Permit (98) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
■. COMMUNITY DEVELOPMENT Permit#: ELR2018-00070
i :' Date Issued: 08/20/2018
T t C ARO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 # Parcel: 2S 102CB00200
9 #./et d . Jurisdiction: Tigard
Site address: 13115 SW PACIFIC HWY
Project: Natural Grocers Tigard Subdivision: None Lot: None
Project Description: Limited energy for fire alarm system for TI. 9/11/2018: REPRINT permit to correct site address.
Contractor: NORTHWEST FIRE SUPPRESSION INC Owner: TIGARD PACIFIC RE LLC
1800 NW 169TH PL,STE C600 CIO LEADERSHIP CIRCLE LLC
BEAVERTON,OR 97006 1521 OXBOW DR STE 210
MONTROSE,CO 81401
PHONE: 503-644-7720 PHONE:
FAX: 503-644-8289
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/17/2018 $75.00
12%State Surcharge-Electrical 05/17/2018 $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 OA 52-001-0090. 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: � -- Permittee Signature: °7_�.8�4 ie` -77e "
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 Application \ FOR OFFICE USE ONLY
:.1,r
City of Tigard Received /" Permit No /
Ill .. 13125 SW Hall Blvd.,Tigard,OR 97223 MAY 7 201 Date/B : e _ ��� -41,0y
/d�
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/13 : - ii� Other Permit: 0 4/>y
TIGAKD Inspection Line: 503.639.4175 CITY OF t iCARD Date Ready/By: i Juris: 0 See Page 2 for
Internet: www.tigard-or.gov 'Ill lt'I4I(` 1?Iv' ON Notified Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more ❑Building over three stories.
0 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.
less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings.
El Multi-family El Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
J SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
,, 0 Addition of new motor load of 0"A","E","1-2","1-3",
Job no.: Job site address: 13125 SW Pacific Highway 100HP or more. occupancy.
❑Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 0 Health-care facilities. 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Natural Grocers 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. i Total
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'1500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Monitored Fire Alarm S stem Limited energy,multi-family
75.00 2
Y residential(with above sq.ft.)
,F(�`, 17 . k L Renewable Energy 0 See Page 2
IN,....e ptJLc i d, .M�i'�''. PI"sol t' , /� Services or feeders installation,alteration,and/or relocation
0 PROPERTY OWNER 0 TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( )
relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
0 APPLICANT A.Fee for branch circuits with
0 CONTACT PERSON above service or feeder fee,
Business name:Northwest Fire Suppression,Inc each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name:Erin Hedrick service or feeder fee,first 56.18 2
branch circuit
Address: 1800 NW 169th Place Suite C600 Each add'l branch circuit 7.42 2
City/State/ZIP:Beaverton,OR 97006 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)644-7720 Fax: :(503)644-8289 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:erin@nwfire.com
Pump or irrigation circle 67.84 2
u =^' CONTRACTOR Sign or outline lighting 67.84 2
Business name:Northwest Fire Suppression,Inc Signal circuit(s)or limited-energySee
panel,alteration,or extension. 1 Page 2 75.00 2
Address: 1800 NW 169th Place Suite C600 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Beaverton,OR 97006 Investigation(1 hr min) 66.25/hr
Phone:(503)644-7720 \I...0 Fax:(503)644-8289 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lie.: 88629 VAP Electrical Lic.: 34-5 7 V. -t/ Suprv.Lie.:2? Lj , specifically listed CA hr min)
dELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: 75.00
Print name: Dan Loch Date: 5/2/18 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 9.00
Authorized signature: .., TOTAL PERMIT FEE: 75.00
This permit application expires if a permit is not obtained within 180
Print name: Erin Hedrick Date: 5/2/18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 05/21/2013 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
*
Fee for all residential systems combined: $75.00 DescriptionI Qty. I Eeeh I Total I
3' Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less 100.70 2
5.01 to 15 kva 133.56 2
n Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
n G• arage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
n 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:
n 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(%hr min)
COMMERCIAL WORK ONLY:
ELECT RIOAL PERMIT,;FES
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
❑ Data Telecommunication Installation
n-Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n L• andscape Irrigation Control*
H Medical
TI N• urse Calls
H Outdoor Landscape Lighting*
H Protective Signaling
❑ Other:
Total number of commercial systems:
*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:
13115 SW PACIFIC HWY, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2018-00070
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor