Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00068
"T I GAFt.D' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/27/2010
Parcel: 1S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 350
Subdivision: LINCOLN TOWER Lot: 0
Project: Clean Net
Project Description: Fire alarm.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 04/27/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 04/27/2010 $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 Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 - . • • - - +- 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. • ENTION: Oregon' requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 thr gh OAR 952- 001 -01 . ou may obtain a copy of the rules or direct questions to OUNC b c ' 503. 46.6699 or 1.800.332.23444.
Iss -d By: • / Permittee • nature: �� ✓
-'
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.
• pi •
E►'tctrical Permit Application -r . . OR OFFICI WSE ONLY
City of Tigard APR .21.2010 Received / (�
Ill ` 1 g DateB y 0 /0 +i Permit No.: / aQ _ Q� 10 O'
4 1 3125 SW Hall Blvd., Tigard, OR 97223 P lan Review
C :. Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGARD Date/B : Other Permit: /6yad --MO ys
Inspection Line: 503.639.4175 D Date Read /B H
Internet: www.tigard- or.gov Supplemental See Page 2 for
TIGARD p BUILDING DIVISIO Notified/Method: Information
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
JOB SITE INFORMATION AND LOCATION ' • ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: IooHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 10260 SW Greenburg Rd ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 350 Project name: Clean Net ❑ 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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
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
Name: 401 amps to 600 amps 200.34 2
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 I25.08 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, Qer panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT above service or feeder fee,
❑ CONTACT PERSON each branch circuit 7.42 2
Business name: Safe Technology Group Inc. B. Fee for branch circuits without
service or feeder fee, first
Contact name: Jason Sweet
branch circuit 56.18 2
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 circuits) or limited - energy
Business name: Safe Technology Group Inc. panel, alteration, or extension. 1 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
Suprv. Electrician signature, required: f Subtotal:
Plan review (25% of permit fee): 67.84
Print name: Jason Sweet Date: £/). 0 _/ V State surcharge (12% of permit fee): r r , /i
/J /J TOTAL PERMIT FEE: 9S y4
Authorized signature: �� �5 T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Jason Sweet Date: 4 -20 -10 • Number of inspections allowed per permit.
I:\ Building \ Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(l l /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL:WORK;
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 WQRK.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
❑ 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
C\ Buildin \Permits\ELC- PermitApp.doc 10/01/09