Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111- 2 '- COMMUNITY DEVELOPMENT Permit#: ELR2013-00206
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2013
Parcel: 1 S126DC80001
Jurisdiction: Tigard
Site address: 9385 SW LOCUST ST
Project: Family Practice Clinic Subdivision: LOCUST OFFICE PARK CONDO Lot: 1
Project Description: Data telecommunication for new tenant in a medical office.
Contractor: POINT MONITOR CORP Owner: TSE INVESTMENTS LLC
5863 LAKEVIEW BLVD SUITE 100 PO BOX 1754
LAKE OSWEGO, OR 97035 LAKE OSWEGO, OR 97035
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/19/2013 $75.00
12%State Surcharge-Electrical 08/19/2013 $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: 1 Fire Alarm: 0
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 95A00 !490. Y• may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I
Issued By: / � � Permittee Signature: i0X /e4/ 77d,■.1
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 603.639.4176 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.
08/14/2013 14:48 5036270110 POINT MONITOR CORPOR PAGE 01
Electrical Permit A licatio . EIVErl Fol. sal tic i': t xh O\i.\
City of Tigard Received 006
w »mss t rA ' � PermitNo..a :�8/3_.e
:� 13125 SW Hall Blvd.,Tigard.OR 97223 d l' 1 4 Plan Review
Phone: 503.718.2439 Fax: 503.598,J96 2013 pat : Other Permit:
.1 1 •,,i.t, Inspection Line: 503,639.4175 Date ReadyI8y: Ell See Page 2 for
Internet:
www.tigard-or.gov w.1ga
d-n gny CITY OF
....:...:..... pp W
N
ot ifed/Me ttWd'
' h 1117E111 Supplemental me f a 1
Information n
.i, .. .' ,. i R � r ,. 1�l � l. �34 lLl`.,:' ,;!!,:i r,,'j ...rti:40 .0,8 , ,!ii;:,... d
';
®❑Other:Ari/alteratlOn/replact Addition/alteration/replacement ❑Service or feeder 4 0 amps or'more ❑Building e v checked bee
❑New construction Please check all that apply below):
Demolition where the available fault current ❑Marinas and boatyards,
., . , • ......;,� a('i
❑ i and 2-family dwelling Commercial/industrial I ; ;;: � �' � �'�+L�' � �y'}��;�-�N'•.:1{�'�:?5�:p.,.';.i',d.V,u.,i���'a exceeds 10.000 amps at 150 volts or ❑Floating b�;ldings,
less to und,or exceeds 14.000 ❑Commercial-use a�icultural
Y g ® industrial ❑Accessory building amps for all other installations. buildings,
1:3 Multi-family ❑Master builder ❑Outer: ❑Fire pump. ❑installation of 150 KVA Or
u T' ; 0 Emergency system. larger.eparalety derived system.. 1 ��r�a ar g ; , i. '.,. etrst s s l ad. ,iwrrat tt^ Ors ta!i6 R,;A I, 1 .r . 8
❑Addition of new n r
rat n load of ❑,.A„ "E"."1‘2",-1 ;..
JOb no.: Job site address:9385 SW Locust Street IOOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks
City/State/ZIP:Tigard,OR 97223 ❑HeaIrh-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt,no.: i Project name:Dr.Tanya Carter ❑Service or feeder 600 amps or more.
Croce atrveddiroctione eojob°rto: yKenOW C1,,,. vac. I Total
New residential single-or multi-family dwelling unit.
includes attached garage.
Subdivision: J Lot no.: 1,000 sq.ft.or Icss 168.54 4
^
_Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no Limited mere,residential
1:: IfI I!n. rat +rt x r I� with above 75.11(1 2
.'� I' l'.
�. 1 f•}iLeC' L3'.:tNt 1)1 4 t ati'`l :II 1'1:''.'t~ •11; (with it.)
Limited energy,multi-family 75.00 2
Add Phone/Data to TI space residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
..... ,_'. �.`:a ■'i.. 1 4e4S 100.70
;,t
.. , ,..-. , .PI.... t•. ,.4:..i ,,,'n.y .�c.,�','i uFti:� .. .�. a., ., ;. ,';W/i:i° amps or
201 amps to OU amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps _ 2
- Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) I Fax:( ) relocation
200 amps or less 59.36 I
Owner installation:This installation is being made on property that I own which is not z01 amps to 400 amps 125.08
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps _ 168.54 2
Owner signature: Date: nch Circuits-new site t or extension,new, ra ion,o n,per panel
I i, i I: N , '!$'1.!; ';
08/14/2013 14:48 5036270110 POINT MONITOR CORPOR PAGE 02
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Iggigg _ igaN' g L X93"9k u ... :, i.
Fee for all residential fCx,.l°(� ";t;i 1 •
ntial systeflns combined.. $75.00 � f � �K T L.
y 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
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301.04 2
❑ Garage Door Opener* 50,01 to 100 kva 552.26 2
>100 kva(fee in accordance with 552.26 2
Heating,Ventilation and Air Conditioning
OAR 918-309-0040)
System* Solar generation systems In excess of 25 kva:
Each additional kva over 25 7.42 3
El 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(1 hr min)
Inspections for which no fee is
rr�1 ��0 a i;:�>:.• ,�1 e;.+.�r. �• Psws s•v.,i?. specifically listed(%s hr Olin) 90.00/hr
Fee for each commercial system
$75.00 Subtotal:
(SEE OAR 918-309-0000) Plan review,if required(25%of permit fee);
State surcharge(12%of permit fee):
Check Type of Work Involved: TOTAL PERMIT FEE:
This permit eppikatlon expires if a permit it not Obtained within 180
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per permit
❑ 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
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:'Building\Permits\ELG PcrmOApp ELR ERE.doc Ro,05/21/2013