Permit (208) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELR2016 00274
T GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/12/2016
Parcel: 1 S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE# 150
Project: American Family Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Low voltage for fire alarm
Contractor: POINT MONITOR CORPORATION Owner: PNWP LLC#2
5863 LAKEVIEW BLVD STE 100 PNWP LLC
LAKE OSWEGO, OR 97035 6600 SW 105TH AVE#175
BEAVERTON, OR 97008
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/09/2016 $75.00
12%State Surcharge-Electrical 12/09/2016 $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 .. of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: j �,f. _ _...r."" 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' 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.
DElectrical Permit Applic" _ FOR OFFICE [SE(t1 LY
City of Tigard Received �tY" IPIM
DateB . 1? % Permit#: e4.42_9(5/4a'150 27
't 13125 SW Hall Blvd.,Tigard,OR 972;3"� • 0 n I l Plan Review
: C Phone: 503.718.2439 Fax: 503. 16t�) U Date/B : Related Permit#:
Inspection Line: 503.639.4175 ,, . Ready Date-By: Pori,: ® See Page 2 for
TI(.i A R D Internet: www.ti and or. ov ITV Notified/Method:
g T1'P �.�S I� yt RI) Supplemental Information
1• pIVISI ON PLAN REVIEW
®New construction ®Addit ton/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 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
less to ground.or exceeds 14.000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®CommerciaUindustrial 0 Accessory building 8
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other:
0 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:11850 SW 67th Ave. 100HP or more. ❑'A ^E", 1-z". 1-3'.
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:American Family Insurance 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 e
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 I
DESCRIPTION OF WORK Limited energy,residential 75.00 2
Notification devices (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
0.PROPERTY OWNER I ® TENANT Services or feeders installation,alteration,and/or relocation
Name:American Family Insurance 200 amps or less 100.70 2
Address:11850 SW 67th Ave. 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
oi
APPLICANT ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per 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 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
Address:5863 Lakeview Blvd.Suite 100 pinealairwito)or!extension, ® See Page 2 I 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
Industrial plant(1 hr min) 78.18/hr
Email:bwilliams@pointmonitor.com
Inspections for which no fee is 90,00/hr
CCB Lic.: 135901 Electrical Lic.: 34508CLE Suprv.Lie.: 4460LEA specifically listed(Y3 hr min)
�� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ Subtotal: 75.00
Print name: Ben Breit Date: 12/7/16 0 Plan Review Required(25%of permit fee):
I State surcharge(12%of permit fee): 9.00
Authorized signature:' TOTAL PERMIT FEE: 84.00
This permit application expires if a permit is not obtained within 180
Print name: Ben Breit Date: 12/7/16 days after it has been accepted as complete.
* Number of inspections allowed per permit,
I.Building Permits ELC_PermitApp_ELR_ERE.doc Rev 06-17 2015 440-4615T(I i 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
Description I Qty. ( Each i Total
Fee for all residential systems combined: $75.00 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:
❑ 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
❑ Vacuum Systems* 100 kva-no additional charge 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(%hr min) 90.00/hr
COMMERCIAL WORK ONLY: ELECTRICAL PERttfirr`FEES
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
1 Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
I.Building Permits ELCPermitApp_ELR_ERE.doc Rey 06 1"2015