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Permit
14 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: ELR2020-00086 Tigard OR 97223 503.718.2439 13125 SW Hall Blvd.,Ti Date Issued: 07/09/2020 Tli;;ARD 9 Parcel: 2S101AB03100 Jurisdiction: Tigard Site address: 12115 SW 70TH AVE 202 Project: Med RX Subdivision: 2012-009 PARTITION PLAT Lot: 3 Project Description: Limited energy for fire alarm. Contractor: POINT MONITOR CORPORATION Owner: TIGARD TRIANGLE PARTNERS LLC 5863 LAKEVIEW BLVD STE 100 BY DEERING MANAGEMENT GROUP LAKE OSWEGO, OR 97035 4800 SW MACADAM AVE STE 120 PORTLAND, OR 97239 PHONE: 503-627-0100 PHONE: FAX: 503-627-0110 FEES Description Date Amount Specifics: Restricted Energy Permit 07/09/2020 $75.00 12%State Surcharge-Electrical 07/09/2020 $9.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 0 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 S84.00 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 9 -001-0090. You y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: ----I ...---1 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. RECEIVED Electrical Permit Application JUN 2 2020 FOR OFFICE USE ONLY City of regard T )1--- Received : © %t!, OM t� � 13125 SW Hall Blvd,Tigard OR 97223�''1 ' :' tAri� Plan Review � y�/ Phone: 503.718.2439 Fax: 503.598.f9�i(.(�i,,G DIViG CN Da 7 "15 � //(/'(- Inspection Line: 503.639.4175 Ready DateBy: man 1a See rage<.v. I I..AIt I) Internet: www.tigard-or,gov Notified/Method: Supplemeal Information TYPE OF WORK PLAN REVIEW ❑New construction ®Addition/alteration/replacement Please check ail that apply(submit sets of plans w/items checked): 0 Service or feeder 400 amps or more ❑Building over three stories. ❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. ❑ I-and 2-family dwelling ®CommerciaVindustrial El Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural El Multi-family for all other installations. buildings. El builder 0Other: 0 Fire h'iro pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived AddJob#: Job site address:12115 SW 70th Ave. 0 100HP o of new motor load of system. OOHPmmore. ❑"A","P',"I-2","]-3" City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg.apt.#:202 Project name:MED Rx 0 Hazardous loalions. 0 Supply voltage for more than - 0 Service or feeder 600 amps or more. 600 volts nominal. Cross street/directions to job site: [ ,$Cl1E1ZULE Desolation I City. I Each I Total I `` New residential single-or multi-family dwelling unit. Subdivision: Lot#: Includes attached garage. 1,000 sq.ft.or less 168.54 4 Tax map/parcel#: ._ __ Ea add9 500 sq.ft or portion 33.92 1 DESCRIPTION OF WORK Limited energy,residential Fire Alarm Notification Devices (with above sq.ft.) 75.00 2 _ -.... Limited energy,multi-family 75.00 2 residential(with above sq.fl.) ❑ PROPERTY OWNER ® TENANT Renewable Energy ❑ SeePaQe2 - Services or feeders iostaBationiaiteradon,and/or relocation Name:MED Rx 200 amps or less 100.70 2 Address 12115 SW 70th Ave.Suite 202 201 amps to 400 amps 133.5E 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2 Phone:( ) Fax:( ) Over 1,000 amps or volts 552.2E 2 Temporary services or feeders installation,alteration,and/or Email: relocation Owner installation:This installation is king 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 Branch circuits—new,alteration,or extension,per panel ® APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with Business name:Point Monitor Corp. above service or fader fee, each branch circuit 7.42 2 Contact name:Brooke Williams B.Fee for branch circuits without service or feeder fee,first Address:5863 Lakeview Blvd.Suite 100 branch circuit 56.18 2 City/State/ZIP:Lake Oswego,OR 97035 Each add'I branch circuit 7.42 2 Miscellaneous(service or feeder not included) Phone:(503)627-0100 Fax::( ) Each manufactured or modular dwelling,service and/or feeder 67.84 2 Email:bwiliiams@pointmonitor.com Reconnect only 67.84 2 CONTRACTOR A Pump or irrigation circle 67.84 2 Business name:Point Monitor Corp. Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Address:5863 Lakeview Blvd.Suite 100 panel,alteration,or extension. IN See Page 2 l 2 City/State/ZIP:Lake Oswego,OR 97035 Each additional inspection over allowable in any of the above Additional inspection(1 hr min) 66.25/hr Phone:(503)627-0100 Fax:( ) Investigation(I hr min) 90.00/hr Industrial plant(1 hrmin) 78.18/br Email:bwilliams@pointmonitor.com . Inspections for which no fee is 90.00/hr CCB Lic.: 135901 Electrical Lie.: 34508CLE Suprv.Lic.: 4460LEA specifically listed(1/2 hr min) Suprv.Electrician signature,required: Tom.? --, `y ELECTRICAL PERMIT FEES Subtotal: Print name: Ben Breit Date: 6/23/2020 0 Plan Review Required(25%of permit fee): 7� State surcharge(I2%of permit fee): Authorized signature:��}a 1 TOTAL PERMIT FEE: This permit applicatbe expires if a permit Is not obtained within 180 Print name: Ben Breit Date: 6/23/2020 days after it has been accepted as complete. • Number of inspections allowed per permit. I'.Buildivg,Pennils Etl_PamitApp_ELR ERE.doc Per 06 1"2015 4404615T(11/05•C0MWEB Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORKQNII,Y;�, _ FEE SCHEDULE Fee for all residential systems combined: $75.00 Dse plan I ar. f e.el I Teal I Renewable electrical energy systems: Check Type of Work Involved: 5 ova or 100.70 2 5.01to15kva 133.56 2 ❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2 ❑ Burglar Alarm Wind generation systems in excess of 25 kva: 25.01 to 50 kva 301.04 2 El Garage Door Opener* 50.01 to 100 kva 55226 2 >100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 7.42 3 El Vacuum Systems* >100 kva—no additional charge 0.0 3 Each additional Inspection over allowable In any of the above: n Other: Each additional inspection is 66•25/hr l charged at an hourly(1 hr min) Inspections for which no fee is 90.00/hr specifically listed('h hr min) COMMERCIAL WORK ONLY: Ef ECf12IC�[ P>RMI1 FEES Fee for each commercial system: $75.00 Subtotal(Enter on Page 1): • Number of inspections allowed per permit. (SEE OAR 918-309-0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls El Clock Systems n Data Telecommunication Installation ® Fire Alarm Installation ❑ HVAC El Instrumentation ❑ Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other: Total number of commercial systems: 1 *No licenses are required. Licenses are required for all other installations IAB5ildins,Pemlits ELC_PermitApp_ELR_ERE.doc Rev 061-2015