Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II 2 COMMUNITY DEVELOPMENT Permit #: ELR2012 -00056
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03130/2012
Parcel: 2S113AB00101
Jurisdiction: Tigard
Site address: 16101 SW 72ND AVE 200
Project: Perlo Construction Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: Low voltage for fire alarm
Contractor: Owner: PACIFIC REALTY ASSOCIATES LP
ATTN: N PIVEN
15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: PHONE: 503 - 624 -6300
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/30/2012 $75.00
Type of Use: COM 12% State Surcharge - Electrical 03/30/2012 $9.00
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 applicabl . II work will
be done in - •r•ance w : pproved r ans. This permit will expire if work is no1 started within 180 days of issuance, or if •rk is su ded for mo the 180
days. AT • NTION: Oregon la • uire you to follow the rules adopted by the Oregon Utility Notification Center hose es are set f in OAR
952 -001 1010 t •ugh OAR 952 -00 0090. Y. • • = , y � obtain a a of the rules or direct questions to OUNC by calling 503.232.1 • .800.3 .2344.
Issue By: � . l "t— j6 Permittee Signature: 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 � ^� FOR OFFICE USE ONLY
of Tigard S � NY Date Received ��� Permit No.: f qua —G SIQ
a 13125 SW Hall Blvd., T igard,r• OP � z'� Plan Re
l C Phone: 503.639.4171 Fax: 13.598.1960 O `t0 %" DateBy Other Permit: f, �.+4. c
C I G A R D Inspection Line: 503.639.4175 P� Date Ready/By: Juris: 63 See Page 2 for
Internet: www.tigard- or.gov — � �� r t .. Notified/Method: 75.6) Supplemental Information
TYPE OICOR` ' 1 `► PLAN REVIEW
El New construction ®Additiok�t�tf 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.
CATEGORY OF CONSTRUCTION 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: 16101 SW 72 ND AVE 100HP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: PORTLAND, OREGON 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 200 Project name: PACTRUST ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I oty. 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
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
INSTALL THREE STROBES / RELOCATE EXISTING AS INDICATED ON Limited energy, multi - family 75.00 • 2
DRAWING residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
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
® APPLICANT I ❑ CONTACT PERSON 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 name: GARY TAUSCHER first branch circuit
Each add'I 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) 968 -3355 Fax: : (503) 968 -3398 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: STANLEY SECURITY SOLUTIONS energy panel, alteration, or
extens n. Descr be: / Page 2 A 0 2
Address: 15495 SW SEQUOIA PARKWAY i /1,.E,�}Qf r / 5 '
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
• Industrial plant per hour 73.75
CCB Lic.: 161567 Electrical L 'Q: 37 -1054C Suprv. Lic.:
g i ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 7$ ou
Plan review (25% of permit fee):
Print name: STEVE MOREHOUSE Date: 03/30/2012 - !?ci
41) / State surcharge (12% of permit fee):
Authorized signature: ,,, l o TOTA PERMIT FEE: b This permit application expires if a permit is not obtained within 180
Print name: GARY TAUSCHER Date: 03/30/2012 days after it has been accepted as complete.
• Number of inspections allowed per permit.
IABuitding\ Permits \ELC- PermitApp.doc 05/23/06 440-4615T(II/O5 /COM/WEB
•
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 WORK ONLY:
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