Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
F'! m COMMUNITY DEVELOPMENT Permit#: ELR2013 00196
-r JCARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/08/2013
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16165 SW 72ND AVE
Project: CCK Restaurants LLC Subdivision:COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Data telecommunications and security systems.
Contractor: POINT MONITOR CORP Owner: PACIFIC REALTY ASSOCIATES LP
5863 LAKEVIEW BLVD SUITE 100 ATTN: N PIVEN
LAKE OSWEGO,OR 97035 15350 SE SEQUOIA PKWY#300
PORTLAND,OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/08/2013 $150.00\
12%State Surcharge-Electrical 08/08/2013 $18.00
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: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 1 Other: 0 Total $168.00
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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
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' 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.
08/07/2013 13:26 5036270110 POINT MONITOR CORPOR PAGE 02
Electrical Permit Applicatio . 4
1• )R 01.1.1t 1: IL `,1-. 0\1 1
City of Tigard
..--- 13125 SW Hall Blvd..Tigard,0'',,' '''''''.
p„,,
Phone: 503.7182439 Fax: 503.'r.'87.196 \§.1,
4 ' ..k3 A 15\''' , Received ,
:tem/ EIMIllififir
,O.v., Plan Review Other Permit: i /4.0/3 -voiq
Inspection Line: 503.639.4175 el See Page 2 for
,. ',1:i, 6‘c,,Af3\- iTtt7r.R.1,1,-.4
Internet: www.tigard-or.gov o e : lani Supplemental Information
}-•'0'. ,Crar7.7.77, --,).,;.11'7.i7',,, 7,oesvi-, ':lt "44ktqc4At.i,), h., I)•4',Iir. .r..rf%..11113"ri'c;,+.'t3.1111gialialfiWK:NtV"1,1,1r,,T .--..1.f
0111,i-cv,-(-1.1.4t,:i0,44.K411404&1044Pini4,9*,..,.-v T''.,in"t V''',4^"'•■ ,t''''','-.. ..ir, 4," e0,:, ■-•,' ' .2, A-1,, k . * 14; 4101.1%1;i:415F • t 4, . .1.42,..• ":" k",ail-'b.,wvillakil 1
0 New construction Additiort/alteratio
Please check all that apply(submit 2 sets of plans wittems checked below):
IS3 9-\•i acement
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other where the available fault cunrent 0 Marinas and boatyards,
`I''''."!'.".':..f. 1!,7'.4 •',P'...',■‘;'.7 V777,77,77.:777775,77Far,5ggigR.F,14yiWP ". exceeds 10000 amps a l l 50 volts or 0 Floating buildings
.2..ai ..i)':,,,,,i Z.,',.-f,a7&,-:.,,,li;:■;; ;...1,',.■34,,;2,',,,!,,,, ,,,,,,, "0.1 .ki,V,,Wr:M,..,,,s...,:l'Ilif.:;:-MA,St'in;2 ‘.;V0',5 less to ground,or exceeds 14,000 LI Commercial-use agricultural
CI 1-and 2-family dwelling El Commercial/industrial 0 Accessory building amps for all other installations. buildings.
El Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 installation of 150 KVA or
i.7..,r;;a1[7.771',74..! 7777.11'n i'■97745,'''471.:T !1:INNFRY14" =7;' 0 EmergencY°Item. larger separately derived system.
..,.hi',:;,,e..."4;-,,.,4,i I'J,,,, •061 , .' '-'.'•t.,-4' It.,.'43• '14-4 i':..:. '4,',41".•"■;...,4,-, ,4' 1.•,, CI Addition of new=AID load Of 0-A-,-E",-1.2-,"1.3-,
.
Job no.: Job site acklress: 16165 SW 72nd Ave 100HP or more
0 Six or more residential uni occupancy.
ts. 0 Recreational vehicle parks.
City/State/ZIP: Portland,OR 97224 0 Health-care facilities. 0 Supply voltage*r more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:CCK Restaurants 0 Service or fkeder 600 amps or more.
ru, , ,,q, air),:i 01.'.'4,• ,,74)Z.7.77•777:71:177T
,...' .' '■.•::, ',....'---' ...:,., ,,..... .,..,...,.........g..iwp.s.
