. ] 7 4 d F F Y ,, 1 87 ,,, ;. r e rfi + ii { r , , , t )ely� N ∎ N i ,'1 yq,' i1 , Ilion::' I l . , ,' exeeads 10,D40 am at 150 volts or • Plill ls� dl ,ai.,k s'4: ' i R. - c. r v... r A, , . M ;r,r..w u, ;x,� 1 , I L1 ) , r o l e , . . .. .. p . 1 11i ,,v,. � + '',, ' ❑ Floating buildings
.,
tee, to pound, or exceeds 14.000 ❑ ca Imam hi -uaa agioultw ai
❑ 1 - and 2- family dwelling tgl Commercial/industrial ❑ Accessory building amp) for all other installations, buildings,
❑ Multi family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
I '�� - ' 1 � t r ?t�" " 4r'91'"a ;, ppG1 11``r .l �1 4u7"'' a u.� 4rc?: :T m . 7 vaelnnu,ly , Mnc ,1,,I',^* Min,�1n���nn, 1 p ,p . ; ,, . ❑ Eroergonoy a"P"int large separately derived system,
4i1N1, � ''y ''1iitfCu�l�l
i' , 14,∎.4 , 4, ai Z'a ; r.i a,i;' ∎e 0 A tilt ,,, ,9 t , 7,rn _, 7 1' . i �t�lrf Ne S
vas -wren, umr °rm,t,)f,1a5Q:l usw,rH Cl Addition of new motor load of ❑ "A” "E","1.2", "t.$ ",
lob no.: 2750 Job site address: 1: 1 : 74 I 51 S 1DOt. P or more, occupancy
❑ SIX or more residential unite. ❑ Recreational vehicle parka.
City /Stale/ZIP: Tigard OR Q Health.ea a facilities, ❑ Supply voltage lbi more than
❑ Hazardous looationa, 600 volts nominal.
Suite /bldg. /apt no.: 105 Project name: Cognex 1 Service or feeder 600 maps or more. Gp hg1J
7 ll�l{11 ` CNllil��,7 .,`t . "" ` e '1 +.��ai . env ir; <r;+.1a> sd,; hn��ii, `CIi7 W, ,; , �;
Cross street/directions to job site: Description
Qry. Pos. Total
New residential single- or multi•famlly 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
t + 1M , r 1+,r, el }� a,1 +,r,'f 7x' fwanlo w >n, {, ao�a, na,n er a', nn: �.°Pk x<�'a'„ Limited energy, residential
S ' :i., k r ,.1:�.,a, a el�.iiul ' ., x „,,'i.�r7,��!)ll.P,ar:..11.i:m I r rfh s ^''�S�� rr 42 rerl,' ni +l . ri ... t,n � Y !
l a'` , ��'� y""r` ” ° it ' f r„ : { 'r'' 1 A w N a n , (with above sq. ft .) 75.00 2
Limited energy, multi - family
Add to existing Fire Alarm Panel residential (with above St ft,) 75.00 2
Services or feeders Inetallsfton,alteration, and /or reloeatlon
4 t1>1i�Q 1 � i u i ' s,srgi ,.,, rc rct n r1 ti ra vi�a fw aver •M' + � ^ if "r1 1 7 ,C C+ ,`177 iA'lgfl 1 v 1 ti S$,�1 i 1 ll l! ff It 200 amps or less 80.30 2
y, A f a+ar si ll s i f if } l l i� am amps .,IA 01. � 1 1 ° iN i d: " t • 1 �� "
I' 0 1 hr` x0#403 '! } +'1'1,'tl : I l Q :E rSt.{') 7 201 a r il B t0 400 am s 106 2
r M ! u..i �`rilul twawuuva. nGSusi.nmcntY, . J,Ii, +n IA,N r �gaS1. x mvdr��t,�n',rv,�nr }rvu.rx . +� ,., h� lr , (9r
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, rind /or
relocation
Phone: ( ) 1331 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 anrps 133.75 - 2
., Branch circuits— new, alteration, or extension, per panel
Owner signature Date A. Fee for branch circuits with
lt1 EE , " W r1�P1 Ino yu �' ,a�� {1, f'�' N Sf S, 4.14"kiF1 �� D R i��u�' IraF(a Maf C hrY, l [,x .i'S �i 1tL
\' l�' °1� f� 4 i tx „ nsaa, t a,k .. I ale t A .... +''5.4. , }�t'ra „, ..Qa,,84
` �Rl{ LI��i above service or flj9der foe, 6.65 2
each branch oiroutt
Business name: Fire Protection Services Inc B. Fee fbr branch circuits
without service or feeder fee.
