Permit (35) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2018-00060
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/23/2018
T I c. I<.n g Parcel: 2S101 DA00101
Jurisdiction: Tigard
Site address: 13190 SW 68TH PKWY 130
Project: Kimsa Subdivision: VARNS ACRES Lot: 9
Project Description: Limited Energy for fire alarm TI.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC NW PROPERTIES LIMITED PA
5863 LAKEVIEW BLVD STE 100 STERN FAMILY LIMITED PARTNERSHIP
LAKE OSWEGO, OR 97035 STERN, HELEN R REVOCABLE TRUST
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 04/23/2018 $75.00
12%State Surcharge-Electrical 04/23/2018 $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 through 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 By: orj4,- /ti 6%a4‘ Permittee Signature: 1t'eGe 0/7
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.
a- .,,
Electrical Permit Applic t1on FOR 01 11( I 1 SF ()NI 1
City of Tigard , Da'B: t- At ,/1 Permit#: =` t -,'
II U 13125 SW Hall Blvd.,Tigard,OR 1"91'223 L Plan Review �'
li Phone: 503.718.2439 Fax: 503.$98.1960 Date B : Related Permit#:f145. 04 `di 2,
Inspection Line: 503.639.4175 (- ReadyDate'By: Paige 2 for
f I C: A l:I) Internet: www.tigard-or.gov c.., i. Notified/Method: ® S ppemental Information
,'''^ a. L. ,..0. ...„ ` TYPE,;,OI? WO_• ..l , ..&.., 4.1','''''''' ft.M---REVIEW ,
®New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans n'items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
l'3:::::r ,. , C151EGORittiN,CrQSST1 10'10 / ,S ',.. exceeds 10,000 amps at 150 volts or ❑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 El Master builder 0 Other: ❑Fire pump,
❑Installation of 150 KVA or
..x„. ::2-„„. . '.OB S1TE j'.. 74,0t1)`i LOCATTUI ..,, 0 Emergency system. larger separately derived
❑Addition of new motor bad of system.
Job#: Job site address:13190 SW 68th Ave. 100HP or more. ❑�A~,"E, 't-z ,"t-3^,
City/State lZIP•Tigard,OR 97224
El Six or more residential units. occupancy.
0 Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:130 Project name:Kimsa 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: -'171,,,5%.,,' „ ,-
. �'EE-`>'�CAEDIJI:;E ' �° M �;
Description I Q4'• 1 Each I Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#:
1,000 sq.fl.or less 168.54 4
Ea.add'1500 sq.ft.or portion 33.92 1
: - SDESCRTPT('ON.,OF.VO ",.s=' • . ,;.- Limited energy,residential
(with above ) 75.00 2
Fire Alarm Notification Devices sq.fl
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
” Renewable Energy 0 See Page 2
CrPROPERTY OWNER , tt-: el TENNI I,}n'
Services or feeders installation,alteration,and/or relocation
Name:Kimsa 200 amps or less 100.70 2
Address: 13190 SW 68th Ave.Suite 130 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/Z1P: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
APPLICANT.,k. . ".
oK OnAct PERSON Branch circuits-new,alteration,or extension,per panel
A.Fee for branch circu
its with
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
serAddress:5863 Lakeview Blvd.Suite 100 branche
it feederitfee,first 56.18 2
branch circuit
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
67.84 2
dwelling,service and/or feeder
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
Address:5863 Lakeview Blvd.Suite 100 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: 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 specifically listed(A hr min) 90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Ben Breit Date: 4/19/18 0 Plan Review Required(25%of permit fee):
,,�-- State surcharge(12%of permit fee):
Authorized signature�- � _ TOTAL PERMIT FEE:
~� This permit application expires if a permit is not obtained within 180
Print name: Ben Breit Date: 4/19/18 days after It has been accepted as complete.
• Number of inspections allowed per permit.
I.BuildmgPermns ELC_PernwApp_ELR_ERE.doc Rev 06"I'2015 44046151(11 05 COM WEB
e
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
'FEE:SCHEDULE
_ .. i Fad, � Notal.
Fee for all residential systems combined: $75.00 DeacrlDtba � QV.Renewable electrical energy systems:
Check Type of Work Involved: s 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
El G• arage Door Opener* >100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
❑ H• eating,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-no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
El Other: Each additional inspection is 66.25/hr
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
specifically listed('A hr min)
l,Fel1tICAL PERMIT
COMMERCIAL WORK O Y: Subtotal(Enter on Pagel):
Fee for each commercial system: $75.00
(SEE OAR 918-309-0000) = Number of inspections allowed per permit.
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
D Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El 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'Permit,ELC_PermttApp_ELR_ERE.doc Re%06 I'2015