Cross street/directions to job site:SW Upper Boone'Ferry Rd Description oiy. Fee. Tom •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft_or less 168.54 4
Ea.addl 500 sq.ft,or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
1 ?&"-:411.21':."..41111.41:1:-Mar'71:7747171=M117,32DREEREWEIRK51;1, I ill above ''R. 75.00 2
Limited energy,multi-family
Teledata and Security installation residential(with above sq.IL) 75.00 F
- Renewable Energy CI See Page 2
Services or feeders installation,alteradon,and/or relocation
I. '.■11.7!;‘'.1:'1 77'77,.77..,,.,P77,7"177,WITAlliM,31114,74717A77717,7777,74m7,474,7,7 7,-; 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2,
Address: 601 amps to 1,000 amps 301.04 2
- Over 1,000 amps or volts 552.26 2
City/State/ZIP:
Temporary services or feeders installation,alteration,and/or
Phone:( ) I Fax'( ) relocation
200 amps or less 59,36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. .
401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
•;,i„:•,...:.;.:.:1-.i . ..,., L I., ,!. A.Fee for branch circuits with
• ,...-zo,',...o.,,,--”eoniv A 413:qa..mrxnteuovaorr3wanwr,...-,..;:4,.r.,),.,.:,,,,s,A-20.,,,,,,,,,,m.,,,tn.,,..,,,,,,L..,.. above service or feeder fee,
Business name:Point Monitor Corporation each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name:Ben Breit service or keder fee,first
56.18 2
branch circuit
Address:5863 Lakeview Blvd,#100 Each add'l branch circuit 7.42 12
Miscellaneous(service or feeder not included)
City/State/ZIP:Lake Osvvego,OR 97035
Each manufactured or modular
Phone: (503)627-0100 Fax: :(503)627-0110 dwelling,service and/or feed 67.84 2
• er ,
Reconnect only 67. 4 2
E-mail:benbreit@pointmonitor.com Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Business name:Same as above Signal circuit(s)or limited-energy
2 Sec
15000
panel,alteration,or extension. Page 2 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:
investigation(1 hr min) _ 66.25/hr
Phone:( ) I Fax:( ) ,./..cAddustrial plant(1 hr min) 78.18/hr _
-
Inspections for which no fee is -
CCB Lic.: 135901 6/34/ikEiectrical Lic.:3Y-atCaSuprv.Lic.: cp466 LA specifically listed min) 90.00/in
,,,---"-') ' • .' . •.41,S00111r444 ll140$61:414/* ; i, •. , '
Suprv.Electrician signature,required; .- . , '• Subtotal: 150.00 .
Print name: Ben Breit Date: 8/7113 , Plan review(25%of permit fee):
State surcharge(12%of permit fee): 18.00
Authorized signaturer ---, r
TOTAL PERMIT FEE: 168.00
signature! : ...... ,
. ....--- Thin permit application eapirea if a permit is not obtained within 180
Print name: Ben Breit Date: 8/7/13 days after It has been accepted as complete.
4 Number of inspections allowed per permit.
PktioliOsnaTermits\ELC_PermitApp.ELREREdoc Rev 05/21/2013 440-46151111/05/COMAVED
08/07/2013 13:26 5036270110 POINT MONITOR CORPOR PAGE 03
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
t,!,t C,V,L.1.,r Mt� i k ,y It Magi 44 1 r I
OEW l4 4444N _
F
Fee for AI residential systems combined ... $75.00 Description Fee Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
D Audio and Stereo Systems* 1 5.01 to 25 kva 200.34 2
El Alarm
Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
OAR 91&309.0040)
❑ Heating,Ventilation and Air Conditioning -
System* Solar generation systems in excess of 25 kva:
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:
111
Other: Each additional inspection is 66.25/hr 1
charged at an hourly(I hr min)
Inspections for which no fee is 9000/hr
ifically listed
%a hr m,'
�
ou� i� ,Pl ""
e.t„ a nLrr rwd..ut .,no.u..o i,rxr:1•'1[.a.t*n��. •
Fee for each commercial system $75.00 - Subtotal:
(SEE OAR 918-309-0000) Plan review.if required(25%of permit fee);
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE;
This permit application expires if a permit is not obtained within ISO
❑ Audio and Stereo Systems days after it bas been accepted at complete.
s Number Of inspections allowed per permit.
❑ 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 Security
Total number of commercial systems: 2
*No licenses are required. Licenses are required
for all other installations
1:\auilGtngWermh5\ELC_PermtAOD_eLti,EREAoc Rev 0321,2013