Permit (46) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT1 pi
Permit#: ELR2017-00206
Date Issued: 09/28/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 28/201 3200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 290
Project: Thenell Subdivision: WEST PORTLAND HEIGHTS Lot: 9-25,PT
Project Description: Fire alarm installation.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 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 09/28/2017 $75.00
12%State Surcharge-Electrical 09/28/2017 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
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 throug 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 : tf 411.1 ,
-Inv"/ - Permittee Signature: ./1/ '9/' L"/L' T7 t7 `-'
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 Applicatio - -4r-,,,
.( 4iE ' FOR 01 U ICI 1 SE ONL1
City of Tigard Received y/ r/ �(j, Permit p'�`1`
a 13125 SW Hall Blvd.,Tigard,OR 97223 S F F 2 p 2017 Plan Revrev// 7 $7� /�
��j �` �,
III = Phone: 503.718.2439 Fax: 503.598.1960 Date By: Related Permit _$ ,LO/7 tt9/y7
Inspection Line: 503.639.4175 CITY
`{ fo' d i' Ready Date/By: �7 arts. BI See Page 2 for
T I Ci t\R 1) �P V F�'i ) t l`Y 't' Notified/MethodY/ /// Supplemental Information
Internet: www.tigard-or.gov 11 !! ;�y511, 3 f, e-e ��b!�p fer �1 /�
3J�Lt.J7i'll F Uitf'ISiL 1 Gi'� /L_, .61P&
TYPE OF WORK REVIEW
®New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w'items checked):
❑Service or feeder 400 amps or more 0 Building over three stories.
❑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.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑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: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:12909 SW 68th Parkway 100HP or more. ❑"A", 'E `t-2 "1-3".
City/State/ZIP:Portland,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:290 Project name:Thenell Law Group 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 Qtr. 1 Each I Total I
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 16834 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESC'.t>;1FTION'OrI/MORK Limited energy,residential
75.00 2
(with above sq.ft.)
Fire Alarm Notification Devices Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
TENANTRenewable Energy El Sec Page 2
0 PROPERTY OWNER
El '' Services or feeders installationtalteration,and/or relocation
Name:Tbenell Law Group 200 amps or less 100.70 2
Address:12909 SW 68th Parkway#209 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Portland,OR 97223 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 l
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 c — teration,
0 APPLICANT I ' a.CONTACT PERSON AFce for branchircuits circuitsnew alit
wh or extension,per panel
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 rce or feeder fee,first
braannch circuit 56.18 2
b
City/State/Z1P:Lake Oswego,OR 97035 Each add'1 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
Signal circuit(s)or limited-energy ® See Page 2 1 2
Address:5863 Lakeview Blvd.Suite 100 panel,alteration,or 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(l hr min) 78.181 hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 135901 Electrical Lie.: 34508CLE Suprv.Lic.: 4460LEA specifically listed el.hrmin)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ''—` , -z _ Subtotal: 75.00
Print name: Ben Breit Date: 9/26/17 0 Plan Review Required(25%of permit fee):
State surcharge(12%of pennit 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: 9/26/17 days after It has been accepted as complete.
Number of inspections allowed per permit.
I:'Buiding+Penuits`ELC PermiiApp_ELR_ERE.doc Rev06172015 440-4615T(11'05COMWEB
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 Description Q�• I BathI Total
Renewable electrical energy systems:
Check Type of Work Involved: s kva or less 100.70 2
5.01 to 15 kva 133.56 2
0 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
C 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 solareneration
System* g 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:
❑ Other: Each additional inspection is
66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is
specifically listed 0 hr min 90.00/hr
COMMERCIAL WO. NLY P r
�'FEES
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
O Clock Systems
❑ Data Telecommunication Installation
• Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
O Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
I.Buildiog•Pcrmita ELC PermitApp_ELR_ERE.doc Re%06.'1'2015
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12909 SW 68TH PKWY 290, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2017-00206
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor