Permit a CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° . COMMUNITY DEVELOPMENT PERMIT #: ELR2007 - 00291
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/19/2007
PARCEL: 1 S135BB -00501
SITE ADDRESS: 10575 SW CASCADE AVE 130 ZONING: I -
SUBDIVISION: CASCADE BUSINESS CENTER LOT: JURISDICTION: TIG
PROJECT: HEMCON
Project Description: Fire alarm low voltage.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: X OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER: .
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
HEMCON MEDICAL TECHNOLOGIES POINT MONITOR CORPORATION
10575 SW CASCADE 7869 SW NIMBUS AVE
TIGARD, OR 97223 BEAVERTON, OR 97008
Phone: 503- 245 -0459 Contact #: PRI 503- 627 -0100
FAX 503- 627 -0110
FEES Reg #: ELE 34- 508CLE
LIC 135901
Description Date Amount
[ELPRMT] ELR Permit 7/19/2007 $75.00
[TAX] 8% State Surcha 7/19/2007 $6.00 REQUIRED ITEMS AND REPORTS
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these
rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: ( J/ P ermittee Signature: ,_„„o/ . M i'
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
�t
Electrical Permit Ap ad &-
c 1 ' ,'' T ��; FOR OFFICE USE ONLY
l _ ;l �'i •l � t
L_u ._ Receive=
City of Tigard Date/B • /715117/11111 Permit N., ii, .Ob _ •
, ° 13125 SW Hall Blvd., Tigard, Oli 23 Plan Rev' ,
` Phone: 503.639 4171 Fax: 50 §0$.19( V 2007 Date/B Other Per '� ���
TI G A R D Inspection Line: 503 63' 4, 75 Date Ready /By. funs. ,. See Page 2 for
Internet: www tigard -.' : a II U - T iiu-ARD Notified/Method. Supplemental Information
1 7 ' 'r � ' = '- - - legvin T i _ *. _ _ - PLAN RE W ''
El New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/iterns checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
CATEGORY :OF CONSTRUCTION > exceeds 10,000 amps at 150 volts or ❑ Floating buildings
a
__L_' less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling al Commercial/industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
- JOB SITE INFORMATION AND LOCATION Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 "1 -3 ",
10OHP or more. occupancy
Job no.: Job site address: 105 sc.,/ (,otSC,,atQ A. $• ❑ Six or more residential units ❑ Recreational vehicle parks
City/State/ZIP: P ®f Ie? O G ❑ Health -care facilities. ❑ Supply voltage for more than
} 1 7 Z Z ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: 13 p Project name: F}t rvl CO n ❑ 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 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq ft.)
f /ibt 1 a Limited energy, multi - family
P I 0 cAt / Sad 9! F; f f. i 1! o t+y1 Sy c :., residential (wall above sq. ft.) 75.00 2
f �
1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
,❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6 65 2
each branch circuit
Business name:
pp o n I Mon on r40 r_ Corr occ i r o `'1 B. Fee for branch circuits
{�
without service or feeder fee,
Contact name: S 13 ye. Y t/ y S. first branch circuit 46.85 2
Address: 7g-6 c c \A/ A/; m � A,v e, Each add' l branch circuit 6 65 2
✓ / Miscellaneous (service or feeder not included)
City/State /ZIP: 13e0.1 vY J n OR c► 7 g' Each manufactured or modular 90.90 2
J dwelling, service and/or feeder
Phone: (SDI ) 62 ? - CI D O Fax: : ( SO3 ) 62- T e- O 1 1 O Reconnect only 66.85 2
E - mail: S bf•edns @, roi,j- P'1oh.for,r,,vrl Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
V \ Business name: P 1� f Signal circuit(s) or limited -
Qih M dnt r ri0! �t .0 n energy panel, alteration, or
,, _
((�� extension. Describe: Page 2 75 , 00 2
Address: '7 Sw /y2rvlbvS �t✓�
City /State /ZIP: ge. ire a el Oa 1 ?0 0 g 0, 0 Each additional inspection over allowable in any of the above
Per Inspection 62.50
N Phone: (S`o3) 6-1? _ o 1 o O �� // ( 517.3 6' 27 -0 Il f 0 / Investigation per hour (I hr nun) 62.50
CCB Lie.: 1 3 5-1 o 1 Electrical i ld.: .4 -s, 'c L su Lic.: 33 S ,-4 2 LEA Industnal plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: r Subtotal:
Print name: , 4 1, 4 e - G , #(6 G ft/ 5 Date: p 7 Plan review (25% of pe fee):
�— �a State surcharge (8% of permit fee): -&
Authorized signature: TOTAL PERMIT FEE: i 1 ..pQ
G �� N g This permit application expires if a permit is not obtained within 180
Print name:
(� 6 D ate: 7 — �� d 7 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I \Buildmg\Permus\ELC- PermitApp doc 05/23/06 440- 4615T(t 1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
El Other:
COM1 ' Rg
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
❑ Boiler Controls
El Clock Systems
El Data Telecommunication Installation
E:1 Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: Building \PermitsWLC- PermnApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELR2007.00291
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/19/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 " '' _ 1..
INSPECTION WORKSHEET FOR DATE: 12!512007 TIME: 7 :01AM PAGE: 29
SITE ADDRESS: 10576 SW CASCADE AVE 130 CLASS OF WORK:
SUBDIVISION: CASCADE BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: HEMCON
DESCRIPTION: Fire alarm low-voltage.
OWNER: HEMCON MEDICAL TECHNOLOGIES, PHONE #: 503-246-0469
CONTRACTOR: POINT MONITOR CORPORATION PHONE #: 503
Inspection Request Scheduled For: Date: 1'J5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
109 , Electrical final 060843 -03 503.623-8802 N
Corrections /Comments /Instructions: .
�NAL— Wit&I PRO‘) f L e
Po St idiNI 0 i drcleiL-
k_\ ,
•
c
71/
Z ; PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G , N t 66 Date: 12 C-61 Phone #: (503) 718- Z-* ' V
l
CITY OF TIGARD
BUILDING DIVISION 1 PERMIT #: ELR2007 -00291
• 13125 SW Hall Blvd., Tigard, OR 97223 • DATE ISSUED: 7/19/2007
Phone: (503) 639 -4171 � 11'
Inspection Requests (24 Hrs.): (503) 639 -4175 �!..:!
INSPECTION WORKSHEET FOR DATE: 7/26/2007 TIME: 7 :03AM PAGE: 44
SITE ADDRESS: 10675 SW CASCADE AVE 130 CLASS OF WORK:
SUBDIVISION: CASCADE BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: HEMGON
DESCRIPTION: Fire alarm low voltage.
OWNER: HEMCON MEDICAL TECHNOLOGIES, PHONE #: 503 - 245 -0459
CONTRACTOR: POINT MONITOR CORPORATION PHONE #: 503 - 627
Inspection Request Scheduled For: Date: 7/26/2007 Pour Time:
Code # Inspection Description - • Contact # Message
135 Low voltage 052787 -01 503.348 -1501 N
Corrections /Comments /Instructions:
•
•
❑ PASS I 1XPARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • Date: '1 ' 1,6• to Phone #: (503) 718-