Permit , ELECTRICAL RESTRICTED ENERGY PERMIT
1 gi
`
I _,- :,- . :, -: . -: CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00076
_ ,E _ Date Issued: 04/30/2010
,. � 13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171
TIGAR Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 960
Subdivision: LINCOLN TOWER Lot: 0
Project: Northwest Mortgage Group
Project Description: Data telecommunications installation
FEES
Owner: Description Date Amount
LINCOLN CENTER LLC
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 04/30/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 04/30/2010 $8.14
PHONE:
Contractor:
SUPERIOR TEL
PO BOX 69599
PORTLAND, OR 97239
PHONE: 503 - 242 -1543
FAX: 503 - 241 -3704
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: Y Fire Alarm: N
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 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 -601 -410 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
'���- pL/ Cel' % /d�
Issued By: /Vj Permittee S ignature: (? �!
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 603.639.4176 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.
2
Electrical Permit Application - – . - - - FOR OFFICE -USE ONLY _ _ _ _ ..
City of Tigard Date/By: tF S9/6 502494— Permit N o . 814€42o/O — e)00 7
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie'
a Phone: 503.639.4171 Fax: 503.598. ] Date /By Other Permit
p
Ins ection Line: 503.639.4175 RECEIVE D Date Ready/By: l El See Page 2 for
TIGARD N otified Method: Su lementalInformation
Internet: www.tigard- or.gov 1 1 pp
TYPE OF WORKAPR 2 7 Z010 PLAN REVIEW •
❑ New construction ® Addition/alteration/re lace Please check all that apply (submit 2 sets of plans w /items checked below):
CITY OF "MAW ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: C �{� [�� where the available fault current 0 Marinas and boatyards.
CATEGORY OF COOF N DIVISION 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 ® Conunercial/ildustrial ❑ 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 1 -3",
Job no.: Job site address: 10260 SW Greenburg Road 100HP or more. occupancy.
El Six or more residential units. ❑Recreational vehicle parks.
City /State/ZIP: Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: 960 Project name: Northwest Mortgage Group ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, esidential
gy 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 67.84 2
Limited Energy Cat 5 cabling 9 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or Tess 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 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 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: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: ' /Staie/1,I1' Each manufactured or modular 67.84 2
5 dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
1
Business me: Superior Tel panel, alteration, or extension. Page 2 67.84
name: 2
Each additional inspection over allowable in any of the above
Address: PO Box 69599 Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Portland OR 97239 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (503) 242 - 1543 I I Fax: (503) 2 i { 704 1 l I i i Inspections for which no fee is
90.00/ hr
I 1 I n specifically listed (' /z hr min)
1 C B Lic.: 78741 I I Electrical Lie.: 26 -712CL 1 uprv. Lic 1664 LEB
ELECTRICAL RJCAL PERMIT FEES
� Subtotal: 67.84
Suprv. Electrician signature, required: ` �� /,L c Plan review (25% of permit fee):
Print name: Vance N Broady Date: 4.26.10 State surcharge (12% of permit fee): 8.14
,A TOTAL PERMIT FEE: 75.98
Authorized signature: de/ �� This permit application expires if a permit is not obtained within l80
`/`� .�-7 days after it has been accepted as complete. `�
Print name: Y �� N yew Vt �� N, Date: 4.26.10 * Number of inspections allowed per permit.
\
l: \Buil ding Penults \EI.C- PermitApp.doc 10/01/09 440- 4615T(II /05'COM/Wt6
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORRONLI'i
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 WORKONLY;
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ 13oiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ 1 andscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
I: \Building \Permits \ELC- PermitApp.doc 10/01/09