Contact name: David M Phipps first branch circuit 46.85 2
Address: 5573 SW Arctic Dr Each add'l branch circuit 6.65 _ 2
Miscellaneous (service or feeder not Included)__
City/State/ZIP: Beaverton Or 97005 Each manufactured or modular 90.90 2
Phone: (503) 590 -3732 Fax :: (503) 628 -6214 iteoonneot only 66.85 2
E - mail: phipps@fpsnw.com Pump or irrigation circle 53.40 2
i+ "�'h ,1f' i't ,1, f ^rRrt , nn , f : r� r ' +fj, r i�ft(!'r�1J' s t or out
"' Si linelighting 53 .40 2
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t
�tP� �a +y1 a9; »w��,,�tiF iu ,Don,9k�nN�Y IH�2Y �'V d1d1,711 „1l'f1rl'tl Ij,i171�t �"{r t gt1
nr1,4e; , ,.,,, w 1 .r.. 1 ..,..a Signal circuit(,) or limited -
Business name: Fire Protedtion Services Inc energy panel. alteration, or
Address: 5573 SW Arctic Dr extension, Describe: 1 Page 2 79.,00 2
City /State /ZIP: Beaverton, OR 97005 Each additional inspection over allowable in any of the above
Pcr inspection 62.50
Phone: (503) 590-3732 Fax; ( I 628 -6214 '
• Investigation per hour (I lrr min) 62.50
r
MEZEOM /•j•
Electrical Lic.: Suprv. Lic.: 4120LEA Industrial •lath per hour 73.75
lI Vl llflMMtl.a v � ; r r i .? ,111, Y1} 7r 7;?.. 1,..,15 iETRE..
Suprv. Electrician signature, required: ,/j Subtotal: 75.00
dr& s;; _o
Print name: David M Phipps Date: 1/18/12 Plan review {25 °h of permit foe};
State surcharge (12% of permit fee): 9,00
Authorized signature: 1111MEMIll TOTAL PERMIT FEE: 84,00
Print name: David M Phipps .7 Data: 1(18/11 This permit application expires if a permit is not obtained wiihln 180
days after it has been accepted as complete.
• Number of inspections allowed per permit
l \Builthri \Persrlta\BLGPerm11ADp•doo 2003/06 440.4515T(11/O3/COaJWEB
Jan 18 2012 3:42PM FireProtectionServicesInc (5031 628 -6214 p. 2
Electrical Permit Application - City of Tigard
Page 2 , Supplemental Information
LIMITED ENERGY PERMIT FEES:
cud ,;', „'Li, ,}.i: :C 'I •:'!,'. -:„'I .uJf,.:9';!;qr;; %:v.;6'ti.aMAii IfigP, + ii:J(Wf'tO
Fee for all. residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar . Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System's
❑ Vacuum Systems*
❑ Other:
1ei : .. :i1+ ?,,, i':+ S f 14' i:�� 1 : ' ' : ,lv r �:, x, ii
0iii; i +A∎,,±;i.M�t iil:
0�„ :e,n,,., ' .,aF,x,xrf ^ .tin,. .m,ay...e „” d,Mn$,d ansxiala?M a 1,,1(�. II +!)h +,k
,,, t4i��fu.,3
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
[] Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
,
J Fire Alarm Installation
El HVAC
El Inst meatatiort
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
E Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signalivag
❑ Other
Total number of commercial systems: 1
*No licenses are requited. Licenses are required
for all other installations
I. 1Buildug1PermitslHA ,P arm liApp 03/23!06