Permit (20) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
II I COMMUNITY DEVELOPMENT Permit#: ELR2016-00071
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2016
Parcel: 2S 10X602300
Jurisdiction: Tigard
Site address: 13240 SW PACIFIC HWY
Project: Westside Surgery Center/Eye Health NW Subdivision: FREWING'S ORCHARD TRACTS Lot: 8
Project Description: Low voltage for fire alarm
Contractor: AMERICAN SECURITY ALARMS, INC. Owner: INLINE PROPERTIES LLC
5411 SE MCLOUGHLIN BLVD 13200 SW PACIFIC HWY
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503-231-0303 PHONE:
FAX: 503-230-1044
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/12/2016 $75.00
12%State Surcharge-Electrical 04/12/2016 $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 co. . .- rules or direct questions to OUNC by calling 503.232.19 or 1.8 0.3 .2
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.
Electrical Permit AnnlicatioRECEIVE1l O K O l l I( 1 I ,l ()NI 1
Received !��D
City of Tigard Date/ : 0) 3 llo�, Permit No.: gf��
• 13125 SW Hall Blvd.,Tigard,OR 9722)0 0 2, Plan Review
. Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date/B
Inspection Line: 503.639.41751 : Date Ready/By: Juris: ® See Page 2 for
1 I l,A l:1> �q p t� �ilk � l Notified/Method: Supplemental Information
Internet: www.tigard-or.gov 1 1 y
TYPE OF 1 i�I5t R�i It PLAN REVIEW,
1:1 New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 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
❑ I-and 2-family dwelling KCommercial/industrial 0 Accessory building amps for all other installations. buildings.
0
❑Multi-family 0
Master builder 0 Other: Fire pump. 0 Installation of 75 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND<LOCATION 0 Addition of new motor load of ❑"A","E","1-2","1-3",
' s /O i+ n tilt),/ IOOHP or more. occupancy.
Job no.: n a Job site address: �/ 5z .i r C �Fi C' % ❑Six or more residential units.
0 Recreational vehicle parks.
City/State/ZIP: 7 7& —Kz 0 '7 LZ� 0 Health-care facilities. ❑Supply voltage for more than
,� �/ ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: vi/ 5/5 /J7� Ss' '' /Z-/ 0 Service or feeder 600 amps or more.
F /./ .Ai!7, /V/ FEE SCHEDULE
Cross street/directions to job site: -- `yC' -/ J^/ 14,/ Description I Qty. I Fee. I Total I .
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: 7 Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: 'Limited energy,residential
DESCRIPTION OF WORK ' (with above sq.ft.) 67.84 2
Limited energy,multi-family
e//A JG E (iAT ,/i /��rL/'S FQu1Proatif residential(with above sq.ft.) 67.84 2
,, Services or feeders installation,alteration,and/or relocation
/�
Ai D 1v /s- 4 36A/LD ' 200 amps or less 100.70 2
0 PROPERTY OWNER 0 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
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Branch circuits-new,alteration,or extension,per panel
Owner signature: Date: A.Fee for branch circuits with
® APPLICANT 0`CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B.Fee for branch circuits without
ArnPriCan Security OMJarms, Tne_ service or feeder fee,first
Contact name: ig/CN/ A /LLE�L
branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: 5411 SE McLouglin Blvd. Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
ty Portland. OR. 97202 dwelling,service and/or feeder 67.84 2
Phone:(503 )
231-0303 Fax: :(503 ) 230-1044 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: /Q/010 A5# 14/2_. '1'S. CO".1
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energyW
Business name: panel,alteration,or extension. + Page 2 75 2
American Security Alarms, Inc. Each additional inspection over allowable in any of the above
Address: 5411 SE MPLovglin Blvd Additional inspection(1 hr min) ' 66.25/hr
City/State/ZIP: Investigation(1 hr min) 66.25/hr
Portland. OR. 97202 Industrial plant(I hr min) 78.18/hr
Phone:( ) Fax:( ) Inspections for which no fee is
503 231-030 503 230-1044 specifically listed(1/2 hr min) 90.00/hr
CCBLie-•
58640 Electrical Lic.:26-283CL Suprv.Lic.: /21/1-454 ELECTRICAL'PERMIT FEES
',cuo
Suprv.Electrician signature,required: Subtotal: 7
/ Plan review(25%of permit fee):
Print name: C +C f G/1 H f C-�- t Date: 3 - Z 3 ' /{p State surcharge(12%of permit fee): ,�
d � �'_ — g y.
Authorized signature: vv dz'u TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: (7. ,,'C/.7 n/t_L. Date: .3is, it days after it has been accepted as complete. 1
Number of inspections allowed per permit.
I:1Building\Permits\ELC-PermitApp.doc 10/01/09 440-4615T(11/05/COM/WEB
Electrical Permit Application—City and
Pa of Tigard
Pap-2-=-17-Supplemental� pplementalInformation
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Fee for all reside r. Plt° 4
p rc*l f L Y 9 i
ntial systems ce1
combined... $75,00 Description f Qty. Fee Total
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
(
I Audio and Stereo Systems* 5.01 to 15 kva 133.56 2
15.01 to 25 kva 200.34 2
Burglar 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
( ( Heating, Ventilation and Air Conditioning OAR 918-309-0040) 552.26 2
System* Solar generation systems in excess of 25 kva:
Each additional kva over25 7.42 3
( I Vacuum Systems* >100 kva—no additional charge 0.0 3
( Each additional inspection over allowable in any of the above:
1 Other: Each additional inspection is
charged at an hourly(1 hr min) 66.25/hr
for
® Inspectionsall1 steel
�1i (which is 90.00/hr
s
peccifi �i'_re'�c5 �' gI
sn go 1
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 180
Audio and Stereo Systems days after it has been accepted as complete.
* Number of inspections allowed per permit.
I Boiler Controls
I ( Clock Systems
( I Data Telecommunication Installation
%Fire Alarm Installation
I HVAC
Instrumentation
( I Intercom and Paging Systems
n Landscape Irrigation Control*
( I Medical
(
I Nurse Calls
( ( Outdoor Landscape Lighting*
Protective Signaling
( ( Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13240 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
May 19, 2016 at 10:55:29 AM
ELR2016-00071
Herb Stabenow
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13240 SW PACIFIC HWY, TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2016-00071
Herb Stabenow
Violation Summary:
Inspector Contractor