Permit rW` CITY ®F TIGAR® ELECTRICAL RESTRICTED ENERGY PERMIT
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l : ® COMMUNITY DEVELOPMENT Permit #: ELR2010 00067
+ Date Issued: 04/27/2010
T E GAM./ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 380
Subdivision: LINCOLN CENTER/TWO LINCOLN Lot: 0
Project: Waldron Co.
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
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permi . subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do. - in accordance . appro ed plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day . ATTENTION: Oregon re. ir ou to follow the rules adopted by the Oregon Util a ation enter. Those rules are set forth in OAR
95 - 001 -0010 through OAR • •11-010 • may obtain a copy of the rules or direct questions to s 1 NC b ' ..6699 or 1.800.332.2 44. •
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sued By: � Permittee -': nature: �' � i.� V
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.
CaII 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.
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Electrical Permit Application ati I " I OR OFFICI _ IJS L ON 1 , ,
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- "' City of Tigard
( r Received . a.
l P ;r„ yam, , �s� �. Permit No.: /—/ '7
a `J g DateB : v /0 „11I, GL • / r "19 d (/ 6
4 a 131 25 SW Hall Blvd., Tigard, OR 97223 P Review
II 1:111 , Phone: 503.639.4171 Fax: 503.598.1960 APR 2010 DateB : Other Permit/C-Ac2.0/t, rr
Inspection Line: 503.639.4175 Date Ready/By: Juries ® See Page 2 for
T 1 GA D { Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: .11 Supplemental Information
• TYPE OF Wi#LDING DIVISION 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 -2 ", "1 -3 ",
Job no.: Job site address: 100HP or mare. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 10220 SW Greenburg Rd ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: 380 Project name: Waldron ❑ Service or feeder 600 amps or more.
FEE SCHEDULE .
Cross street/directions to job site: Lincoln 2 Description 1 Qty. 1 Fee. I 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
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. 1 Page 2 67 2
Each additional inspection over allowable in any of the above
Address: 6400 NE Hwy 99 Suite G375 Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Vancouver WA 98665 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 (1: hr min)
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv. Lic.: 4272LEA ELECTRICAL PERMIT -FEES • .
/
Suprv. Electrician signature, required: S Subtotal:
Plan review (25% of permit fee)) : 67.84
Print name: Jason Sweet Date: C/-,2 State surcharge (12% of permit fee): F, Authorized signature: /
,fi'i TO TAL PERMIT FEE: /25 , tp n Jason re: T his permit application expires if a permit is not obtained within 180
days after it has been accepted as complete. Print �'1
Print name: Jason Sweet Date: 4 - - • Number of inspections allowed per permit.
I:\Building\Permits\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:
RESLD.ENTIAL,WORK . •
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
I - 1 Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
1 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
H HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \ Permits \ELC- PermitApp.doc 10 /01 /09