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Permit (3) II o CITY OF TIGARD s IOZ, n ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit#: ELC2023-00400 T[G A IID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/29/2023 Parcel: 2S 111 AA02400 Jurisdiction: Tigard Site address: 14385 SW 86TH AVE Project: Robbins Subdivision: GREENSWARD PARK Lot: 14 Project Description: Reconnect only. Contractor: OWNER Owner: SCOTT ROBBINS 17420 SW 110TH AVE TUALATIN, OR 97062 PHONE: 503-969-1233 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 06/28/2023 $67.84 Specifics: 1 ea 12%State Surcharge- 06/28/2023 $8.14 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 Required Items and Reports(Conditions) This permit is issued subject to the regulations containe d g in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance wit p roved 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: re law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 throuoh A -001-0090. Yc obtain a coos/of the rules or direct auestions to OUNC by calling 50�\\}}32.1987 or 1.809.332.234`4,,, Issued By: _� .� Permittee Signature: �Itt 6/11 /1 /Z 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'N 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. rt CITY OF TIGARD ELECTRICAL PERMIT "1 COMMUNITY DEVELOPMENT Permit#: ELC2023-00400 Date Issued: TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111AA02400 Jurisdiction: Tigard Site address: 14385 SW 86TH AVE Project: Robbins Subdivision: GREENSWARD PARK Lot: 14 Project Description: Reconnect only. Contractor: Owner: SCOTT ROBBINS 17420 SW 110TH AVE TUALATIN,OR 97062 PHONE: 503-969-1233 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 06/28/2023 $67.84 Specifics: 1 ea 12%Stale Surcharge- 06/28/2023 $8.14 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total S75.98 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 =.•proved plans. This permit will expire if work is not started within 180 days of ' uance, or if work is suspended for more the 180 days. ATTENTION: • •••• law requires you to follow the rules adopted by the Oregon Utility Notificati Center. Those/rules are forth in OAR 952-001-0010 through• - • r 0011-00 YY9imay obtain a coov of the rules or direct questions to OUNC by callina 503.23 987 or 1.88a7riLL2344. Issued By: // Permittee Signature: ////// 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'N 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. RECEIVE Property Owner Statement JUN 2 8 2023 Regarding Construction Responsibilities- Oregon Law requires residential construction permit applicants who are no licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. CO1 t K bi N J Pr ame of Permit Applicant C,126A- z3._ Signature of Permit Applicant Date Permit it LC1011. 60466 Address: l43%S tt' Issued by: f"' Date: (4 kit 114 Z (11 • This Copy for Permit Offices 1:1 Information Notice to Owners About L` „� rvI Construction Responsibilities lYj. '. O 114c (ORS 701.325 (3)) l=i Homeowners acting as their own general contractors to construct a new home or make a substantial improvement to an existing structure, can prevent many problems by being aware of the following responsibilities: • Homeowners who use labor provided by workers not licensed by the Construction Contractors Board, may be considered an employer, and the workers who provide the labor may be considered employees. As an employer, you must comply with the following: • Oregon's Withholding Tax Law: Employers must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. • Unemployment Insurance Tax: Employers are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. • Oregon's Business Identification Number(BIN): is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or go to htt1://www.oregon.gov/DOR/BUS/does/211-055.pdf for the appropriate forms. • Workers Compensation Insurance: Employers are subject to the Oregon Workers Compensation Law, and must obtain Workers Compensation Insurance for their employees. If you fail to obtain Workers Compensation Insurance, you could be subject to penalties and be liable for all claim costs if one of your workers is injured on the job. For more information, call the Workers Compensation Division at the Department of Consumer and Business Services at 503-947-7815. • Tax Withholding: Employers must withhold Social Security Tax and Federal Income Tax from employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax. For a Federal EIN number, call the IRS at 1-800-829-4933 or visit their website at www.irs.aov. Other Responsibilities of Homeowners: • Code Compliance:As the permit holder for a construction project, the homeowner is responsible for notifying building officials at the appropriate