Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• is • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00190
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/27/2012
Parcel: 1 S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE# 140
Project: Broad River Expansion Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Low voltage for fire alarm
Contractor: POINT MONITOR CORP Owner: PNWP LLC #2
7869 SW NIMBUS AVE PNWP LLC
BEAVERTON, OR 97008 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 08/27/2012 $75.00
12% State Surcharge - Electrical 08/27/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: Y
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N 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 copy of the rules or direct questions to OUNC by calling 503.232.1967 or 1.800.332.2344.
in
Issued By: `� K w 1 py 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.
Electrical Permit Application :, a X 1 1 FOR OFFICE USE ONLY
II City of Tigard Date /B ved : G Permit No.: 1 � � 00 ° 13125 SW Hall Blvd., Tigard, OI231 ¶¶ Received
4 2012 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date /B : Other Permit:
Inspection Line: 503.639A1717 7. TT: ) ;,‘,90 Date Ready /By: ® See Page 2 for
Internet: www.tigard or.gov t „ . . . , „, p Notified/Method: Supplemental Information
TYPE OF' WORK PLAN REVIEW
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ",' l -2 ", "I -3 ",
Job no.: Job site address: 11850 SW 67 Avenue I OOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223 Cl Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 140 Project name: Broad River Expansion ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Add/Relocate Fire Alarm notification in TI Space residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: Point Monitor Corporation B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Steve Bruns branch circuit
Each add'I branch circuit 7.42 2
Address: 7869 SW Nimbus Avenue Miscellaneous (service or feeder not included)
Each City/State/ZIP: Beaverton, OR 97008 dwelling, service and/or or r feeder 67.84 2
dwelling, service and/or feeder
Phone: (503) 627 - 0100 Fax: : (503) 627 - 0110 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: SBruns @PointMonitor.com Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Point Monitor Corporation panel, alteration, or extension. I Page 2 75 2
Each additional inspection over allowable in any of the above
Address: 7869 SW Nimbus Avenue Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Beaverton, OR 97008 Investigation (I hr min) 66.25/hr
Industrial plant (I hr min) 78.18/ hr
Phone: 503 627 -0100 Fax: (503) 627 -0110 Inspections for which no fee is
Phone: ( 503) ax: ( ) 90.00 / hr
specifically listed ('/2 hr min)
CCB Lic.: 135901 Electrical Lie.: - 508CL Suprv. Lic.: �433s2, ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: ' l (2Wf " s x Subtotal: 75
Plan review (25% of permit fee):
Print name: 6 , /1-16 Gi A Date: e f — /;,--/ - State surcharge (12% of permit fee): 9
TOTAL PERMIT FEE
Authorized signature: yg �
This permit application expires if a permit is not obtain withi
days after it has been accepted as complete. —
Print name: Date: • Number of inspections allowed per permit.
1:\ Building \ Permits \ELC- PcnnitApp.doc 07/01/10 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ 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
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
1: \Building \Permits \ELC- PermitApp.doc 07/01/10
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• is • COMMUNITY DEVELOPMENT Permit #: ELR2012 -00190
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/27/2012
Parcel: 1 S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE# 140
Project: Broad River Expansion Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Low voltage for fire alarm
Contractor: POINT MONITOR CORP Owner: PNWP LLC #2
7869 SW NIMBUS AVE PNWP LLC
BEAVERTON, OR 97008 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 08/27/2012 $75.00
12% State Surcharge - Electrical 08/27/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: Y
HVAC: N Instrumentation: N
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N 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 copy of the rules or direct questions to OUNC by calling 503.232.1967 or 1.800.332.2344.
in
Issued By: `� K w 1 py 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.