Permit (66) 7F ,1 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2COMMUNITY DEVELOPMENT Permit#: ELR2019-00112
T GAR 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2019
Parcel: 1 S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 700
Project: Road Scholar Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Adding and relocating fire alarm notification devices for TI.
Contractor: POINT MONITOR CORPORATION Owner: LINCOLN CENTER LLC
5863 LAKEVIEW BLVD STE 100 BY SHORENSTEIN PROPERTIES LLC
LAKE OSWEGO, OR 97035 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/20/2019 $75.00
12%State Surcharge-Electrical 06/20/2019 $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 r more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules ar t forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a cooY..nt_the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.3 . 4.
Issued By:igg-wesra ..,i Permittee Signature: /1".7244
/ f
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 USF.ONLY
" City of Tigard1,1 'eceived
- Date/B :
e 13125 SW Hall Blvd.,Tigard,OR 97223 n� Em 201 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 UN Date/B : Related Permit#� j �. `.
Inspection Line: 503.639.41 75 . s :..,... Ready Date/By: Anis: _ w® SeerPage 2 for
TIGARD CITY TIGARotrfed Method. Supplemental Information
Internet: www.tigard-or.gov
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❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Dem011tlOn Elwhere the available fault current 0 Marinas and boatyards.
r w . IZGORY ( sys , exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: 0 Fire pump. 0 Installation of 150 KVA or
+&1l )Li 'I e . R_r r M"+ t A"- 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 10200 SW Greenburg Rd. 100HP or more. 0"A","E","1-2","1-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:700 I Project name:Road Scholar-Lincoln 5 ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: "-q, t4t :1 „ .
Description I Qty. Each I Total
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#:
Ea.add'I 500 sq.ft.or portion 33.92 1
7,:. r:,:',°= ,',.' 4tt'1$i.:? " c• *Gii:1 x``: r ?V:;t1: '-':r,,. :' Limited energy,residential 75.00 2
FIRE ALARM (with above sq.ft.)
Limited energy,multi-family 75.00 2
residential(with above sq.ft.)
v $ v Renewable Energy
0 See Page 2
4. _ ,PROPER `Y' nt=- -•l` � ... .$ Services or feeders installation,alteration,and/or relocation
Name:Road Scholar-Lincoln 5 200 amps or less 100.70 2
Address: 10200 SW Greenburg Rd.,Suite 700 201 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
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
f � i . cit• 7 1�i t' t Branch circuits-new,alteration,or extension,per panel
� - a..l. "' 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
service or feeder fee,first
Address:5863 Lakeview Blvd.Suite 100 branch circuit 56.18 2
City/State/ZIP:Lake Oswego,OR 97035 Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)627-0100 I Fax: :( ) Each manufactured or modular
dwelling,service and/or feeder 67.84 2
Email:bwilliams@pointmonitor.com Reconnect only 67.84 2
t y
;.: !! ,i '.:.b :xa 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 circuit(s)or limited-energy El See Page 2 1 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(I 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 Lie.: 135901 Electrical Lic.: 34508CLE Suprv.Lie.: 4460LEA
pefill listed(v hr mn
.k
"O
Suprv.Electrician signature,required:� ZY
Subtotal:
Print name: Ben Breit t Date: 6/4/19 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: --- —.. g,--- TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Ben Breit _ Date: 6/4/19 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 06/17/2015 440-4615T(11/05/COM/WEB
EjectFical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
rs. ,v ,. ..,.�.. .i
Description Qty. I #�d.
Each I Total 7 *
" 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:
❑ 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
with OAR 918-309-0040) 552.26 2
❑ 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:
El 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•=ificall listed '%hr min
,; # .�, • s y�s+ 4 ,,.a .a.'�' " '"tl t9.t# d:.i"°"s ;.'�.. x y;� s... _`""
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00
(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
® Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
- other installations
I:\Building\Permits\ELC_PermitApp_ELRERE.doc Rev 06/17/2015