Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
• re�i rl
C COMMUNITY DEVELOPMENT Permit #: ELR2013 -00006
•,, Date Issued: 01/10/2013
TIGARD. 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439
e sn p7*' Parcel: 2S110DC00500
Jurisdiction: Tigard
Site address: 11455 SW SUMMERFIELD DR
Project: Schwindt Medical /Dental Office Subdivision: WILLOW- BROOK -FARM Lot: 17
Project Description: (2) low voltage for Data/Telecommunications and AudioNideo
Contractor: POINT MONITOR CORP Owner: CDBK PROPERTIES LLC
7869 SW NIMBUS AVE 11565 SW DURHAM RD BLDG F 100
BEAVERTON, OR 97008 TIGARD, OR 97224
• PHONE 503 - 627 -0100 PHONE:
FAX 503 - 627 -0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/10/2013 $150.00
12% State Surcharge - Electrical 01/10/2013 $18 00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo Y Boiler Controls N
CCTV N Clock Systems N
Data & Telecommunications' y Fire Alarm: N
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 � m f ay obtain of the rules or direct questions to OUNC by calling 503 232 1987 1 800 332 23 0
Issued By: ���1Lub J% �Le(.^ Permittee Signature: ()At /T` r L' ` ATI 0
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.
01/09/2013 15:56 5036270110 POINT MONITOR CORPOR PAGE 01
Electrical Permit ApplicatiRECEIVED I ON 01 1 li: I: l SI t►NI
City of T Received d igard Date/13 • ( I /3 _ Permit No.' • -'I it
1 3125 SW Hall Blvd., Tigard, OR 9722 �N 0 9 2013 Plan Review
� Phone: 503.718.2439 Fax: 503.598.1960 Date/ : Other Permi y /�(�
I i ,, It I , Inspection line: 503.639.4175 / 11GARD Data Ready /By 1 ' 8 See Page 2 for
Internet www.tigard - or.gov Cl1 1 Notified/Method: I (p supplemental Information
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, . :1- I !r,' „ � M i.,. utf
m R j .M.t:NLlirtion evsk.m.i,, r tI : t. .1.1.gA . I 1.10Y4r's ;Ant • `� •f �, wl' 'i ••,�f ' j91Y � S" '11" p v
Please check an m
Was apply (submit b sets of plans w/ites checked below):
❑ New construction ® Addition /alteration/replacement
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other. where the available fault current ❑ Marinas and boatyards.
•, -7 a `, rl pr , t �t^i �t< '' ' " ,Iv $, • i F+� { m,� r n ;Or,: rti I I _t,( { ,.7 ? r 1;1 1 } gc� i ,r*s - exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
-• .. ° reblf .w,. +rt •te i,.l':an. n. xtwr «r../1 ,.r, i.r,,, �d ° l.b ■ l ess to ground, or exceeds 14 .000
: -' ❑ Cotntneretal -use agcuultural
❑ 1 and 2 family dwelling ® Commercial /industrial ❑ Accessory building amps fir all other installations. buildings.
❑ Multifamily ❑ Master builder ❑ Other 0 Fire pump. ❑ Installation of 75 KVA or
Ir i , , „ ; , rr ,1:: k ' r' `„t o , t „ a7,' r • a i : ❑ Emerge tin). system. larger separately derived system.
'4 ""'" I, 4.,+ ae.,, ;l trim ,.- eL' rngl,irc i..74.t,, x.+ .r6,.'imr r.,A.1,rY zPf f�, ❑ Add i t i on of motor badof ❑` ' "1- 2", "1 -'i
IOOHP Or more. occupancy.
Job no.: Job site address: 11455 SW Summerfleld Drive occ
❑ Sts or more residential units. ❑ Recreational vehicle parks,
City /State/ZIP: Tigard, OR 97224 ❑ Health - case facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. n o.: i Project name' Dr. Scbwindt ❑ Service fbed 600 amps or more. N p��+ I
:6414i I�7*4M1,".'19G`�1'h*Y.'r ;. mi l ,. 4. . ... i� 1 1 +, %:�) r .,,CE�!!.�i
Cross street/directions to job site: oaei+pnon Qty. Fea Total •
New residential single- or multi- family dwelling unit.
