Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2021-00003
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1l11/2021
TIG±\kD g Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 140
Project: Mercury Development Subdivision: 1996-048 PARTITION PLAT Lot: 2
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 SW SEQUOIA PKWY#300
•
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/11/2021 $75.00
12%State Surcharge-Electrical 01/11/2021 $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. T .ermit 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 • • 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. Y. obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ��� Permittee Signature:
�J e
OWNER INSTALLATION ONLY
The installation is being m..-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 ApplicatioECE VED ,.0., („ ,rl(.l 1 4 (ivI 1.
CityofTigard Received 0)m2a/ a Cs z O o'3
g Datei: ✓/ � Permit tl:G L/CJ
N . 13125 SW Ha1I Blvd„Tigard,OR 97 O 7 2021 plan Review 0 Related Permit 06520U aCO a A'
• Phone: 503.7182439 Fax: 503.598,19.1960# fAWB
Inspection Line: 503.639,4175 Ready Date/By:
1 Ic,''\IC I) Internet www.ligard-or.gov . ITY OF TIGARD Notified/Method: EMI See Pentl I
Supplemental lnfn[ormaaan
TYPE of wgDING DIVISION PLAN REVIEW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit j,sets of plans whims checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ID Other: where the availabk fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISo volts or 0 Hosting buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Multi-family ❑Master builder amps for all other installations. buildings.
❑Other: ❑Fire Pump- 0 installation of 150 KVA or
. JO13 SITE INFORMATION AND LOtA`t'IDN ❑Fmpgen'Y system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:15350 SW Sequoia Pkwy _ 100HP or more ❑ A• „E"�1 2„�i 3„
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units, occupancy.
❑ticabh-cam facilities. ❑Recreational vehicle parks.
Suite/bldg./apt#:,., . I Project name:PCC241 0 Hazardous locations. 0 Supply voltage for more than
— 0 Service or feeder 600 amps err more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE
Description I Ole. I Each I Total I. e
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 aq.ft.or less 168.54 4
Ea.add'l 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.0,)
❑ PROPERTY OWNER ® TENANT Renewable Energy 0 See Page 2
Services or feeders inatallationr alteration,and/or relocation
Name:PCC241 200 amps or less 100.70 2
Address: 15350 SW Sequoia Parkway Suite- 140 201 amps to 400 amps 133.56 2
City/State/ZEP:Tigard,OR 97224 401 amps to 600 amps 200.34 2
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
service or feeder fee,first Address:5863 Lakeview Blvd.Suite 100 branch circuit 56.18 2
City/State/ZIP:Lake Oswego,OR 97035 Earls 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:bwllliams@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
Address:5863 Lakeview Blvd.Suite 100 p panel, circuit(a)eronor limited-energye , ® See Page 2 1 2
alteration,or extension. 8
City/State/ZIP:Lake Oswego,OR 97035 Each additional Inspection aver allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503)627-0100 Fax:( ) Investigation(1 brmin) 90.00/hr
Email:bwilllams@pointmonitor.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 135901 Electrical Lic.: 34508CLE Suprv.Lic,: 4460LEA specifically listed CA hr 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): `l
Authorized signature \ \ > TOTAL PERMIT FEE: 7
This permit application expires If a permit Is not obtained within 180
Print name: Ben Breit Date: 1/7/2021 days after it has been accepted as complete.
Number of inspections allowed per permit.
1'Buitdioy Permits\ELC_PnrmirApp_ELR_ERE.doc err:Of 172015 440-4615T(1 IPo5/COM,:NEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 Description Ian I r•es 1 Thal i •
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or lei 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 55226 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309.0040)
E Heating,Ventilation and Air Conditioning Solar eneration
System* g systems in excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >tookva-noadditionalcharge 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 fee is
specifically listed VAhr min) 90.00!hr
Co
1fO '�+' C9.10.Y: �-. CfRIt:AI. PFdt11iIT,FEES.'.
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
•
(SEE OAR 918-309-0000) Namt erofinspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
[1 Clock Systems
❑ Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
1'd3uildinelPermits\ELC PmnilApp FLR ERE.dor Re,e5/172015