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Permit (39) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit#: ELR2017-00250 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/07/2017 �[ Parcel: 2S101AB03100 Jurisdiction: Tigard Site address: 12115 SW 70TH AVE 201 Project: Advanced Endodontics Subdivision: 2012-009 PARTITION PLAT Lot: 3 Project Description: Fire alarm notification devices,security,and phone/data systems. Contractor: POINT MONITOR CORPORATION Owner: TIGARD TRIANGLE PARTNERS LLC 5863 LAKEVIEW BLVD STE 100 18187 SIERA DR LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97034 PHONE: 503-627-0100 PHONE: FAX: 503-627-0110 FEES Description Date Amount Specifics: Restricted Energy Permit 12/07/2017 $225.00 12%State Surcharge-Electrical 12/07/2017 $27.00 Type of Use: COM Class of Work: ALT Total Number of Systems: 3 Audio&Stereo: 1 Boiler Controls: 0 CCTV: 0 Clock Systems: 0 Data&Telecommunications: 1 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 $252.00 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 a - s forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy• - . - or direct questions to OUNC by calling 503.232.1987 or 1.800. ' Issued By: ANC' 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. E..1-fferrical Permit Application RECEI V City of Tigard Received If 9 7 �,Z S� 2 Ry: ^`/�� Permit#: ��e�j7 r IN . 13125 SW Hall Blvd.,Tigard,OR 97223 NO V 2 2017 Plan Review = Phone: 503.718.2439 Fax: 503.598.1960Related Permit tt:F15�j7/Y} / /�/ C� OF TIGAR Date/By: ® See Page 2 for G Inspection Line: 503.639.4175ad Date/B [I G A R D Internet: www.tigard-or.gov .t' ed/Method kris: Supplemental Information ®New construction ®Additton/alteratiOn/replacement Please check all that apply(submit 2 sets of plans w/items checked): ❑Demolition 0 Other; ❑Service or feeder 400 amps or more ❑Building over three stories. where the available fault current 0 Marinas and boatyards. ' � ', � I 1 tom, _ «`is . ° exceeds 10,000 amps at 150 volts or ❑Floating buildings. 0 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural amps for all other installations. buildings. Multi family 0 Master builder ❑Other0 Fire pump. 0 Installation of 150 KVA or } .' ,... e ❑Emergency system. larger separately derived Job#: Job site address: 12115 SW 70th ❑Addition of new motor load of system. 1001-IP 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.#:201 I Project name:Advanced Endodontics ❑Hazardous locations. 0 Supply voltage for more than ❑Service or feeder 600 amps or more 600 volts nominal Cross street/directions to job site:Red Rock Center-Bldg C Description Qty. Each Total 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'l 500 sq.ft.or portion 33.92 1 ' " " f Limited energy,residential Fire Alarm Notification Devices,Security and Phone/Data (with above sq.ft.) 75.00 2 Limited energy,multi-family residential(with above sq.ft.) 75.00 2 4, e Renewable Energy 0 See Page 2 ' *5y Services or feeders installation_alteration,and/or relocation Name:Advanced Endodontics Dr.Barry 200 amps or less 100.70 2 Address: 12115 SW 7Oth Suite 201 201 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 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 Address:5863 Lakeview Blvd.Suite 100 service or feeder fee,first branch circuit 56.18 2 City/State/ZIP:Lake Oswego,OR 97035 Each add'l branch circuit 7.42 2 Phone:(503)627-0100 I Fax:: Miscellaneous(service or feeder not included) ( ) Each manufactured or modular Email:bwilliams@pointmonitor.com dwelling,service and/or feeder 67.84 2 „_ Reconnect only 67.84 2 x $• 67.84 2 Business name:Point Monitor Corp. Sign or outline lighting 67.84 2 Address:5863 Lakeview Blvd.Suite 100 Signal circuits)or limited-energy ® See Page 2 3 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(1 hr min) 78.18/hr Inspections for which no fee is CCB Lic.: 135901 Electrical Lic.: 34508CLE Suprv.Lic.: 4460LEA s.' ificall listed '/2 hr min 90.00/hr Suprv.Electrician signature,required:C � �� - K" �`— Subtotal: 225.00 Print name: Ben Breit Date: 11/22/17 ❑Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): 27.00 Authorized signature: TOTAL PERMIT FEE: 252.00 a This permit application expires if a permit is not obtained within 180 Print name: Ben Breit Date: 11/22/17 days after it has been accepted as complete. * Number of inspections allowed per permit. I/Building\Permits\ELC PermitApp_ELRERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB "Electrical Permit Application—City of Tigard Page 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: aw comoznEmErnmsa Fee for all residential systems combined: $75.00 Renewable electrical energy systems: Check Type of Work Involved: 5 kva or less 100.70 _© 5.01 to 15 kva 133.56 _© ❑ Audio and Stereo Systems* 15.01 to 25 kva - 200.34 _© Wind generation s stems in excess of 25 kva: ❑ Burglar Alarm 25.01 to 50 kva 301.04 _© ❑ G• arage Door Opener* 50.01 to 100 kva 552.26 © >100 kva(fee in accordance IIII with OAR 918-309-0040 552.26 _© ❑ H• eating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva: System* Each additional kva over 25 111. 7.42 _© ❑ Vacuum Systems* >100 kva-no additional charge - 0.0 _© Each additional ins'ection over allowable in an of the above: ❑ Other: Each additional inspection is ■ 66.25/hr charted at an hourl 1 hr min Is.nspcificall ections floistedr whichhr nomin is El fee 90.00/hr Fee for each commercial system: $75,00Subtotal(Enter on Page 1): * 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 ® Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical O Nurse Calls O Outdoor Landscape Lighting* O Protective Signaling ❑ Other: Total number of commercial systems: 3 *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 12115 SW 70TH AVE 201 , TIGARD, OR, 97223 Record Type: Record ID: Commercial - Electrical Limited Energy ELR2017-00250 Inspection Type: Inspector: 198 Low voltage final Jeff Grove Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor