Permit _� CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
ay COMMUNITY DEVELOPMENT Permit #: ELR2010 00081
Date Issued: 05/11/2010
tT t G AR OI 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Subdivision: LINCOLN TOWER Lot: 0
Project: Axiom EPM
Project Description: Low voltage for fire alarm.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 05/11/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 05/11/2010 $8.14
PHONE:
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360 - 699 -2130
FAX: 360 - 719 -1527
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: y
HVAC: N Instrumentation: N Total $75.98
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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. AT • • '. •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -1010 through 0 • - 952 -00 -$100. You may obtai a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue. =y: k . _ . ! A� Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
'TOR' OI H ICF US- ONLI ;
Received
- 71 <: City of Tigard DateB : /f f Permit No.: it2o?o /o —oez
III a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
'`' Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit: / O$ A —(X2QS3
Inspection Line: 503.639.4175 Date Ready /By: Juris: H See Page 2 for
T IG �RD1 N otified/Method: Supplemental Information
:.,-.1 =,..,.,:, Internet: www.tigard- or.gov
TYPE OF WORK • PLAN REVIEW
❑ New construction ® Addition /alteration replacement
Please check all that apply (submit 2 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.
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 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: 1096 Job site address: 10260 SW Greenburg Rd 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard OR ['Health facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 710 Project name: Axiom ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Lincoln Tower Description 1 Qty. 1 Fee. 1 Total 1
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.) 67.84 2
Limited energy, multi - family 67.84 2
Fire alarm residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
• ® APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: Safe Technology Group Inc. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Jason Sweet branch circuit
Each add'I branch circuit 7.42 2
Address: 6400 NE Hwy 99 Suite G375 Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: Vancouver WA 98665 dwelling, service and/or feeder 67.84 2
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: sales @safetechnology.net
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Safe Technology Group Inc. panel, alteration, or extension. I Page 2 67.84 2
Each additional inspection over allowable in any of the above
Address: 6400 NE Hwy 99 Suite G375 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Vancouver WA 98665 Investigation (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (360) 699 - 2130 Fax: (360) 719 - 1527 Inspections for which no fee is 90.00! hr
specifically listed (/ hr min)
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv. Lic.: 4272LEA ELECTRICAL PERMIT FEES
/Y
05 Subtotal:
Suprv. Electrician signature, required: j Plan review (25% of permit fee):
Print name: Jason Sweet Date: 5 -6 -10 State surcharge (12% of permit fee):
�
Authorized signature: ) TOTAL PERMIT FEE: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Jason Sweet Date: 5 - - * Number of inspections allowed per permit.
1: \BuildingWermits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
1 RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL 'WORK ONLY:
Fee for each commercial $67.84
system
(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
n 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
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09