Permit (51) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I � ' COMMUNITY DEVELOPMENT Permit#: ELR2019-00119
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/02/2019
Tit;,E R f f 9 Parcel: 2S 101 AD02400
Jurisdiction: Tigard
Site address: 12753 SW 68TH AVE
Project: George Fox University Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: Fire alarm.
Contractor: POINT MONITOR CORPORATION Owner: GEORGE FOX UNIVERSITY
5863 LAKEVIEW BLVD STE 100 ATTN: FINANCIAL AFFAIRS
LAKE OSWEGO, OR 97035 414 N MERIDIAN
NEWBERG, OR 97132
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/02/2019 $75.00
12%State Surcharge-Electrical 07/02/2019 $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 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: (1tePermittee Signature: c� GG G L/rG� ct,
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 i
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 LSE ONLY
w Cl ofTigard Received j_ u x
- `J' g Date/B Y 1�7
' IN ® 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.5 Related Permit#:Date/B : 1 AI —rl 1
Inspection Line: 503.639.4175 EIVED Ready Date/By: ® See Page 2 for
TI G A R D Internet: www.tigard-or.gov Notified/Method: iiiiiiiM Supplemental Information
,n,.0 .,�n�s,�t� . , 44 i_.*s -1r.„=x _v;,_
:.:...:t..„,,.,„:::'
400 # I
❑New construction ®Addition alter���rn� Please checklltapply(submit 2oplans w/items checked):
0 Service hat y more ❑Building over three
stories.
❑Demolition Other: where the available fault current 0 Marinas and boatyards.
E�U��.p1NC �l�l1S�n�
�° �` exceeds 10,000 amps at 150 volts or 0 Floating buildings.
,.�� ATEGORYIF.€ 1!I::y. .C7'ION .. . �. �. ....,t:, axr�'
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.
❑Multi family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
of new motor load of sys
a g"-h,- :.IQ alllHss (); l_# ts ' 0 Emergency system. larger separately derived
' t
❑Addi
Job#: Job site address:12753 SW 68th St. 100Htion P or more. 0"A"em.,"E","1-2","1-3",
❑Six or more residential units. occupancy.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. 0 Recreational vehicle parks.
❑Hazardous locations.
0 Supply voltage for more than
Suite/bldg./apt.#: I Project name:GFU Portland Center 600 volts nominal.
El Service or feeder 600 amps or more.
Cross street/directions to job site: '5 1r.' -
,;FEE°SCHFpULE'�' is>v �-�.
Description I Qty. I Each I Total I *-
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'l 500 sq.ft.or portion 33.92 1
^"_ @. ;:`t 1 € .; t r f k. Limited energy,residential
(with above sq.ft.) 75.00 2
FIRE ALARM Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
Renewable Energy 0See Page 2
I* ,PM11,,°WNR h� I' "7,r ., i' .ANT_'at., =. -- . Services or feeders installation,alteration,and/or relocation
Name:GFU Portland Center 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 12753 SW 68th St
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
73 zz, Branch circuits-new,alteration,or extension,per panel
r k,, 0 AP c i ' ` `PO O yr: 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 56.18 2
Address:5863 Lakeview Blvd.Suite 100 branch circuit
City/State/ZIP:Lake Oswego,OR 97035 Each add'l 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
t; "t ° 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 ., See Page 2 1 2
Address:5863 Lakeview Blvd.Suite 100 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)627-0100 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:bwilliams@pointmonitor.com Inspections for which no fee is
spectficall listed '/z hr min) 90.00/hr
CCB Lic.: 135901 Electrical Lic.: 34508CLE Suprv.Lic.: 4460LEA Y
(--
. ;" LECT2ICAL =
i.ERMIT-n -
Suprv.Electrician signature,required: �'�_ '47Subtotal:
Print name: Ben Breit � Date: 6 1/19 0 Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee):
�'- L"- t---
TOTAL PERMIT FEE:
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Ben Breit Date: 6/21/19 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\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:
Description Qty. Each I Total
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
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>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
spec= xtf(call listedm
CA hr
., .* i
Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * 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
❑ 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:\BuildingTermits\ELCPermitApp_ELR_ERE.doc Rev 06/17/2015