Permit /
Electrical Permit A 1ppic.p. ARECEIVED FOR OFFICE. t SF ON IA'
City of Tigard Received 7 7�
,i� 2021 Detc By: �� r �� Permit#: E F--f/2/—�O6Z
13125 SW Hall Blvd.,Tigard,OR 97223 JAN 0 � Plan Review
Phone: 503.718.2439 Fax: 503.598.t 960 Date/By: Related Permit x:
1 IC R p Inspection Line: 503.639.4175 CITY OF TIGARD Ready Date/By: kris: 4] See Page 2 for
Internet: www,tigard-or.govUIL DING DIVISIONNotifie/Method;
Supplemental Information
TYPE OF WORK PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans v'items checked):
0 Demolition ❑OtheI: ❑Service or feeder 400 amps or more 0 Building over three stories.
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 ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder 0 Other: Cl Fire pump.P ❑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:15350 SW Sequoia Pkwy 100HP or more. ❑"A","E","l-z^,"I-3",
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-cam facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: 110; Project name:PCC241 0 Hazardous locations. ❑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 Qty. 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
(with above75.00 2
Fire Alarm Notification Devices sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0 PROPERTY OWNER ® TENANT Services or feeders installation alteration,and/or relocation
Name:PCC241 200 amps or less 100.70 2
Address: 15350 SW Sequoia Parkway Suite 110, 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97224 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
El APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,Qer 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.Fcc 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'l 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
CONTRACTOR 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. ® See Page 2 1 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
Email:bwilliams@pointmonitor,com Indusrialplant(I hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 135901 Electrical Lic.: 34508CLE Suprv.Lie.: 4460LEA specifically listed ehhr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required:
Subtotal:
Print name: Ben Breit Date: 1/7/2021 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature TOTAL PERMIT FEE: ,Pr
This permit application expires it a permit is not obtained within Igo
Print name: Ben Breit Date: 1/7/2021 days after it has been accepted as complete.
Number of inspections allowed per permit.
I.Building Pennin`ELC PermitApp_ELR_ERE.doc Rev 06 17,2015 440a615T(11 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
DesFee for all residential systems combined: $75.00 Qty. Each Total a
y Renewable electrical energy systems:
Check Type of Work Involved: 5 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:
n B• urglar Alarm 25.01 to 50 kva 301.04 2
n G• arage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
I Vacuum Systems* 7100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 6625!hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed(/hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
7 A• udio and Stereo Systems
n B• oiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
I.Building Permits ELC_PermitApp_ELR XRE doc Rev It.17.20i5