Permit (30) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
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COMMUNITY DEVELOPMENT Permit#: ELR2017-00008
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/18/2017
Parcel: 1S136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE# 150
Project: American Family Insurance Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Phase 3-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 01/18/2017 $75.00
12%State Surcharge-Electrical 01/18/2017 $9.00
Type of Use:
Class of Work:
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 $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throu.gh OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue By: A ! /�� Permittee Signature �' •� 4,r);Gtr
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
' r4t 14 t`
Electrical Permit Applica L� ,"".�.. FOR OFFWE UST OvLv
City of Tigard ��AA�� Received MillPermit#: /
a 1, 1 0 /.ill 1
Date/13 : �� iar rI•
•" 11 13125 SW Hall Blvd.,Tigard,OR 97 Plan Review 00
Phone: 503.718.2439 Fax: 503.59$'.1460 Date.•B : Related Permit II:
- Inspection Line: 503.639.4175 • ,< Read DateB : .tugs:
Tlt;ARD' "g ; �n y y 0 Seement2for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
-, ' - - ITT .a:t f k,b•'1 k' _ OtViSithteliik., '411''1
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®New construction irl Addition/alteration/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:
11 where the available fault current 0 Marinas and boatyards.
4 L' ,,j1% CA t'so1K 1QF 0-#+ 1 1 6 i.. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling El Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
'. amps for all other installations. buildings.❑Multi-family 0 Master builder 0 Othero Fre pump. 0 installatio
n of 150 KVA or Z:';'-'1"'
m6» i g4 ' tW „,4tL0�' t 1;
❑Emergency system larger separately derived
Job#: Job site address:11850 SW 67th Ave. ❑Addition of new motor load of system,
100HP or more ❑"A""E""1-2""1-3
City/State/ZIP:Tigard,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#: Project name:American Family Insurance 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 601)amps or more 600 volts nominal
Cross street/directions to job site:
5T. 61*;. + i ilk., - . ' ..;
Description 1 Qty 1 Each Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy,residential
75.00 2
Notification devices (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Pa e 2
i�it. ;' = " Rt rER�` OiVNE ... - ., i* 'Ga-, t '9 R
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
Branch circuits—new,alteration,or extension, erpanel
i
L ,., .. ,),..= I l° t 0 A -I ' , A.Fee for branch circuits with p p
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
Address:5863 Lakeview Blvd.Suite 100 service or feeder fee,first 56.18 2
branch circuit
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
dwelling, ice and/or feeder 67.84 2
service
Email:bwilliams®pointmonitor.com _
Reconnect only 67.84 2
,ire, i ;9166 16O `CTOR wpb �ii ; 9r
�r� . iViF;. a�ii,��: 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 Signal circuit(s)or limited-energy ® See Page 2 1 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
Email:bwilliams®pointmonitor.com Industrial plant(i hr min) 78.18/hr
Inspections for which no fee is
CCB Lie.: 135901 Electrical Lie.: 34508CLE Suprv.Lie.: 4460LEA specifically listed(%hr min) 90.00/hr
a,,,,_ 'g, EI E( li;iCU,PERMIT FEES 1-11L.:' GIW1
Suprv.Electrician signature,required: Subtotal: 75.00
Print name: Ben Breit I Date: 1/10/17 0 Plan Review Required,(25%of permit fee):
v State surcharge(12%of permit fee): 9.00
Authorized signature: TOTAL PERMIT FEE: 84.00
This permit application expires if a permit b not obtained within 180
Print name: Ben Breit Date: 1/10/17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1.Building'Permits•.ELC_PennitApp_ELR_ERE.doc Rev 06'17'2015 440-4615T(1141$/COM WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Fee for all residential systems combined: $75.00 Description I Qty. 1 Each Total I
Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to 15 kva 13356 2
EI 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
with OAR 918-309-0040) 552.26 2
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
Each EI Other:
charged atanhourlonal inspection min 6625/hr 1
s yhr� )
Inspections for which no fee is
s.-ifically listed(''/s hr min
90.00/hr
Fee for each commercial system: $75,00 Subtotal(Enter on Page 1):
(SEE OAR 918-309-0000) • Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
® Fire Alarm Installation
C HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
EI Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
I:"_Building,Pennita ELC_PermitApp ELR ERE.doc Rev 06.,1";2015