Permit (8) CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2022-00091
Date Issued: 8/23/2022
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AB01002
= 2
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 571
Project: Lincoln Tower Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Low voltage for ethernet cabling for data ports and WAP's
Contractor: BLUE HORIZONS TECHNICAL SOLUTIONS INC Owner: LINCOLN CENTER LLC
1982 NE 25TH AVENUE SUITE 14 BY SHORENSTEIN PROPERTIES LLC
HILLSBORO,OR 97124 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-939-3633
PHONE:
FAX. FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/23/2022 $75.00
12%State Surcharge-Electrical 08/23/2022 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCN: 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
Total $84.00
Security Alarm: 0 Other: 0
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 OA952-001-0090. You ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or .800.332.2344.
Issued By: J ILi7 /1 Permittee Signature:
JL
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
Date:
OWNER'S SIGNATURE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'N /3 Off Date: —Z'Z
LICENSE NO. ! L F,2k
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
_
Received Permit#
City of Tigard Date/B : 8 '
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Related Pennit#:
i Phone: 503.718.2439 Date/By:
Email: TigardBuildingPermits@Tigard-or.gov Ready Date/By: runs: See Page 2 for
Inspection Line: 503.639.4175 Internet: www.tigard-or.gov
Notified/Method: Supplemental Information
TYPE OF WORT{ PLAN REVIEW
❑New construction ;KAddition/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 ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling .Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION
[I Emergency system. larger separately derived
` ❑Addition of new motor load of system.
Job#: Job site address: 10 (� N 1V� IOOHP or more. ❑"A","E","1-2","1-3",
occupancy.
❑Six or more residential units.
City/State/ZIP: �C a ❑Health-care facilities. ❑Recreational vehicle parks.
• ❑Hazardous locations. El Supply voltage for more than
oject name: 600 volts nominal.
Suite/bldg./apt.#: S Pr ❑Service or feeder 600 amps or more.
Cross street/directions to job site: `,M
FEE SCHEDULE
Description Each Total
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']500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
• w 1Gl T ��• with above s .
W Limited energy,multi-family 75.00 2
• residential with above sq.ft.
DA C a
WAF; Renewable Ener [I See Page 2
PROPERTY OWNER ❑ TENANT Services or feeders installation alteration and/or relocation
Name: 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Address: 401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) Over 1,000 amps or volts 552.2(1 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
I----
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 er pane
El APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
Business name: above service or feeder fee, 7.42 2
each branch circuit
Contact name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2
Address: branch circuit
Each add']branch circuit 7.42 2
City/State/ZIP: Miscellaneous service or feeder not included
Phone:( ) Each manufactured or modular 67.84 2
dwelling,,service and/or feeder
Email: Reconnect only 67.84 2
CONTRACTOR Pump or irrigation circle 67.84 2
• �— ( • Sign or outline lighting 67.84 2
Business name: 1 (�• •' 'l Signal circuit(s)or limited-energy
See Page 2 2
Address: panel,alteration,or extension.
Each additional inspection over allowable in an of the above
W-
City/State/ZIP: , ` D Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 90.00/hr
Phone: ) ' 3 Industrial plant(1 hr min) 78.18/hr
Email: ma / Inspections for which no fee is 90.00/hr
specifically listed %hr min
CCB Lic.: Electrical Lic.:� Suprv.Lie. ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: _ Subtotal:
Print name: Date: 8-�3-Z0� ❑Plan Review Required(25%of permit fee):
A� State surcharge(12%of permit fee):
7 TOTAL PERMIT FEE:
Authorized signature: This permit application expires it a permit is not obtained within 180
Date: days after it has been accepted as complete.
Print name: 46-TrZ— * Number of inspections allowed per permit.
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Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
Fee for all residential systems combined: $75.00 Description Each Tntat
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 s stems in excess of 25 kva:
❑ Burglar Alarm 25.01 to So kva 301.04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 kva(tee in accordance
with OAR 918-309-0040) 552.26 2
❑ Heating, Ventilation and Air Conditioning
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
Each additional inspection over allowable in an of the above:
❑ Other: Each additional inspection is 66.25/hr
!n I
charged at an hour] 1 hr min
Inspections for which no fee is
s ecificall listed /,hr min 90.00/hr
77-7
r '7777777
Fee for each commercial system: $75.00 subtotal(Enteron Page >: i
(SEE OAR 918-309-0000) * Number of inspections allowed per permit.
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
K 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
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