times, so that the required inspections can be performed. Homeowners are also responsible for resolving any failure to meet code requirements that may be found through inspections. • Property Damage and Liability Insurance: Homeowners acting as their own contractors should contact their insurance agent to ensure adequate insurance coverage for accidents and omissions, such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be redone. Liability Insurance must be sufficient to cover injuries to persons on the job site who are not otherwise covered as employees by Workers Compensation Insurance. • Expertise: Homeowners should make sure they have the skills to act as their own general contractor, and the expertise required to coordinate the work of both rough-in and finish trades. CONSTRUCTION CONTRACTORS BOARD PO Box 14140, Salem, OR 97309-5052 Telephone: 503-378-4621 —Fax: 503-373-2007 Website Address:www.oregon.00v/ccb f/property_owner adopted 9-23-08 This Copy for Permit Applicant A' • SYSTEM RECORD OF COMPLETION This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to mods this Jorm as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets, data, or calculations as necessary to provide a complete record. Form Completion Date: 6-27-23 Supplemental Pages Attached: 0 1. PROPERTY INFORMATION Name of property: ECI,Expansion @ Tigard Triangle Park Ill Address: 13221 SW 68tb Parkway Description of property: Mid rise commercial 5 story Name of property representative: Chris Wright,Walen Construction Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: Point Monitor Address: 5863 Lakeview Blvd Phone: 503.627.0100 Fax: E-mail: Service organization: Unchanged Address: Phone: Fax: E-mail: Testing organization: Point Monitor Address: 5863 Lakeview Blvd Phone: 503.627.0100 Fax: E-mail: Effective date for test and inspection contract: Unknown Monitoring organization: Unchanged Address: Phone: Fax: E-mail: Account number: Unchanged Phone line I: Phone line 2: Means of transmission: Cellular Entity to which alarms are retransmitted: Unchanged Phone: Unchanged 3. DOCUMENTATION On-site location of the required record documents and site-specific software: Aboce FACP 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ❑New system E Modification to existing system Permit number: FPS2023-00074 NFPA 72 edition: 2019 4.1 Control Unit Manufacturer: EST Model number: 1 4.2 Software and Firmware Firmware revision number: Unchanged 4.3 Alarm Verification E This system does not incorporate alarm verification. Number of devices subject to alarm verification: 0 Alarm verification set for 0 seconds Copyright©2012 National Fee Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. ct�, • 1! SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120 VAC Control panel amps: 4 Overcurrent protection: Type: Breaker Amps: 20 Branch circuit disconnecting means location: Number: 5.1.2 Secondary Power Type of secondary power: Batteries Location,if remote from the plant: Calculated capacity of secondary power to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 15 5.2 Control Unit ® This system does not have power extender panels ❑ Power extender panels are listed on supplementary sheet A 6. CIRCUITS AND PATHWAYS Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line Device Power Initiating Device 1 B 0 Notification Appliance 1 B 0 Other(specify): • 7. REMOTE ANNUNCIATORS Type Location None 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations Smoke Detectors 2 Addressable Alarm Photo Duct Smoke Detectors Heat Detectors Gas Detectors Waterfiow Switches Tamper Switches Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. Ofi 01- SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible 1 Strobe Combination Audible and Visible 4 Horn Strobe 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices HVAC Shutdown Fire/Smoke Dampens Door Unlocking Elevator Recall Elevator Shunt Trip 11. INTERCONNECTED SYSTEMS ® This system does not have interconnected systems. ❑ Interconnected systems are listed on supplementary sheet 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This system as specified herein has been installed according to all NFPA standards cited herein. Signed: Printed name: Brian Downey Date: 6-28-23 Organization: Point Monitor Title: Tech Phone: 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Brian Downey Date: 6-28-23 Organization: Point Monitor Title: Tech Phone: 12.3 Acceptance Te st est Date and time of acceptance test: 6-28-23 Installing contractor representative: Brian Downey Testing contractor representative: Brian Downey Property representative: Chris Wright,Walen Construction AHJ representative: Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution.