Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111111 g COMMUNITY DEVELOPMENT Permit#: ELR2015-00029
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/12/2015
Parcel: 25101 DC00200
Jurisdiction: Tigard
Site address: 13535 SW 72ND AVE 200
Project: Umpqua Bank Subdivision: 72ND BUSINESS CENTER Lot: 13
Project Description: Fire alarm.
Contractor: NORTHWEST FIRE SUPPRESSION INC Owner: PNWP LLC#2
15385 SW BEAVERTON CREEK CT BY PACIFIC NW PROP LTD PTNSP
BEAVERTON, OR 97006 PO BOX 2206
BEAVERTON, OR 97075
PHONE: 503-644-7720 PHONE:
FAX: 503-644-8289
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/12/2015 $75.00
12%State Surcharge-Electrical 02/12/2015 $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: 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. / wo 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 ore y�180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility otification -• -r. Those rules are • fo//in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy - or direct questions to OUNC by ca • • 5;232.1987• .:10.332.2 •
/Id
Issued By: /'�� Permittee Signature: ,�
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 Applicatio�ECEIVED 1 ()R (1 1 1 1( I 1 • I 11\1 1
City of Tigard JAN 2 6 2015 Received
Dat/B : / /S ell?' Permit No.:EL2ail/s—4919,Q 9
I • 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
' . Phone: 503.718.2439 Fax: 503.59 Other Permit:
g(�P1( OF TIGARD nate/B : /05.247/3°— 000/
1,1 Inspection Line: 503.639.4175 BUILDING DIVISION DateReadyBy: ® see Page 2for
Internet: www.tigard-or.gov Notified/Method: rilM Supplemental Information
TYPE OF WORK PLAN`REVIEW
®New construction ❑Addition/alteration/replacement Please check all that apply(submit;sets of plans w/items 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.
❑ 1-and 2-family dwelling ®Commercial/industrial Accessory building
less to ground,
other a exceeds ons, ❑Commercial-use agricultural
❑ �' g amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 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",
Job no.: Job site address: 13535 SW 721'd Ave IoOHP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard Oregon 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name:Umpqua Bank ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:217 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
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family
75.00 2
Installation of controls for clean agent fire suppression system residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER , [] TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name:Umpqua Bank 401 amps to 600 amps 200.34 2
Address: 13535 SW 72ed Ave 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard oregon 97223 Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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: Branch circuits—new,alteration,or extension,per panel
❑ APPLICANT I 0 CONTACT PERSON A.Fee for branch circuits with
I
above service or feeder fee,
7.42
Business name:Northwest Fire Suppression each branch circuit `
B.Fee for branch circuits without
Contact name:Dan Loch service or feeder fee,first
branch circuit 56.18 2
Address: 1800 NW 169th place suite C600 Each add'l branch circuit 7.42 _ 2
City/State/ZIP:Beaverton,Oregon 97006 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)644-7720 Fax::(503)644-8289 dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail:danloch@nwfire.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:same as above Signal circuit(s)or limited-energy See
panel,alteration,or extension. I Page 2 75-Ot 2
Address: Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: Investigation(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90 00/hr
CCB Lic.: 088629 Electrical Lie.: 275LEA Suprv.Lie.: 2755LEA specifically listed(V2 hr min)
�Y_Si e , id ///7 ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: 7/,/7 Subtotal: 257-a)
Print name: Dan ,oc Date: 1 26 2015 Plan review(25%of permit fee):
State surcharge(12%of permit fee): f.ph
Authorized sign•ture'��"` TOTAL PERMIT FEE: e'q. rid
Print name: Dan Loch Date:
T This permit application expires if a permit is not obtained within 80
���,� days after it has been accepted as complete.
r • Number of inspections allowed per permit.
1:\Building\Permits\ELC_PermitApp_ELR_ERE.doe Rev 05/21/2013 440-4615T(t1/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE sai®dul.E
Fee for all residential systems combined $75.00 Description I Qty. 1 Fee 1 Total 1
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
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
1:1 Other: additional inspection over allowable in any of the above:
Other: Each additional inspection is
charged at an hourly(I hr min) 6625/hr 1
Inspections for which no fee is
90.00/hr
specifically listed(%J hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT its
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 application expires if a permit is not obtained within ISO
❑ 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
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13535 SW 72ND AVE 200, TIGARD, OR, 97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00029
Jeff Grove
Violation Summary:
Inspector Contractor