Permit (190) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT
Permit#: ELR2016-00260
13125 SW Hall Blvd.,Ti Date Issued: 11/16/2016
TES� and OR 97223 503.718.2439R.T9 9
Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 320
Project: Allstate Insurance Company Subdivision: None Lot: None
Project Description: Low voltage for fire alarm
Contractor: POINT MONITOR CORPORATION Owner: PORTLAND SW CENTER LLC
5863 LAKEVIEW BLVD STE 100 BY FELTON PROPERTIES INC
LAKE OSWEGO,OR 97035 ATTN: FELTON,MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 11/16/2016 $75.00
Type of Use: COM 12%State Surcharge-Electrical 11/16/2016 $9.00
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. ATTE Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through O 952-001- . You may obtain a copy of the rules or direct questions to OUNC ng S0 .- 1987 or 1.800.332.2344.
1
Iss d By: Permittee Signatule• /° /L
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 503.839.4175 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 FOR OFFICE'.USE ONLY
74 City ofTigardeceived
g NOVN( U ¢ 2Q16 / , Pear" E42�/G-cos(0o
a 13125 SW Hall Blvd.,Tigard,O 97 23 Plan Review a
C Phone: 503.718.2439 puy. 598v110/ Datc/B: Related Permit q:c�,�p/lp-e1Of 7d
Inspection lane: 503.63 a jl�*,'A;RaJ Ready Date/By: Niro HSee Page 2for
1l4Aht> Internet www.tiga 7r rr/r e12I Notified/Method: Supplemental Information
141 i WOI 1IY SI1_7_' PLAN REVIEW
121 New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w'items chocked):
❑Demolition Otho ❑Service or feeder 400 amps or more 0 Building over three stories.
where file available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
-
0 1 and 2-family dwelling Qa Commercial/industrial 0 Accessory building less to groans,or exceeds t 4,000 0 Commercial-sae agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump.
0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived
0 Addition of new motor load of system.
Job#: Job site address:7632 SW Durham Rd. 10011P or more. 0"A","E","1-2","1-3",
City/State/ZIP:TIgard,OR 97224 ❑Six or more residential units, occupancy.
❑Health-caro facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:3rd Floo Project name:Allstate Insurance ❑Hazardous locations. 0 Supply voltage for more than
- 0 Service or feeder 600 amps or more. 600 volts nominal. I
Cross street/directions to job site: FEE SCHEDULE
Desolation I4ty. I EWA I Total L.
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'l 500y, ft.or portion 33.92 1
Limited
DESCRIPTION OF WORK 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 ❑ See Page 2_
CI PROPERTY OWNER ® TENANT Services or feeders installationtlteration,and/or relocation.
Name:Allstate Insurance 200 amps or less 100,70 2
Address:7632 SW Durham Rd.3r1 Floor 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 30L04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner Installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
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
''t APPLICANT I El 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,
each branch circuit 7.42 2
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')branch circuit 7,42_ 2
Miscellaneous(service or feeder not included)
Phone:(503)627-0100 Fax::( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
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 panel,gnal lter circuit(s)orlixtensienergy ® See Page 2 I 2
panel,alteration,of extension.
City/State/ZIP:Lake Oswego,OR 97035 Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
Phone:(503)627-0100 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:bwilliams@pointmonitor,com industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90,00/hr
CCB Lie.: 135901 Electrical Lie.: 3450&CLE Suprv.Lie.: 4460LEA specifically Bated('A hr min)
ELECTRICAL PERMIT FEES 1
Suprv.Electrician signature,required: Subtotal: 75.00
Print name: Ben Breit Date: 11/14/16 0 Plan.Review Required(25%of permit fee):
- 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: 11/14/16 days after It has been accepted as complete.
* Number of inspections allowed per permit,
1.BaildtnaU'amitmELC PamitApp_ELR_ERE.doc Rev 06 172015 440-46t57't1105'CoAVwEn
Electrical Permit Application--City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
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* 1547 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 500 kva 552.26 2
>100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
0 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—io additional charge 0.0 3
Each additional Inspection over allowable in an of the above:
❑ Other: Each additional inspection is 66.25/hr
charged at an hourly(I hr min)
Inspections for which no Pee is
specifically listed(Vs hr min) 90.00/hr
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enteron page 1): [
" Number of inspections allowed per permit
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
O Boiler Controls
O Clock Systems
O Data Telecommunication Installation
® Fire Alarm Installation
O HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
O Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: I
*No licenses are required. Licenses are required for all
other installations
-1.8uildina\PermkaF_LC_PetmitApp_ELR ERE.doc Rev 06/17:2015