Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I! • COMMUNITY DEVELOPMENT Permit# ELR2012 -00218
T f GARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued 09/18/2012
Parcel 2S 101 DD00800
Jurisdiction Tigard
Site address 14020 SW 72ND AVE
Project United Rental Subdivision SALEM FREEWAY SUBDIVISION Lot 4
Project Description (1) limited energy for Fire Alarm and (1) limited energy for Data/Telecommunications
Contractor POINT MONITOR CORP Owner I S PROPERTIES LP
7869 SW NIMBUS AVE ATTN UNITED RENTALS LEASE ADMIN
BEAVERTON, OR 97008 BY FISCHER & COMPANY URI
13455 NOEL RD, STE 1900
DALLAS, TX 75240
PHONE 503 - 627 -0100 PHONE
FAX 503 - 627 -0110
FEES
Description Date Amount
Specifics Restricted Energy Permit 09/18/2012 $150 00
12% State Surcharge - Electrical 09/18/2012 $18 00
Type of Use COM
Class of Work ALT
Total Number of Systems 2
Audio & Stereo N Boiler Controls N
CCTV N Clock Systems N
Data & Telecommunications Y Fire Alarm Y
HVAC N Instrumentation N
Intercom/Paging N Landscape /Irrigation N
Landscape Lighting N Medical N
Nurse Calls N Protective Signal N
Security Alarm N Other N Total $168 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
V
Issued By Permittee Signature
l
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 C)Nl.1
City of Tigard Date /B d ii I , // Permit No .62, I s ply , p4.1.18'
a 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
0�1 vA/sQ
C Phone 503 718 2439 Fax 503 598 1960 Date /B Other Permit 17
TI C. A It D Inspection Line 503 639 4175 Date Ready /By IE. la See Page 2 for
Internet www tigard - gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below)
❑ New construction ® Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stones
❑ Demolition ❑ Other where the available fault current ❑ Mannas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi- family ❑ Master builder ❑ Other ❑ Fire pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately denved system
JOB SITE INFORMATION AND LOCATION
0 Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no Job site address 14020 SW 72 °d Ave tooliP or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
City/State/ZIP Tigard, OR 97224 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal
Suite/bldg /apt no Project name United Rental TI ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site Description I Qty I Fee I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision Lot no 1,000 sq ft or less 168 54 4
Tax map /parcel no Ea add'I 500 sq ft or portion 33 92 1
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
Limited energy, multi -family 75 00 2
Fire Alarm mag door release. residential (with above sq ft )
Services or feeders installation, alteration, and/or relocation
200 amps or less 100 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133 56 2
Name 401 amps to 600 amps 200 34 2
601 amps to 1,000 amps 301 04 2
Address Over 1,000 amps or volts 552 26 2
City/State/ZIP Temporary services or feeders installation, alteration, and/or
h' relocation
Phone ( ) Fax ( ) 200 amps or less 59 36 1
201 amps to 400 amps 125 08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701
Branch circuits — new, alteration, or extension, per panel
Owner signature - Date , A Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee 7 42 2
each branch circuit
Business name Point Monitor Corporation B Fee for branch circuits without -
service or feeder fee, first 56 18 2
Contact name Steve Bruns branch circuit
Each add'I branch circuit 7 42 2
Address 7869 SW Nimbus Ave Miscellaneous (service or feeder not included)
City/State/ZIP Beaverton, OR 97008 Each manufactured or modular 67 84 2
h' dwelling, service and/or feeder
Phone (503) 627 - 0100 Fax (503) 627 - 0110 Reconnect only 67 84 2
Pump or imgation circle 67 84 2
E -mail SBruns @PointMonitor.com Sign or outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name Point Monitor Corporation panel, alteration, or extension 2 Page 2 75 2
Each additional inspection over allowable in any of the above
Address 7869 SW Minbus Ave Additional inspection (I hr mm) 66 25/ hr
City/State/ZIP Beaverton. OR 97008 Investigation (1 hr min) 66 25/ hr
industnal plant (I hr mm) 78 18/ hr
Phone (503) 627 -0100 Fax (503) 627 - 0110 Inspections for which no fee is 90 00/ hr
specifically listed ('/2 hr mm)
,'CCB Lic 135901 I ctrical Lic 34 - 508CL i pry Lic WO L�,4 ELECTRICAL PERMIT FEES
AII
Supry Electrician signature, required - ...or" Subtotal 150 00
Plan review (25% of permit fee)
Pnnt name 13e, l/\ '&71 Date 9/ g/i Z_ State surcharge (12% of permit fee) 18 00
TOTAL PERMIT FEE 168 00
Authorized signature This permit application expires if a permit is not obtained within 180
��jj,, •� Date 0tii...-- days after it has been accepted as complete
Print name �3{ it-p N umber o inspections allowed per permit
I \Building\Permits \ELC- PermuApp doe 07/01/10 440- 4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other
COMMERCIAL WORK ONLY: 1
Fee for each commercial $75.00
system
(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 Signahng
❑ Other
Total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
I \Buddutg\Permits\ELC- PermitApp doc 07/01/10