Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
; COMMUNITY DEVELOPMENT Permit#: ELR2020-00140
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/14/2021
T 11J A 12❑ g Parcel: 2S101AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY
Project: PacTrust Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25, PT
Project Description: Fire alarm.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO,OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/14/2021 $75.00
12%State Surcharge-Electrical 01/14/2021 $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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344..�1
Issued By: 11�Uct.n.1e-w e _. Permittee Signature: (]Y\ G?pit C l \b
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 Applicatlblt" ED FOR OFFICE USE ONLY
CI o Tigard 2 1 ZOLO Received
-J f g DEC Date/B : AO:CM Permit#: y=`ali..,—On
fIO
/l, 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review J/
• Phone: 503.718.2439 Fax: 503.598.0e OF TIGARD Davy. /Y 1 I Related Permit it: F�369206—an 33
I I C;A R D Inspection Line: 503.639.4175 BUILDING��� Ready Date/By: runs. El See Page 2 for
Internet: www.tigardor.govNotified/Method: ///ty/A/ # .(y Supplemental Information
TYPE OF WORK gt lrs--a4 J t./ gry{a,lt t/ PLAN REVIEW
0 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked)
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 21-anddwellingCommercial/industrial less to ground,or exceeds 14,000 0 Commercial-use agricultural
-family ® El building amps for all other installations. buildings.
❑Multi-family 0 Master builder ❑Other: ['Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 12909 SW 68th Parkway 100HP or more. ❑"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:082 Project name:PPC082 ❑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 I QD. 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.add'I 500 sq.ft or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
Fire Alarm Notification Devices (with above sq.ft.)
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:PPC082 200 amps or less 100.70 2
Address: 12909 SW 68th Parkway#082 201 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 I
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
a..';N Cfa - Branch circuits—new,alteration,or extension,per panel
T .--''''' , - 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
Address:5863 Lakeview Blvd.Suite 100 service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP:Lake Oswego,OR 97035 Each add'l branch circuit 7.42 2
Phone:(503)627-0100 Fax: : Miscellaneous(service or feeder not included)
( ) Each manufactured or modular
Email:bwilliams@pointmonitor-corn dwelling,service and/or feeder67.Sa 2
Reconnect only 67.84 2
CONTRACTOR 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 Signal circuit(s)or extension. El 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(I hr min) 78.181 hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 135901 Electrical Lic.: 34508CLE Suprv.Lic.: 4460LEA specifically listed(Vs hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 7
Print name: Ben Breit Date: 12/17/2020 0 Plan Review Required(25%of permit fee):
` State surcharge(12%of permit fee): if
AA-
J TOTAL PERMIT FEE: fsi'
Authorized signatu 111---��� v i.
This permit application expires if a permit is not obtained within 180
Print name: Ben Breit Date: 12/17/2020 days after it has been accepted as complete.
• Number of inspections allowed per permit.
IdBuilding\Permits\ELC_PermitApp_EIR__ERE doe Rev 06/17,2015 440-4615T(11/05/COM'wEB