Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
°'� 4 ,` COMMUNITY DEVELOPMENT Permit#: ELR2020-00103
Date Issued: 8/17/2020
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S135A601004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 570
Project: Maxim Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire alarm.
Contractor: POINT MONITOR CORPORATION Owner: LINCOLN CENTER LLC
5863 LAKEVIEW BLVD STE 100 BY SHORENSTEIN PROPERTIES LLC
LAKE OSWEGO, OR 97035 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/17/2020 $75.00
12%State Surcharge-Electrical 08/17/2020 $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 $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 throudb OAR 952-001-g0,09,00.. You
may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 oor1.1.�8000.332.2344.�,2,_rs
Issued • -/-1I �""`� Permittee Signature: e,t✓ r / ✓ �G `'`/ O/'�.•�
/// 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
. Cl ofTigard ated
gv y Permit k
lli '1 13125 SW Hall Blvd.,Tigard,OR 97223 C 111 1 Review "00 1 D 3
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Related Permit Si:
Inspection Line: 503.639.4175 I Read Date/By: r+/ / tuns. H Sec Page 2 for
TIGARD P -L.1L 1 5 20zc Notifiedi1Nethod. f% Supplemental Information
Internet: www.tigard-or.gov ` 1 pP
TYPE OF WORKr 01 .i. T R"i:AWIt:..,)' V `--.':11-'.- ,�y..4�✓ PLAN REVIEW
❑New construction ®Addition/alteration/replacerI`ent Please check all that apply(subsoil 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
D Demolition E Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling LE] Commercial/industrial 0 Accessory building less to ground or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: ID Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION Ai& ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 10220 SW Greenburg Rd. IOOHP or more. ❑"A "E","1-2","1-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:570 Project name:Maxim @ Lincoln 2 ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description 1 QV. 1 Each I Total 1 •
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less -
168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
MIL DESCRIPTION OF WORK t` 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.ft.)
Renewable Energy 0 See Page 2
❑ PROPERTY OWNER ® TENANT Services or feeders installation,alteration,and/or relocation
Name: Maxim @ Lincoln 2 200 amps or less 100.70 2
Address: 10220 SW Greenburg Rd.Suite 570 201 amps to 400 amps 133.56 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 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: 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
® APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension, .er panel
- - A.Fee for branch circuits with
Business name:Point Monitor Corp. above service or feeder fee, 7.42 2
each branch circuit
Contact name:Brooke Williams B.Fee for branch circuits without
seAddress:5863 Lakeview Blvd.Suite 100 branche c or feederitfee,first 56.18 2
branch circuit
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 67.84 2
dwelling,service and/or feeder
Email: bwilliams@pointmonitor.com
Reconnect only 67.84 2
?` CONPR ACTOR Pump or irrigation circle 67.84 2
Business name: Point Monitor Corp. Sign or outline lighting 67.84 2
Address:5863 Lakeview Blvd.Suite 100 Signaln circuit(s)or limited-energy
CO See Page 2 1 2
panel,alteration,or extension.
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(1 hr min) 90.00/hr
Email: bwilliams@pointmonitor.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 135901 Electrical Lie.: 34508CLE Suprv.Lie.: 4460LEA specifically listed(i4 hr min)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,required: Subtotal:
Print name: Ben Breit Date: 7/14/2020 ❑Plan Review Required(25%of permit fee):
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: Ben Breit Date: 7/14/2020 days after it has been accepted as complete.
* Number of inspections allowed per permit
I:'Building\Permits'ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-46151'(1 l/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
Description ] Q . I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s 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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ 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
Each additional inspection over allowable in any of the above:
❑ Other Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fcc is 90.00/hr
s ifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Subtotal(Enter on Page 1).
Fee for each commercial system: $75.00 Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n 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
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
1:U3uilding\Permits'ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015