Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
S.' COMMUNITY DEVELOPMENT Permit#: ELR2020-00122
T GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/19/2020
Parcel: 2S 101 DA00100
Jurisdiction: Tigard
Site address: 13010 SW 68TH PKWY 140
Project: Spec Space Subdivision: VARNS ACRES Lot: 9
Project Description: Fire alarm.
Contractor: FIRE PROTECTION SERVICES Owner: PACIFIC NW PROPERTIES LIMITED PA
9950 SW ARCTIC DRIVE STERN FAMILY LIMITED PARTNERSHIP
BEAVERTON, OR 97005 STERN FAMILY LLC
6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-590-3732 PHONE:
FAX: 503-628-6214
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/16/2020 $75.00
12%State Surcharge-Electrical 10/16/2020 $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 ma irra-Cbpq f the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.12 ;,
� �
Issued By: Permittee Signature: ,�ry�...00, Dt^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
City of Tigard e"ed j �y Pem,il
13125 S W Hall Blvd.,Tigard,OR 47223 F ,f_4 Date l p L" i r �v f'+wL tiPJ'(J 01A,
• °Plan R' w Related Permit W:
ElIII
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: �Qf �5��for
Inspection line: 503.639.4175 S E P 2 5 Date/By. 1� ® See Page 2 for
1 IGARD Internet: www.tigard-or.gov Ndfilled/Method: ��/(7jr rr Supplemental lnformadoa
TYPE OF WORK CIiV Or IIUAt U gi, i•''«/ de,./ PLAN REVIEW
El New construction El Addition/alter'ation/replact t i-D!NU LlVrSION Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at ISO volts or 0 floating buildings.
less to ground,or exr Ms 14,000 0 Commercial-usc agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: ['Fire pump. 0 installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:7 3010 SW 68th Pkwy I00HP or more. ❑"A","E","i-r','l-3",
0 Six or more residential units. occupancy.
Ci /State/ZIP:Ti ard,OR 973 0 Recreational vehicle parks.
ty g i�""n ❑Health-cam facilities.
Suite/bldg./apt.#:140/ Project name:Triangle Corporate Center Tenant Improvement 0 Hazardous locations. 0 Supply voltage for more than
rfg, pt600 volts nominal.
❑Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
&SW 66th Ave. lr iprioa oty Eli
i I . rectal 1 •
SW 68th Pkwy New residential single-or multi-family dwelling unit.
Subdivision: Lot P. Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Fa.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
Removal and Relocation of 1 Audible Horn/Strobe in Suite 140, Removal and (svith above sq.ft.)
Limited energy,multi-family 75.00 2
Relocation of 2 Audible Hom/Strobes in Suite 145 of Triangle Corporate Center residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER ❑ TENANT Services or feeders installationialteratian,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP: 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
Entail: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.35 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 snips 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
111 APPLICANT El CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits with
Business name:Fire Protection Services, Inc. above service or feeder fee, 7.42 2
each branch circuit
Contact name:David Phipps B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address:9950 SW Arctic Dr. branch circuit
City/State/ZIP:Tigard,OR 97223 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( )503-590-3732 Fax::( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:Fire2112@ymail.com Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
Business name:Fire Protection Services, Inc. Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ® See Page 2 1 2
Address:9950 SW Arctic Dr. panel,alteration,or extension.
City/State/ZIP:Beaverton,OR 97005 Each additional inspection over allowable In any of the above
Additional inspection(I hr min) 66.25/hr
Phone:( )503-590-3732 Fax:( ) Investigation(I hr min) 90.00i hr
Email:Fire2112 mail.com j' Industrial plant(1hrmin) 78.18/hr
Qy 7/i j13 G(12t1 Inspections for which no fee is
CCB Lie.:154333 }hi in Electrical Li.: -488 S .tv.Lie.:LEA 4120
specifically listed(Si hr min) 90.00/hr
tl7(1 I}3 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ...lie,-sir Subtotal:
Print name:David Phipps Date:10/6/2020 ❑Plan Review Required(25%of permit fee):
1e/� � State surcharge(12%of permit fee):
Authorized signature: di/° TOTAL PERMIT FEE:
This permit application expires ifs permit is not obtained within 180
Print name:David Phipps Date:1016/2020 days after it has been accepted as complete.
' Number of inspections allowed per permit.
1:161uildiag'2m Permits PennitApp ELR_ERE.doc Bev 06/I72015 44646I5T(t1/05/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
Ihtx.riptiun 1 Qty. I Lath I Total I •
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: s kva orless 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
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
O Vacuum Systems* >100 kva-no additional charge 0.0 3
Each additional inspection over allowable in antof the above:
n Other: Each additional inepn.tion is 66.25/hr
charged at an hourly(I hr min)
Inspections for which no fee is 90 00/hr
specifically listed('ii hr mint
COMMERCIAL WORK ONLY: ELECTRICAL rExnnr FEES
Subtotal(Enter on Page I):
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
El Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
El 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
1:'BuildingPermurELC_PermgApp_ELR ERE.doe Rev 06/172015