Permit a
III CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
III° COMMUNITY DEVELOPMENT Permit#: ELR2015-00025
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/21/2015
Parcel: 1S135ACO2500
Jurisdiction: Tigard
Site address: 9388 SW MANDAMUS CT
Project: The Reserve At Ashbrook Subdivision: ASHBROOK FARM Lot: 25
Project Description: New fire alarm communicator for existing fire alarm system. Affidavit submitted.2/2/15,address corrected from
9482 to 9388 SW Mandamus.
Contractor: PERFORMANCE SYSTEMS INTEGRATION CORP Owner: MACH 1 GE-ASHBROOK LLC
7324 SW DURHAM RD 851 SW 6TH AVE#1500
PORTLAND, OR 97224 PORTLAND, OR 97204
PHONE: 503-641-2222 PHONE:
FAX: 503-641-1464
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 01/21/2015 $75.00
12%State Surcharge-Electrical 01/21/2015 $9.00
Type of Use: COM Misc Administration Fee 02/02/2015 $45.00
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 1
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 Total $129.00
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 ac • - - _•proved 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. A TION: Oregon la requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0r -0010 throu.h OAR 952-001-6 8•t Y•u ma obtain a copy of the rules or direct questions to OUNC by calling 5 . . 987 or 1.800.332.2344. /,
I =ued By: 1/�LI/�1``"r - Permittee SignatU v[ t LC1/'
OWNER INSTALLATION ONLY U
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.
1 r CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
a ' COMMUNITY DEVELOPMENT Permit#: ELR2015-00025
Date Issued: 01/21/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135ACO2500
Jurisdiction: Tigard
Site address: 9482 SW MANDAMUS CT
Project: The Reserve At Ashbrook Subdivision: ASHBROOK FARM Lot: 25
Project Description: New fire alarm communicator for existing fire alarm system. Affidavit submitted.
Contractor: PERFORMANCE SYSTEMS INTEGRATION CORP Owner: MACH 1 GE-ASHBROOK LLC
7324 SW DURHAM RD 851 SW 6TH AVE#1500
PORTLAND, OR 97224 PORTLAND, OR 97204
PHONE: 503-641-2222 PHONE:
FAX: 503-641-1464
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/21/2015 $75.00
12%State Surcharge-Electrical 01/21/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 1
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 952-001-0090. You may obtain a o t e r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ✓ ,-- 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.
r
r Electrical Permit Application EiN' FOR OFFICE USE ONLY
City of Tigard Received Date/B : /0 I S 14 ,
114
- •• 13125 SW Hall Blvd.,Tigard,OR 97223 2015 Plan Review r- - 4
Phone: 503.718.2439 Fax: 503.598.1960 Date/B Other Permit: r—RT, 115-- 00 1
TI G A R D Inspection Line: 503.639.4175 p►N 2 0 Date Ready/By: ® Page 2 for
Internet: www.tigard-or.gov `�Av{\ Notified/Method: M Supplemental Information
TYPE OF W0,4111�V 1� t11Sr�VpN PLAN REVIEW
❑New construction ®Addition/alter Lltt�nt Please check all that apply(submit 2 sets of plans w/items checked below):
❑Demolition ❑Other: r ❑Service or feeder 400 amps or more ❑Building over three stories.
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:R-2(Apts.) ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A" "E" "l-2" "l-3"
Job no.:PSIQ11661 Job site address:J49d'SW Mandamus Court 100HP or more. occupancy.
R Z ❑Six or more residential units. ❑Recreational vehicle parks.
City/State-/ZIP:Tigard/OR/97223 T! 0 Health care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name:The Reserve at Ashbrook ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:SW Greenburg Rd and SW Shady Ln 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 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
-Cr imited energy,multi-family
75.00 2
NI W c't. ti Le+rt'\ Co Mr1 V✓icA Tf tt e Fi 4.M RM residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
SYSTEM- Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER [ ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: _ Branch circuits-new,alteration,or extension,per panel
® APPLICANT I ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name:Performance Systems Integration Corporation each branch circuit 7.42 '`
B.Fee for branch circuits without
Contact name:Edward Chiong service or feeder fee,first 56.18 2
branch circuit
Address:7324 SW Durham Rd Each add'l branch circuit 7.42 _ 2
City/State/ZIP:Portland/OR/97224 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)641-2222 Fax: :(503)641-1464 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Performance Systems Integration Corporation Signal circuit(s)or limited-energy I See
panel,alteration,or extension. Page 2 2
Address:7324 SW Durham Rd Each additional inspection over allowable in any of the above
City/State/ZIP:Portland/OR/97224 Additional inspection(I hr min) 66.25/hr
Investigation(I hr min) 66.25/hr
Phone:(503)641-2222 Fax:(503)641-1464 Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 150747 Electrical Lic.: 34-522CLi: Suprv.Lic.: 4623LEA specifically listed('/:hr min) 90.00/hr
ELECTRICAL PERMIT FEE S
Suprv.Electrician signature,required: Subtotal:
Print name: Scott LeClair Date: 12/19/2014 Plan review(25%of permit fee):
State surcharge(12%of permit fee):
—
-Authorized signature: !i '� / TOTAL PERMIT FEE:
-. G This permit application expires if a permit is not obtained within 180
Print name: Edward Chiong ate: 12-19/2014 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I I:\Building\Permits\ELC_PcrmitApp_ELR_ERE.doc Rev 05/21/2013 4404615T(I I/05/COM/WEB
' Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined ... $75.00 Description I Qty. [ Fee I Total 1 •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
nBurglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems in excess of 25 kva:
Each additional kva over 25 7.42 3
n Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
I J Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system $75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee):
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
nAudio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n 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\Pcrmits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013