Permit 1 z "', ���� OF TIGARD
t ELECTRICAL RESTRICTED ENERGY PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELR201000082
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/11/2010
TIGARD g
Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 300
Subdivision: LINCOLN ONE Lot: 0
Project: North Pacific Group
Project Description: Voice and data cabling
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:
STONER ELECTRIC
1904 SE OCHOCO
MILWAUKIE, OR 97222
PHONE: 503 - 462 - 6500
FAX: 503 - 659 -4968
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 ,
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 Munidpal 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 0 95 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by caning 503.246.6699 or 1.800.332.2344.
AV
Issued By: P � - -- Permittee Signature:
6/V- /aZ; e
i
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 503.639.4176 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.
May. 7. 2010 1:49PM No. 2620 P. 1 5
It
Electrical Per LLLWAI a tl< on rl 1 'Ill (1 N l � ;
City of Tigard nalor S !! /Q 4071/0 P irii(vec c2 AEI .
I y: /� 010 -(JC O F
M ? a 13125 SW Hall Blvd., Ti OR 97223 MAY - e 2 0 � 0 Plan Review
3;',s ®' Phone: 503- 639.4171 Fax: 503.5911.1960 Date/ily- other permit:
,i� !I ( , , I ` �a TiG
inspection Line: 503.639.4175 CITY OFAR DaleReady/By: ruff' ® See Page 2for
wanirs'aa;ix: " "; ,t Internet: www.Ngard- or.gov Notibed/Method: Supplemental Information
BUILDING DIVISI& I .
TYPE OF WORK PLAN REVIEW
Please chock all that apply (submit seta of plane whims checked below):
❑ New construction 2rAddition /alteration/replatxnlent
❑ Service or feeder 400 amps or more 0 Building over the 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
0 1 - and 2-family dwelling ,CommerclaUindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other; ❑ Fire pump. I] Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
4O0 SITE INFORMATION AND LOCATION ❑ Addition of new motor load of 0 "A ", 'B ", "1 -2 ", "1 -3 ",
Job no.: ( v Job site address: iO3 5vJ Creed 6 ./∎9 270 S�HPormoro. ccy-
(I 0 ,p (/ ❑ R
Six or more residential units, ❑ ecre vehicle parks_
City/ State/ZIP: r 1 a V01 V f� ���., ❑ Hea facilities. ❑ Supply volutes for more than
r 1 ❑ Hazardous locations. 600 volts nominal.
Sulte/bldg. /apt- no.: .3 Project nam C l i t 6�OU Ip ❑ Service or feeder 600 amps ormore.
FEB SClIEDULE
Cross street/directions to job site: - Devcrl • -Ion I Qh I Fee, I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage,
Subdivision: Lot no.: 1,000 sq. It or less X 16 - _ 8_54 4
steel no.: Ea. add'l 500 sq. R. or portion 33.92 _ 1
Tax ma
1/P Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 67.84 2
Limited energy, multi - family 67.84 2
V O t c. bd�, GI RA Nto _ , residential wim above sq. ft.)
Servleta or feeders installation, alteration and/or relocation
_ 200 amps or Leas 100.70 2
❑ PROPERTY OWNER. I D TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps 0 600 amps 200.34 2
601 amps to 1,000 amps I 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ZIP; Temporary services or feeders Installation, alteration, and/or
relocation
`
Phone: ( ) Pax: ( ) 200 amps or less _ 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amp 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, er panel
Owner signature ;,_ _ Date: A. Pee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON • above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 56.18 2
_ _ first branch circuit
Address: Each add'I branch circuit 7.42 2
- -- Miaeellaneous (service or feeder not include
City/State/ZIP: Poch manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) 1 Pax :: ( ) Reconnect only — 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR . • Sign or outline lighting 67.84 2
me: S TONER ELECTRIC, INC.
Signal
nergy panel, or alteration, Business na , _ energy panel, alteration, or u
Address: 1904 SE OCHOCO extension. Describe; Page 2 67' 9 r 2
City/State /ZIP: MILWAUKIE, OREGON 97222 - Each additional Inspection over allowable in an of the above
Per inspection 66.25
0.7. "ono: ( 5 462-6500 I Fax: (503 59 -4968 /Investigation per hour (1 hr min) 66.25
CB Lie.: 44823 I/ Electrical Lie.: 26 220 Suprv. Lie.: 3496S Industrial plant per hour r 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: �w S ,L , , ,, --- 7;;;; - .. --- 7 - 6 - 7 - 4 - 2/3 --
ub
Stotal: t
Print name: MICHAEL FALCONER Date: 511 I 0 Plan review (25 %ofpermit fee) ., —
I i Slate surcharge (12% of permit fee): b1 , i /7
Authorized signature: TOTAL. PERMIT FE13, 75,1 g
This permit appllcadon expires if a permit la not obtained within leo
Print name: Date: •-�- •.. - - -- -• -•-
May. 7. 2010 1:49PM No. 2620 P. 2
' Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: -
Fee for gjj 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:
ti COMMERCIAL WORK ONLYt
Fee for Bach commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
X 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 sys
*No licensee are required. Licenses are required .
for all other installations