Includes attached garage.
r Subdivision: 1 Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
11.1, t'i�')r1t' .t.
'iY":.ry'. p r . ,._ r > {41 ti " (with above sq. ft.) 75.00 2
' • e • 0 •L-etl i ,rt La".t I :d ymerArr 3.l..,r..r_fi }AtIfet:t 7).'f «- ,. t. : fi I S . I .trF; ;t!, , ,`. 1
Limited energy, multi - family 75.00 2
Limited Energy. Teledata, Andio/Video systems. residential (with above s . ft.
Services or feeders Installation,alterstion, and/or relocation
200 amps or less 100.70 2
nrr N r ctal c.. srp1 I 1t I`� [•rlt, :i' 11 t u rr , Ir r'.' 1 i +�rl rl ':(h 6' ' y::• 201 amps to 400 amps 133.56 2
Iii a+oiar. i,lw
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 _ 2
Temporary services or feeders installation, alteration, and /or
City /State /ZiP: _ relocation _
Phone: ( ) j Fax: ( ) 200 amps or less 59.36 1
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, least, rent, or exchange, according to ORS 447, 449. 670, and 701.
Branch circuits — new alteredo or extensio , • er + anel
Owner signature: Date: ' A. Fee fbr branch circuits with
' t'
7n rn "', ° Nan , t I 3� 4L c t , , C M :1' r , x,a , .g above service or feeder fee,
. , i' u
.
,, ' litany i „� . 3,k ,,. q / � K ia,:.AaP li; 3iti6vesimie , rr; ,,
. + ,,,�t, �t �' � 'a each branch circuit - 7 42 2
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'( branch ctrcun 7.42 2
Address: 7869 SW Nimbus Avenue Miscellaneous (service or feeder not included)
Ci / State/ZIP: Beaverton, OR 97008 Each manufactured or modular 67,84 2
tY dwelling, service and/or feeder
Phone: (503) 627 Fax: : (503) 627 - 0110 Reconnect only - 67.84 2
Pump or irrigation circle 67.84 2
E -mail: SBruns@PointM onitor com 1 ( Sign or outline lighting 67.84 2
i a 'ill SE t7lr R ,v- T., 4 1 + 1 , 1 7 : 1 . bt I 1 f ( r. ali . E', g� (� ed- energy -
I � � i •• •t : F.$ ' J• d � a. w,. tarraSGar ....;,'vl,�..>r.,�,R,. : •.,,.,�ea,a. ;c�)r�.1 7 -.w:. hr,�.�ta J,r 1..,.,u,t>m1�_.I n`:; . Signal or limit
Business name: Point Monitor Corporation panel, alteration, or extension. 2 Page 2 150 2
Each additional inspection over allowable in any of the abov
Address: 7869 SW Nimbus Avenue Additional inspection (I he min) [ 66.25/ hr _
City / State/ZIP: Beaverton, OR 97008 investigation (1 hr min) _ 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 627 - 0100 Fax: (503) 627 Inspections for which no fee is
- ifical liste hr min 90.00/ hr
d %t
CCB I -ic.. 135901 Electrical Lic . 34.508CL Su rv. Lic.: . a'� Y � r , , "die r 3 �r��r
Subtotal: 150
$uprv. Electrician signature, requir
Cam' Plan review (25% of permit foe).
■ Print name. -3e,,,,1 e L � Date: //9// State surcharge (12% of pgmit fee): 18
TOTAL PERMiT FEE, 168
Authorized signature: This permit appticatloo expires fro permit a not obtained within 180
Print name:
Prue vi Date: q— Z pi days after it has been accepted as complete.
gran an 4 3 • Number of inspections allowed per permit -
1 \nuildisp rennifc\PLC- PermuApp.doc 07/01'10 440.4615T {I I'05/COMWWEB
01/09/2013 15:56 5036270110 POINT MONITOR CORPOR PAGE 02
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:
p Audio and Stereo Systems*
❑ Bur Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
.., ; ,,,,..i; i.- r ,...�,
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 Signaling
❑ Other
Total number of commercial systems: 2
*No licenses are required. Licenses are required
for all other installations
i :\AoJdmClPmmiro\ELC- PamaAPV.doc 07/0110