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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT ` COMMUNITY DEVELOPMENT Permit#: ELR2020-00033 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/02/2020 T(G:\R 09 Parcel: 2S112DA01400 Jurisdiction: Tigard Site address: 6650 SW REDWOOD LN 380 Project: Health-E Practices Subdivision: 1996-048 PARTITION PLAT Lot: 2 Project Description: Limited energy for 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: 503-624-6300 FAX: 503-627-0110 FEES Description Date Amount Specifics: Restricted Energy Permit 02/28/2020 $75.00 12%State Surcharge-Electrical 02/28/2020 $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 for more the 160 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- 1-0090. You m btain a c y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: /�,� Q! i24 Permittee Signature: �� CCc `.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 ONIy Clf-x, of Tigard Received el ft- e 13125SW NaIlBIvd.,Tigard,OR 97223RECEIVED Dau'By: .Ai . A ill ' k: '�x•-e:adj Plan Review l` v`_v Phone: 503.718.2439 Fax: 503.598.1960 n Date/By: a" Ui/,/�) 1 IUARD:. Inspection Line: 503.639.4175 '-r43 2 0 2020 Ready Date/By: rcris: El See age or Internet: www.tigard-Or.gov Notified/Method: Supplemental Information TYPE OF WORK / OF TIGAR PLAN REVIEW title v' _ .:`. ❑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. ❑ Demolition ❑ Other: _ where the available fault current ❑Marinas and boatyards. CATEGORY OF CONS-Pi UCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings. ❑ I-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: ['Fire pump. ❑Installation of 150 KVA or JOB SITE INFORMATION AND 1,OCeITIQN 0 Emergency system larger separately derived ❑Addition of new motor load of system, Job#: I Job site address: 6650 SW Redwood Lane looliP or more. ❑"A","E^,"t-2","t-3^, City/State/ZIP:Portland,OR 97224 0 Six or more residential units. occupancy. ❑Health-care facilities. 0 Recreational vehicle parks. Suite/bldg./apt.#:380 Project name:Health-e Practice Solutio 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: - FEE SCHEDULE �' il(yi Description 1 Qiy. I Each I Total r• 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'1500 sq.ft.or portion 33.92 I DESCRIPTION OF WORK u:' - Limited energy,residential 75.00 2 Fire Alarm (with above sq.ft.) Limited energy,multi-family 75.00 2 residential(with above sq.ft.) -- Renewable Energy ❑ See Page t ❑ PROPERTY OWNER ® TENANT Services or feeders Installation,alteration,and/or relocation Name: Health-e Practice Solutions 200 amps or less 100.70 2 Address: 6650 SW Redwood Lane suite 380 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 City/State/ZIP:Portland,OR 97224 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 Branch circuits-new,alteratio or extension, .er panel ® APPLICANT © CONTACT PERSON_ A.Fee for branch circuits with Business name:Point Monitor Corp. above service or feeder fee, 742 2 each branch circuit Contact name:Brooke Williams B.Fee for branch circuits without Address: 5863 Lakeview Blvd.Suite 100 service or feeder fee,first branch 2 branch circuit City/State/ZIP:Lake Oswego,OR 97035 Each add'I branch circuit 742 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 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 lie circuit(s)or limited-energy ® 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(1 hr min) 90,00/hr Email:bwilliams@pointmonitor.com Industrial plant(1 lit min) 78.18/hr Inspections for which no fee is 90.00/hr CCB Lic.: 135901 Electrical Lic.: 34508CLE Suprv.Lie.: 4460LEA specifically listed(A hr min) -e-� ELECTRICAL PERMIT FEES Suprv.Electrician signature,required: f' "�� 1 Subtotal: Print name: Ben Breit Date: 2/20/2020 0 Plan Review Required(25%of permit fee): State surcharge(12%of permit fee): Authorized signature "* .,� TOTAL PERMIT FEE: This permit application expires If a permit is not obtained within I80 Print name: Ben Breit —ISate: 2/20/2020 days after it has been accepted as complete. • Number of inspections allowed per permit. I.Building;Permits-ELC_PennitAPp_ELR-ERE.doc Re;06 I'2015 440-4615T(ILO5-COM-WEB Electrical Permit Application—City of Tigard . 'age 2—Supplemental Information Limited Energy Permit Fees: Renewable Energy Permit Fees: RESIDENTIAL WORK ONLY: FEE SCHEDULE Desctiptie. Qn'. I Each Total J 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: C Burglar Alarm 25.01 to 50 kva 301.04 2 (i Garage Door Opener* soot to too kva 552.26 2 100 kva(fee in accordance 552.26 2 with OAR 918-309-0040) C 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 an of the above: C 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 specifically listed('Ye hr min) COMMERCIAL WORK ONLY: ° , t:•[RicAL 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: LI Audio and Stereo Systems C Boiler Controls ❑ Clock Systems Data Telecommunication Installation �1 Fire Alarm Installation ❑ HVAC C Instrumentation C Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical C Nurse Calls Outdoor Landscape Lighting* C Protective Signaling C Other: Total number of commercial systems: I *No licenses are required. Licenses are required for all other installations I.B eliding Permits ELC_PermitApD Et.R ERE.doc Res 06'1?2015