Permit (119) ., ,
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IIIs ` . COMMUNITY DEVELOPMENT
Permit#: ELR2017-00052
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 04/03!2017
Tf ;�1,.[� 9
Parcel: 1S 134CC01700
Jurisdiction: Tigard
Site address: 12325 SW KATHERINE ST
Project: TTSD-Mary Woodward Subdivision: None Lot: None
Project Description: Fire alarm system.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: TIGARD-TUALATIN SCHOOL
7324 SW DURHAM RD DISTRICT 23J
PORTLAND, OR 97224 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 04/03/2017 $75.00
Type of Use: COM 12%State Surcharge-Electrical 04/03/2017 $9.00
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: 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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 800 332 2344.
Issued B4/ e /
Y' Permittee Signature: fIII�L� U .
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.
_a.
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELR2017-00052
13125 SW Hall Blvd.,Ti Date Issued: 04/03/2017
T 4 11:P. and OR 97223 503.718.2439 9
Parcel: 1 S134CC01700
Jurisdiction: Tigard
Site address: 12325 SW KATHERINE ST
Project: TTSD-Mary Woodward Subdivision: None Lot: None
Project Description: Fire alarm system.
Contractor: PERFORMANCE SYSTEMS INTEGRATION LLC Owner: TIGARD-TUALATIN SCHOOL
7324 SW DURHAM RD DISTRICT 23J
PORTLAND, OR 97224 6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: 503-641-2222 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/03/2017 $75.00
Type of Use: COM 12%State Surcharge-Electrical 04/03/2017 $9.00
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: 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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4/4€ G Permittee Signature: is �G/f,//G�Ls�(jj�
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.
, a
Electrical Permit Application Fou QFric I: IIsi ()NIA
City of Tigard . 1' . ,' -- ' .` �* Received
DatePermit#:
B � � ( � 41eAt '-• 5-2
III w 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 p p Related Permit#: 4
(,4't i l l u l l DateB : �� • ��
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
13CARI) Internet: www.tigard-or.gov (`s 1}l ,.sr ' `! '"? Notified/Method: Supplemental Information
k \ '-4i%. T .F.7'.J ..IN,r1t3V:V1Si \: ...Lt .... EV....... `,
Please check all that apply(submit 2 sets of plans w/items checked):
❑New construction ®Add1t10t1/alteratlon/replacement
❑Demolition ❑Other: ❑Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
'.• � , s::A `•O)RY C CONS , IQN i. '..... Nsl """ exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
� 30C40044- \.. ,
amps onil other installations t
❑Multi-family ❑Master builder ❑Other: 0 rcump ❑Inbuildings.
gal Installation
S
KVA or
. �0� � � ,* .:. . . i� ❑EAmgenc system- larger seParatelYdd
of new motor load of system.
Job#: 107844 Job site address: 12325 SW KATHERINE ST 100HP or more.
❑Six or more residential units. occupancy.
City/State/ZIP: TIGARD, OR 97223 0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: I Project name: TTSD- Mary Woodward ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more 600 volts nominal
Cross street/directions to job site: l a
Description I Qty. Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#:
1,000 sq.ft.or less 168.54 4
K* 1 ( ._ 3 Ea.add'l500 sq.ft.or portion 33.92 1
. k a: ,.. .<<. �,>.. .... ,,, �„�.�.,.; ....., Limited energy,residential 75.00 2
Upgrade Fire Alarm Monitoring (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
z m Renewable Energy 0 See
e Page 2
.. : . ... tom: .. . .. .:. . Services or feeders installation,alteration,
and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
- $ 1 ;,-,..144c:,,,,,-;?,!„F Branch circuits new,alteration,or extension,per panel
: A.Fee for branch c—ircuits with
Business name: Performance Systems Integration, LLC above service or feeder fee,
each branch circuit 7.42 2
Contact name: Dan Schelhass B.Fee for branch circuits without
Address: 7324 SW Durham Road service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Portland, OR 97224 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( 503)641 2222 I Fax: :( 503)641 1464 Each manufactured or modular
67.84 2
... - dwelling,
service
e and/or feeder Dan@pslntegrated com Reconnect only 67.84 2
.. :: ' fif a ''',, ,,,,-/'',.;,-,,, ,,,-;,'7..:,' 11: . 3- .... Pump or irrigation
circle 67.84 2
Business name: Performance Systems Integration, LLC Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy r.._.'Address: 7324 SW Durham Road panel,alteration,or extension. See Page 2% 2Each additional inspection over awable in any of the above
City/State/ZIP: Portland, OR 97224
Additional inspection(1 hr min) 66.25/hr
Phone:( 503)641 2222 Fax:( 503)641 1464 Investigation(1 hr min) 90.00/hr
Email: Dan@psintegrated.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 205924 Electrical Lic.: CLE407 Suprv.Lic.: 3172LEA specificall listed /2 hr min)
`
Suprv.Electrician signature,required: > . ... ~`p- ”".. .. a
Subtotal:
Print name: William J. Driver, III: 3172 A Date: / 4'7;46 0 Plan Review Required(25%of permit fee):
‘4/(V s State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Dan Schelhass Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I1Building\Permits\ELC_PermitApp_ELR ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Fee for all residential systems combined: $75.00 Description Qty. Eaeh Totai j *
Renewable electrical energy systems:
Check Type of Work Involved: 5 lova or less 100.70 2
5.01 to 151cva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 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 OAR 918-309-0040) 552.26 2
D Heating,Ventilation and Air Conditioning
* Solar generation systems in excess of 25 kva:
System
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
IDOther
additional inspection over allowable in any of the above:
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is
specifically listed(%z hr mm) 90.00/hr
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
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: Zip
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
IABuildingTermitaLC_PermitApp_ELR_ERE.doe Rev 06/17/2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12325 SW KATHERINE ST, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2017-00052
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor