Permit (2) CITY OF TIGARD FIRE PROTECTION SYSTEM PERMIT
COMMUNITY DEVELOPMENT Permit#: FPS2019-00057
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/14/2019
Parcel: 2S102BA05000
Jurisdiction: Tigard
Site address: 12353 SW GRANT AVE
Project: Elite Care Subdivision: 2013-021 PARTITION PLAT Lot: 1
Project Description: Fire alarm. Adding(1)cellular devise to an existing fire alarm system.
Contractor: FIRE SYSTEMS WEST INC Owner: ELITE CARE GRANT LLC
600 SE MARITIME AVE#300 PO BOX 12564
VANCOUVER, WA 98661 PORTLAND, OR 97212
PHONE: 360-693-9906 PHONE: 503-653-5656
FAX:
FEES
Description Date Amount
Specifics: Permit Fee-COM 05/08/2019 $61.85
12%State Surcharge-Building 05/08/2019 $7.42
Type of Use: MF Plan Review-Fire Life Safety-COM 05/08/2019 $24.74
Class of Work: ALT Type of Const: VB Info Process/Archiving-Sm$0.50(up to 05/08/2019 $2.50
Occupancy Grp: B Height: ft 11x17)
Stories:
Commercial Sprinkler System:
Sprinkler Required: Sprinkler Type:
Standpipe Required: Hazard:
Density: 0 Design Area: 0
K Factor: 0
Commercial Fire Alarm System:
Fire Alarm Required: Yes Alarm Type: Automatic
Pull Station Required: Yes Smoke Detectors Req:
Battery Calcs Provided: Yes Cut Sheets Required:
Total $96.51
Valuations: Required Items and Reports(Conditions)
Sprinkler Valuation: $0.00
Residential Square Footage: 0
Fire Alarm Valuation: $880.00
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �' Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard DateBed _ ��� � ,
'. 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Revie• F_
Irr
Phone: 503.718.2439 Fax: 503.598.1960 O Date/B : 1MIFIIMMAI
I
Inspection Line: 503.639.4175 Ready Date/By: Juris: ® See Page 2 for
TIGARD Internet: www.tigard-or.gov CM/ ' " ;RD Notified/Method: Supplemental Information
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TYPE OF WORKt3"T'; ` t , c, tt..41';,..:441 "$`� ;�
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❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current 0 Marinas and boatyards.
'` CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
❑ 1-and 2-family dwelling ❑ Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
amps for all other installations. buildings.
,Multi-family ❑Master builder ❑ Other: 0 Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived
❑Addition of new motor load of system.
Job#: Job site address:
/Z3�j 3 644,,,i3,74/6-- 100HP more ❑"A» "E» "1.2» "1_3»
City/State/ZIP: �' ❑Six or more residential units. occupancy.
f/6,wQ, i t 9.7„,, ❑Health-care facilities. 0 Recreational vehicle parks.
Suite/bldg./apt.#: Project name: n ❑Hazardous locations. 0 Supply voltage for more than
Q✓ "Lid
i } ❑Service or feeder 600 amps or more. 600 volts nominal.
Cross street/directions to job site: 76416t1 Td ,�� 5 FEE SCHEDULE
64-71 Description I Qty. I Each I Total
R t L 'd I%) S,1 C-s A.rj--,07'01 dam: New residential single-or multi-family dwelling unit.
Subdivision: Lot#: Includes attached garage.
1,000 sq.ft.or less 168.54 4
Tax map/parcel#: Ea.add'l 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
(with above sq.ft.) 75.00 2
X17/] t u L4-tL d'aL �� ,ci. 77••►� 75.00 2
/(, Gf1s Lt Limited energy,multi-family
�� C�2�� residential(with above sq.ft.)
' l - Renewable Energy 0 See Page 2
0 PROPERTY OWN R `,ti
= Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) 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
- „ ' Branch circuits—new,alteration,or extension,per panel
;' APPLICANT ❑ CONTACT PERSON, - A.Fee for branch circuits with
Business name: 06, s 4 C[,1�i5. mi�S/�' above service or feeder fee, 7.42 2 I
each branch circuit
Contact name: . q_._0 tjg._. 70,...4 c B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: food S6 /r1 4 C tGi,,,,i .r1 v&-. branch circuit
City/State/ZIP: G �/ Each add'l branch circuit 7.42 2
vs./0
u v 2 , &i-' / 'th/ Miscellaneous(service or feeder not included)
Phone:(s dio ) (D 9 ? -we,G Fax: :( ) Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Email:
co.o Lr f i- (a„=- A k Sys s (,...../o-0-7 G. rte-- Reconnect only 67.84 2
C NTRACTOR Pump or irrigation circle 67.84 2
Business name: Sign or outline lighting 67.84 2
4, ,a5 E Signal circuit(s)or limited-energy7q See Page 2 2
Address: panel,alteration,or extension. b'^
City/State/ZIP: Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Investigation(1 hr min) 90.00/hr
Email:
Ir 3 /2 1 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 'C.&73 Z. Electrical Lic.:3 (i E Suprv.Lic.:C/1j j,5�4 s,ectficall listed(%z hr min)
`', ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: •
I Subtotal:
Print name: 0-4(6,/vI�ig fe.„,/ Date: /.r x 5'/i 9 0 Plan Review Required(25%of permit fee):
v State surcharge(12%of permit fee):
Authorized signature: /',
® TOTAL PERMIT FEE:
t/`� This permit application expires if a permit is not obtained within 180
Print name: 1/✓(Gi.l--e.5v S(, F Date:W �/l� days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015 440-4615T(11/05/COM/WEB
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Fee for all residential systems combined: $75.00 DescriptionQty. Each Total
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
n 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
n 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
specifically listed(%hr min)
COMMERCIAL WORK ONLY: ELECTRICAL PERMIT FEES
Fee for each commercial system: $75.00 Subtotal(Enter on Page 1):
* Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
E Data Telecommunication Installation
OS Fire Alarm Installation
HVAC
Instrumentation
Intercom and Paging Systems
7 Landscape Irrigation Control*
n Medical
Nurse Calls
n 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\ELC_PermitApp_ELR_ERE.doc Rev 06/17/2015