Permit (67) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
1111
COMMUNITY DEVELOPMENT l Permit#: ELR2019-0
0110
TfG1R,L13125 SW Hall Blvd.,Ti and OR 97223 503.718.243I's ���' Date Issued: 06/20/2019
Parcel: 2S101DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY,STE# 10
Project: Oregon Academy of General Dentistry Subdivision: VARNS ACRES Lot: 9
Project Description: Installing(6)fire alarm notification devices for TI. 8/15/2019: REPRINT to add data telecommunications.
Contractor: POINT MONITOR CORPORATION Owner: TRIANGLE POINTE TWO LLC
5863 LAKEVIEW BLVD STE 100 901 NE GLISAN ST, STE 100
LAKE OSWEGO,OR 97035 PORTLAND, OR 97232
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/20/2019 $75.00
12%State Surcharge-Electrical 06/20/2019 $9.00
Type of Use: COM Restricted Energy Permit 08/15/2019 $75.00
Class of Work: ALT 12%State Surcharge-Electrical 08/15/2019 $9.00
Total Number of Systems: 2
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 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 $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.
S2—
Issued By: Permittee Si nature: d ��Pz C C,97 )74n
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.
E Electrical Permit EE V ®Applicatiopp 'OR OF! a is 1',l.(1y1.1
City of Tigard i'1 Received
filliia 13125 SW Hall Blvd.,Tigard,OR 97223 A U G 15 2019 i'ian R : �� ��� hermit# �c�-0/ ,�(��/Q
a Phone: 503.718.2439 Fax: 503.598.1960 DaaRoview
Dates : Related Permit#:
1 Ic,ARD Inspection Line: 503.639.4175 CITY OF TIGARD ReadyDate/By: )tris: H See Page2 for
Internet www.tigard-or.gov
Nottfied/Method
441- poi ,'VZ.,y '".1,', BU • DIVISION upplemental Information
❑New construction CA Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w'items checked):
0❑Demolition 0 Other: 0 Service or feeder 400 amps or more ❑Building over three stories.
where the available fault current 0 Marinas and boatyards.
V, 1Z. ,,- e_CATECQRY1r) eALm'N�U 1C) f c...: '+1i exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 0 Commercial-use agricultural
❑Mulh famlly ❑Master builder ❑ amps for all other installations. buildings.
Other: 0Fire
4-_ r Jos ErrEpump. 0 Installation 150 KVA or
T' O (#1,-,t; ❑Emergency system. larger separately derived
Job#: Job site address.13333 SW 68th PKWY ❑Addition of new motor load of system.
i00HP or more
-
City/State/ZIP:Tigard,OR 97223 0 Six or more residential units. occupancy.
❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#:10 Project name:Oregon Academy of General ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: ,k
. :OW S01EI>UI E . . 1
Description I Qty.'1 Each rTotal 1 +
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.R.or less 168.54 4
a1'iFE Ea.add':i 500 sq.ft,or portion 33.92 1
i i J d D,SC oi1OF"1VOFt rIf Limited energy,residential
Add Phone/Date to Existing Permit#ELR2019-00110 (with above sq.ft.) 75.00 2
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
[ .PROPERTI (3WNI;Ii 1 i! , Renewable EnergySee Page 2
JP to 1 . � MAE,t 'T 11 t _ ,' Services or feeders installation,ala at on,and/or relocation
Name:OAGD 200 amps or less 100.70 2
Address: 13333 SW 68th PKWY,STE 10 201 amps to 400 amps 133.56 2
City/State/ZIP:Tigard,OR 97223 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) Fax ( ) Over 1,000 amps or volts 552.26 2
Email: Temporary services or feeders installation,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 1 2
Owner signature: Date: 401 amps to 599 amps
168.54 2
,'„' 1,', 1 p t .APPL1cANT:- vg, < p{ ”;' V .eo A Pg b _ 7 rain Branch circuits-new,alteration,or extension,per panel
Business name:Point Monitor Corp. .Fee for branch circuits with
p' above service or feeder fee,
7.42 2
Contact name:Brooke Williams each branch circuit
B.Fee for branch circuits without -
Address:5863 Lakeview Blvd.Suite 100 service or feeder fee,first
branch circuit 56.18 2
City/State/Z1P:Lake Oswego,OR 97035 Each add'l branch circuit 7.42 2
Phone:(503)627-0100 Fax: ( ) Miscellaneous(service or feeder not included)
Each manufactured or modular
Email:bwiliiams@pointmonitor,com dwelling,service and/or feeder 67.84 2Reconnect only 2
i, '77!-;; "' 1 . CO'14.er.QR 67.84
'7° Pump or irrigation circle 67.84 2
Business name:Point Monitor Corp. Sign or outline i¢htida
T -67,84 —,
Signal cinvit(s)or limited ener
Address:5863 Lakeview Blvd.Suite 100
Lakeview 8y I
panel,alteration,or extension. ® See Page 2 ] 2
City/State/ZIP:Lake Oswego,OR 97035 Each additional inspection over allowable In any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)627-0100 Fax:( ) Investigation(1 hr min) 90.00/hr
r
Email:bwilliams@pointmonitor.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90,001 hr
CCB Lie.: 135901 Electrical Lie.: 34508CLE Suprv.Lie.: 4460LEA specifically listed eA hr min)
Suprv.Electrician signature,required. .m _
'.', 3 .:'"""` `Et" ai"TtIGALiPERMi1`FEESr'
\�- Subtotal:
Print name: Ben Breit iDate: 8/15/19 0 Plan Review Required(25%of permit fee):
alla
State surcharge(12%of permit fee):
Authorized signature Etta" TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Ben Breit I Date: 8/15/19 1days after it has been accepted as complete.
Number of inspections allowed per permit.
I.Buiiding.Permits£LC PermitApp.ELR ERE,doc Rev 0617:2015 44446157(11;03 COM WEB
•
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Deseriptiti
Fee for all residential systems combined: $75.00 Renew° Qt'' gfe" Total
Renewable electrical energy systems;
Check Type of Work Involved: 5$vaorless 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to25 kva 200.34 2
Wind generation systems in excess of 25 kva:
n B• urglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ G• arage Door Opener* X100 kva(fee in accordance
with OAR 918-309-0040) 552.26 2
E Heating,Ventilation and Air Conditioning
Solar generation systems in excess of 25 kva:
System*
Each additional kva over 25 7.42 3
❑ 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
90.00/hr
Cally
COMMS �CIAL�WORK ONI;X� . t 'L .f 1-MEC'
'/�hr min)
` 1'E ff -701k---2;
;
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):I• Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
{1 Boiler Controls
n Clock Systems
II Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
C Intercom and Paging Systems
❑ Landscape Irrigation Control*
Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other:
Total number of commercial systems: 1
*No licenses are required. Licenses are required for all
other installations
1:BuildingsPermits ELC_PennitApp_ELR_ERE.doe Rev 06i 17.2015
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Permit`'- COMMUNITY DEVELOPMENT #: ELR2019-00110
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2019
T f Parcel: 2S 101 DA00104
Jurisdiction: Tigard
Site address: 13333 SW 68TH PKWY, STE# 10
Project: Oregon Academy of General Dentistry Subdivision: VARNS ACRES Lot: 9
Project Description: Installing(6)fire alarm notification devices for TI.
Contractor: POINT MONITOR CORPORATION Owner: TRIANGLE POINTE TWO LLC
5863 LAKEVIEW BLVD STE 100 901 NE GLISAN ST, STE 100
LAKE OSWEGO, OR 97035 PORTLAND, OR 97232
PHONE: 503-627-0100 PHONE:
FAX: 503-627-0110
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/20/2019 $75.00
12%State Surcharge-Electrical 06/20/2019 $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. 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 orth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by callin 232.1987 or 1.80%_ .2 4.//
�—
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 h,aivt.tion.
Electrical Permit Application FOR OFFICE USE°NEN'
City of Tigard RECEIVED paw.: il
,'
ate/B : �,S �� � �� r _
a 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.718.2439 Fax: 503.598.1960 JUN m 5 2019 Date/B : Related Permit#: j 1
Inspection Line: 503.639.4175 Ready Date/By: Auris: !a See Page 2 for
TIGARD Internet:
s... www.tigard-or.govCITY OF TIGARD
Notified/Method:r Supplemental
pplemental Information
, x `YPE OF'WotiL IN . ,, t l� REVW
❑New construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
0 Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
t *, < . CATEGORY F ONST`R( q exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ®Commercial/industrial 0 Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
❑Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
r ,,��
a£ ,:it I !g aiT1o1 :, Pip t .4 ° i ., &,,,,6 , 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address: 13333 SW 68th Parkway 100HP or more. ❑"A",°`E","1-2","1-3",
City/State/ZIP:Tigard,OR 97223 ❑Six or more residential units. occupancy.
❑Health-care facilities. ❑Recreational vehicle parks.
Suite/bldg./apt.#:010 Project name:OAGD ❑Hazardous locations. 0 Supply voltage for more than
❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: r{ FEE"SCHEDULE .:.,
Description I Qty. I Each I r
"Total I *
New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
:a. t i Tl ,t ' yf ` �, , ti4 Limited energy,residential
(with above sq.ft.) 75.00 2
FIRE ALARM Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
Renewable Energy 0 See Page 2
I' R Services or feeders installation,alteration,and/or relocation
Name:OAGD 200 amps or less 100.70 2
Address: 13333 SW 68th Parkway,Suite 010 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP:Tigard,OR 97223 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
n :., g APt . A.0 ' O ,, N.. Branch circuits—new,alteration,or extension,per
panel
A.Fee for branch circuits with
Business name:Point Monitor Corp. above service or feeder fee, 7.42 2
each branch circuit
Contact name:Brooke Williams B.Fee for branch circuits without
service or feeder fee,first
Address:5863 Lakeview Blvd.Suite 100 branch circuit 56.18 2
City/State/ZIP:Lake Oswego,OR 97035 Each add'l branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(503)627-0100 I Fax: :( ) Each manufactured or modular 67.84 2
dwelling,serviceand/or feeder
Email:bwilliams@pointmonitor.com Reconnect only 67.84 2
67.84 2
1 Business name:Point Monitor Corp. Sign or outline lighting 67.84 2
Address:5863 Lakeview Blvd.Suite 100 Signal circuit(s)or limited-energy El See Page 2 1 2
panel,alteration,or extension.
City/State/ZIP:Lake Oswego,OR 97035 Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:(503)627-0100 Fax:( ) Investigation(1 hr min) 90.00/hr
Email:bwilliams@pointmonitor.com Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 135901 Electrical Lic.: 34508CLE Suprv.Lic.: 4460LEA ts eclficall listed(Yz hr mm)
I
Suprv.Electrician signature,required: �� "��
Subtotal:
Print name: Ben Breit Date: 6/4/19 ❑Plan Review Required(25%of permit fee):
e State surcharge(12%of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print-name: Ben Breit_ Date: 6/4/19 days after it has beenaccepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitAppELR ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page —Supplemental Information
e
Limited Energy Permit Fees: Renewable Energy wPermit Fees:
a ^. t41. 'JPIY. }
Fee for all residential systems combined: $75.00 Description Qty. i Each ju Total I
3' 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
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* 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 1
charged at an hourly(1 hr min)
Inspections for which no fee is 90.00/hr
s.- ificall listed ''A hr min
-"""nitlitr
CQ � CIO WORK ONLY4,za et,of. , .t .. Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 * Number of inspections allowed per permit.
(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: 1
*No licenses are required. Licenses are required for all
- -other-installation:r--
I:\Building\Permits\ELC_PermitAppELRERE.doc Rev 06/17/2015