Permit (123) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 '> COMMUNITY DEVELOPMENT Permit#: ELR2017-00043
13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 03/07/2017
T[GA RDg Parcel: 25101 BD00100
Jurisdiction: Tigard
Site address: 7650 SW BEVELAND RD 200
Project: Women's Healthcare Associates Subdivision: None Lot: None
Project Description: Fire alarm system.
Contractor: POINT MONITOR CORPORATION Owner: PNWP LLC
5863 LAKEVIEW BLVD STE 100 MILDREN,WALTEN E JR
LAKE OSWEGO, OR 97035 KRIZ, THOMAS J ET AL
6600 SW 105TH AVE STE 175
PORTLAND, OR 97008
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/07/2017 $75.00
12%State Surcharge-Electrical 03/07/2017 $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 cop ofihe..rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
r,
Issued By: ,r?•t....e2—, Permittee Signature: / �..0% _ _,/I
e
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 Applicat t 11 Th, R FOR OFFICU USE Otii.\
'I
City of Tigard Received
Date B : 11� Penult 4: 1 ;
IIII u 13125 SW Hall Blvd.,Tigard,OR r,, .. i f'
_ t� Plan Review
Phone: 503.718.2439 Fax 503.598-1960 Date/B : Related Permit 4: All, /7 V )
Inspection Line: 503.639.417 t R D Ready Date/By: Fa age
I I G A Internet: www.tigand-or.gov . ro 3 Notified/Method: 111
§1 Supplemental forlnformation
D,i V;Q't llk PLAN REVIEW
New construction ®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.
0 Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEi:OR1( OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®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 Other: ❑Fire pump. 0 Installation of 150 KVA or
TOB S1T,E INFORMATtOJ AND LOCATION. ❑Emergency system. larger separately derived
Job#: I Job site address:7650 SE Beveland Rd. ❑Addition of new motor load of system.
100HP or more. ❑"A""E""1-2""1-3'
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Le I Project name:Women's Healthcare Assoc. 0 Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: FEE SCHEDULE`
Description I Qty. I Each I Total J
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
...x -r._ . s% TO tO WOR r ,M,.`' „ .',,,,,i."...7„. Limited energy,residential
Notification Devices (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy ❑ See Page 2
0)10YTii3 0�? VER ';:'1;i:,-
1"' TENANT' Services or feeders installationzalteration,and/or relocation
Name:Women's Healthcare Associates Touch Down Rooms 200 amps or less 100.70 2
Address:7650 SW Beveland Rd. 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( ) I 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 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
°':0$4,00,,, .,, ,77,7„,- .j `` ..4 CONTA T,PERSON: , Branch circuits-c 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
'branch circuit - )0.18 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@a pointmonitor com Reconnect only 67.84 2
CO ' !CIOR 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
panel,alteration,or extension. ® See Page 2 1 2
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:bwilliamsCpointmonitor.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is
CCB Lic.: 135901 Electrical Lie.: 34508CLE Suprv.Lic.: 4460LEA specifically listed N hr min) 90.00!hr
I ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 75.00
Print name: Ben Breit Date: 3/ /17 0 Plan Review Required(25%of pemtit fee):
t State surcharge(12%of pennit fee): 9.00
Authorized signature: ..P"-1._____4 (--- TOTAL PERMIT FEE: 84.00
�i 1 This permit application expires if a permit is not obtained within 180
Print name: Ben Breit Date: 3/1/17 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I-Buildiug,Pamils•ELC PemitApp ELR_ERE.doc Rev 06'172015 440-4615T(11 05 COM'WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qtr. 1 Each I Total I •
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* 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
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* 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* >100k.a—noadditional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 66.25/hr ]
charged at an hourly(1 hr min)
Inspections for which no fee is 90,00/hr
s. ificall listed V2 hr min
CQMME RQT %WOE: N%Y `_ - ,
Fee for each commercial system: $75.00 Subtotal(Enter on Page I):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
Z Fire Alarm Installation
❑ avec- -
•
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ 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
I.Building Permits:ELC_PermitApp_ELR_ERE.doc Rev 06 17 2015