Permit (163) r CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT° COMMUNITY DEVELOPMENT Permit#: ELR2018-00197
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 12/06/2018
T[(i.1[t.f3 9
Parcel: 2S 101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE#20
Project: New Horizons Wellness Services Subdivision: VARNS ACRES Lot: 9
Project Description: Fire alarm.
Contractor: WESTERN STATES FIRE PROTECTION Owner: TRIANGLE POINTE TWO LLC
17500 SW 65TH AVE 901 NE GLISAN ST, STE 100
LAKE OSWEGO,OR 97035 PORTLAND, OR 97232
PHONE: 503-657-5155 PHONE: 503-297-8791
FAX:
FEES
Description Date Amount
Specifics:
Restricted Energy Permit 12/06/2018 $75.00
12%State Surcharge-Electrical 12/06/2018
Type of Use: COM g $9.00
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 throu.••AR 95 -001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. ::7 or .800.332.
Issued : ' ! --" Permittee Signature: W j �
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
r City of Tigard 4 *-., '=i d 4 ----I- •��rifiriiirlaWINESI
N a 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax: 503.598.1960s� . ; INIIIIMI Related Permit#: f i t:.- r
�
Inspection Line: 503.639.4175 11t ady Date/By: Juri ® See Page 2 for
TIGARD Internet: www.tigard-or.gov Notified/Method: Supplemental Information
❑New construction ®Addition/alteration/repl;et t di
''',< J:6+' itI , Please check all that apply(submit 2 sets of plans w/items checked):
v _. ,- x. ❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
i . r t 4 Ew = f s , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: ❑Fire pump. 0 Installation of 150 KVA or
t ,. Ip Q l= ® r 1 ❑Emergency systam. larger separately derived
❑Addition of new motor load of system.
Job#:LL1777 Job site address: 13333 SW 68T0 PARKWAY 100HP or more. ❑"A","E","t-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP:TIGARD,OR 97223 ❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:C Project name:NEW HORIZONS WELLNESS 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:66TH AVE AND SW HAMPTON ST ;e' „ r
Description Qty. Each Total
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: 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
B I Q 9 ,.a
Limited energy,residential 75.00 2
ALTER FIRE ALARM DEVICES FOR NEW TENANT BUILD OUT. (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
Renewable Energy 0 See Page 2
'_(0 ' ' , ! !„_,ti . Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address:
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I 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
r Branch circuits—new,alteration,or extension,per panel
q s - A.Fee for branch circuits with
Business name: above service or feeder fee, 7 42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
City/State/ZIP: Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email: Reconnect only 67.84 2
' v' '
s 6 ' Pump or irrigation circle 67.84 2
Business name:WESTERN STATES FIRE PROTECTION Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy ® See Page 2 1 2
Address: 17500 SW 65TH AVE panel,alteration,or extension.
Each additional inspection over allowable in any of the above
City/State/ZIP:LAKE OSWEGO,OR 97035 Additional inspection(1 hr min) 66.25/hr
Phone:(503)407-0279 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:WILLIAM.STEWART@WSFP.US Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 104570 Electrical Lic.: CLE108 Suprv.Lic.: 2525LEA siecificall listed '/,lir min_
Suprv.Electrician signature,required: Subtotal:
Print name: WILLIAM T STEWART I Date: 11-8-18 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature:
sl�� TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: WILLIAM T STEWART Date: 11-8-18 days after it has been accepted as complete.
* Number of inspections allowed per permit.
C\Building\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:
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 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:
n 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)
❑ Heating,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:
❑ Other: Each additional inspection is 66.25/hr 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s.-cificall listed V2 hr min
a s Z:4
Fee for each commercial system: $75.00 Subtotal(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
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El 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:
13333 SW 68TH PKWY STE 20, TIGARD,
OR, 97223
Record Type: Record ID:
Commercial - Electrical Limited Energy ELR2018-00197
Inspection Type: Inspector:
198 Low voltage final Jeff Grove
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor