Permit (2) CITY OF TIGARD II ELECTRICAL RESTRICTED
Permit#: ELR2020 ENERGY00019 PERMIT
... COMMUNITY DEVELOPMENT
Date Issued: 02/05/2020
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DA01400
Jurisdiction: Tigard
Site address: 6650 SW REDWOOD LN 190
Project: Integrity Medical Subdivision: 1996-048 PARTITION PLAT Lot: 2
Project Description: Fire alarm.
Contractor: POINT MONITOR CORPORATION Owner: PACIFIC REALTY ASSOCIATES
5863 LAKEVIEW BLVD STE 100 ATTN: N PIVEN
LAKE OSWEGO, OR 97035 15350 SW SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/05/2020 $75.00
12%State Surcharge-Electrical 02/05/2020 $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 obt ' a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: -fir -, 2.-.7-,'"`---- --1/
PermitteeSignature: � ��_ �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 FUR 01 lit 1 I SI.0y 1.1
City of Tigard RECEIVE I Received
Date/By: a :: 'f' - Permit
13125 SW Hall Blvd.,Tigard,OR 97223 pp �{r' 7e' �4 t et
II e
i Phone: 503.718.2439 Fax: 503.598.1960 FER Z�2�! Plan Review
Date.By: Related Permit It: I t/J_'i 1
Inspection Line: 503.639.4175 Ready Date/By: Ions: B! See Page 2 for
1 I V A K US Internet: www.ti and-or, ovOF
g b' CITY TIGARC, Notified/Method:
Supplemental Information
TYPE OF WOQ ,,- 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 ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or P 0 Floating buildings.
Li 1-and 2-family dwelling ElCommercial/industrial El Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump.
0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system, larger separately derived
Job#: Job site address:6680 SW Redwood Lane El Addition of new motor load of system.
I00HP or more. ❑"A" ^E"..l y' 'y.3"
City/State/ZIP:Portland,OR 97224 ❑Six or more residential units. occupancy.
0 Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:190 Project name:Integrity Medical 0 Hazardous locations. ❑Supply voltage for more than
- ❑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 1 *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 I
DESCRIPTION OE WORK < Limited ener gy,residential 75.00 2
Fire Alarm
(with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
❑ PROPERTY OWNER Renewable Energy 0 See Page 2
. ® TENANT _ Services or feeders installation,alteration,and/or relocation
Name:Integrity Medical 200 amps or less 100.70 2
Address:6680 SW Redwood Lane Suite 190 201 amps to 400 amps 133.56 2
City/State/ZIP: Portland,OR 97224 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) Fax:( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 I
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 0 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,
each branch circuit 7.42 2
Contact name:Brooke Williams B.Fee for branch circuits without
Address:5863 Lakeview Blvd.Suite 100 service or feeder fee,first
branch circuit 56.18 2
City/State/ZIP:Lake Oswego,OR 97035 Each add'l branch circuit 7.42 2
Phone:(503)627-0100 Fes: :( ) Miscellaneous(service or feeder not Included)
Each manufactured or modular
Email:bwilliams@pointmonitor.com dwelling,service and/or feeder 67.84 2
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 circuit(s)or limited-energy
panel,alteration,or extension. ® See Page 2 I 2
City/State/ZIP:Lake Oswego,OR 97035 Each additional inspection over allowable in any of the above
Additional inspection(I 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
CCB Lic.: 135901 Electrical Lic.: 34508CLE Suprv.L4i446OLEAc.: specifically listed(/a hr min) 90.00/hr
Suprv.Electrician signature,required: r "".1 e ELECTRICAL PERMIT FEES
c-/ 2 Subtotal:
Print name: Ben Brcit Date: 1/31/2020 0 Plan Review Required(25%of pennit fee):
State surcharge(12%of permit fee):
Authorized signature: --..) p. .---2 TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Ben Breit Date: 1/31/2020 days after it has been accepted as complete.
- * Number of inspections allowed per permit.
1.,Building Peril ELC_PennilApp_ELR_EEC doc Rev U6'1'2015 440-4615T(11 05'COM WEB
EIectrical 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 Qty. I Each I TOW j•'
Renewable electrical energy systems:
Check Type of Work Involved: 5 kva or less l 00.70 2
5.01 to 15 kva 133.56 2
El Audio and Stereo Systems* 15.o1 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva
301.04 2
El Garage Door Opener* 50.01 to 100 kva 552.26 2
100 kva(fee in accordance
with OAR 9I8-309-0040) 552.26 2
E Heating, Ventilation and Air Conditioning
* Solar generation systems in excess of 25 kva:
System
Each additional kva over 25 7.42 3
[1 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
specifically listed('/2 hr min) 90.00/hr
COMMERCIAL WORKONE;Y: ELECTRICAL:PERMIT FEES
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:
E Audio and Stereo Systems
r Boiler Controls
[1 Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
Li HVAC
n Instrumentation
C Intercom and Paging Systems
C Landscape Irrigation Control*
Li Medical
[] Nurse Calls
Outdoor Landscape Lighting*
C Protective Signaling
C Other:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
I.BuitdingkPermiu ELC_PermitApp_ELR_ERE.doc Rev 06 1"2015