Permit (104) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2018-00129
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/16/2018
TIGARD 9 Parcel: 25101 DA00102
Jurisdiction: Tigard
Site address: 13221 SW 68TH PKWY 500
Project: Health Net Subdivision: None Lot: None
Project Description: Limited energy for fire alarm.
Contractor: POINT MONITOR CORPORATION Owner: GK TRIANGLE CORPORATE PARK III L
5863 LAKEVIEW BLVD STE 100 ATTN KBS REALTY ADVISORS
LAKE OSWEGO, OR 97035 P 0 BOX 28270
SANTA ANA, CA 92709
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/16/2018 $75.00
12%State Surcharge-Electrical 08/16/2018 $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 OA- 952-001-0090. You ma obtain a co y oft - . - irect questions to OUNC by callin 3.232.1987 or 1.80 . . 44.
Issued By: (' ••e Signature: I
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
City of Tigard ,� Date/BReceivea Permit#: U1 i
71 - q 13125 SW Hall Blvd.,Tigard,OR 97223 AUG�' u tr l' Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 Date/B : MAJAARelated Permit#:.ltiLMM
Inspection Line: 503.639.4175 -Beady Date/By: Juris: ® See Page 2 for
TI GA RD Internet: www.tigard-or.gov ._.. ... .. . . .......Ntlified/Method: Supplemental Information
TYPE OF WORK 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.
CATEGORY 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: 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#: I Job site address: 13221 SW 68th Parkway 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.#:500 1 Project nam ' 0 Hazardous locations. 0 Supply voltage for more than
rrLC���(f I/"''/ ❑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 I *
__ — New residential single-or multi-family dwelling unit.
Subdivision: #: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
75.00 2
Fire Alarm-Notification Devices
(with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
0 PROPERTY OWNER ® TENANT Services or feeders installation,alteration,and/or relocation
Name:Centene Phase II 200 amps or less 100.70 2
Address: 13221 SW 68th Parkway Suite 500 201 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:( ) 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 I ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,per panel
A.Fee for branch circuits 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
Address:5863 Lakeview Blvd.Suite 100r Corp. feeder circuit
City/State/ZIP:Lake Oswego,OR 97035 Each add'l branch circuit 7.42 TT:
Miscellaneous(service or feeder not included)
Phone:(503)627-0100 I 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
Address:5863 Lakeview Blvd.Suite 100 Signal ies t(s)or limited-energy
panel,allteration,or extension. 0 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 I 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 90.00/hr
CCB Lic.: 135901 1 Electrical Lic.: 34508CLE 1 Suprv.Lic.: 4460LEA specifically listed('/hr min)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal:
Print name: Ben Breit Date: 8/10/18 0 Plan Review Required(25%of permit fee):
C---1- . State surcharge(12%of permit fee):
t a., TOTAL PERMIT FEE:
Authorized signatur . - r -
This permit application expires if a permit is not obtained within 180
Print name: Ben Breit Date: 8/10/18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Buildng\Permits\ELC_PermitApp_ELR_ERE.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:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00
Description I Q�. I Each I Total
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
El Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
El 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 552.26 2
with OAR 918-309-0040)
El Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
El 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(I hr min)
Inspections for which no fee is 90.00/hr
specifically listed(1/2 hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system:• $75.00 Subtotal(Enter on Page 1):
y * Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
n Clock Systems
El Data Telecommunication Installation
® Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
1:\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:
13221 SW 68TH PKWY 500, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2018-00129
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor