Permit r t,ti ELECTRICAL RESTRICTED ENERGY PERMIT
,,:�, CITY OF TIGARD
`�c v
d — COMMUNITY DEVELOPMENT Permit #: ELR2010 -00038
T 1 GAR0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/03/2010
Parcel: 1S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 112
Subdivision: LINCOLN BUILDING Lot: 0
Project: NVoicePay
Project Description: Low voltage for voice & data.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 03/03/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 03/03/2010 $8.14
PHONE:
Contractor:
CAPITOL DATA & COMMUNICATIONS
11401 NE MARX ST
PORTLAND, OR 97220
PHONE: 503 - 255 -9488
FAX: 503- 257 -7121
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 ' issued su•1- to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done ' accordance with a. .roved 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. TENTION: Oregon law -• es you to follow the rules adopted by the Oregon Uti' .•- - =nter. Those rules are set forth in OAR
952 -00 -0010 through OAR 952- o may obtain a copy of the rules or direct questions to 'a I 41 0 . 114146.6699 or 1.800.332. 44.
Iss d By: (r 1 L.. , Permittee Ii _/ " r /.0
OWNER INSTALLATION ONL
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.
Cali 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.
.. ' ;� r' , 'r ' FOR OFFICE USE ONLY ., - ,t
Electrical Permit Applica ' i �� r Received QQ ' ^ p F i _ '_ ^ Cc\ : Date /By: d ��� Permit no.: t� 010/e9 _ 0003e C of Ti all ga v rd 97 _^ rl 10 Plan Review
13125 SW H B T O R a R �+ L� Date /By: Other Permit:
J -- 1 2, ' Phone: 503.639.4171 Fax: 503.59811M
` I +ee Page 2 for
t
r rp,� Date Ready /By: Juris: L
Inspection Line: 503.639.4175 4 i! kt+
TIGARD- � ( L_l 1' j Notified /Method: Supplemental Information
Internet: www•.tigard -ongov C1� j �
.
TYPE OF WORK 5X‘Vt- J PLAN REVIEW
Li New construction L Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: ❑ Service over 225 amps, comm'I ❑ Hazardous location
CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
U I- and 2- family dwelling Li Commercial /industrial U Accessory building of 1- and 2- family dwellings 4 or more new residential
Cl Multi - family ❑ Master Builder ❑ Other ❑ System over 600 volts nominal units in one structure
JOB SITE INFORMATION AND LOCATION Cl Building over three stories ❑ Feeders, 400 amps or more
Job no.: C10057 Job site address: 10250 SW Greenburg Rd. ❑ Occupant load over 99 persons El Manufactured structures or
❑ Egress /lighting plan RV park
Ciry /State / "LIP: Portland
El Health-care facility El Other:
Submit 2 sets of plans with any of the above.
Suite /bldg. /apt. no.: 112 Project name: NVoicePay The above are not applicable to temporary construction service.
FEE SCHEDULE
Cross Street/Directions to job site: Description I Qty. I Fee. I Total
New residential - single or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Let no.:
1000 sq. ft. or less S 168.54 4
Tax map /parcel no.: Ea. Add'I 500 sq. ft or portion 8 33.92 1
DESCRIPTION OF WORK • Limited energy residential S 67.84 2
Install voice and data cables Limited energy, non- residential S 67.84 2
Each manufactured home or modular
U PROPERTY OWNER 1 LJ TENANT dwelling, Service and /or feeder S 90.90 2
Service or feeders installation, alteration, and /or relocation
Nanie:
200 amps or less S 100.70 2
Address: 201 amps to 400 amps 8 133.56 2
401 amps to 600 amps S 200.34 2
City /State /ZIP: 601 amps to 1000 amps S 301.04
Over 1000 amps or volts S 552.26
Phone:
Reconnect only 5 67.84 2
. _.: • Fax:
503- 295 -5555 Temporary services or feeders installation, alteration, and /or
Owner installation: This installation is being made on property that I own which is not relocation .
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less 5 59.36 1
Owner signature: Date: 201 amps to 400 amps S 125.08 2
401 amps to 599 amps 8 168.54 2
U APPLICANT 1 ❑ CONTACT PERSON Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
Business Nanie:
service or feeder fee, each
branch circuit S 7.42 2
Contact name:
B. Fee for branch circuits
without service or feeder fee,
Address:
each branch circuit S 56.18 2
Each additional branch circuit: S 7.42 2
City /State /ZIP:
Miscellaneous (service or feeder not included)
Phone: Fax: Pump or irrigation circle S 67.84 2
Sign or outline lighting 5 _ 67.84 2
E -mail: Signal circuits(s) or limited-
CONTRACTOR energy panel, alteration, or
Business Name: Capitol Data & Communications, Inc. . extension. Describe: Tele/Data 1 67.84 67.e4 2
Page 2
Contact name: Terry Brasch Each additional inspection over allowable in any of the above
Per inspection S 66.25
Address: 11401 NE Marx Street Investigation per hour (1 hr min) S 66.25
Industrial plant per hour S 78.18
City /State /ZIP: Portland, Oregon 97220 ELECTRICAL PERMIT FEES*
Subtotal 67.84
Phone: 503 - 255 -9488 Fax: 503 257 - 7121 Plan review (25% of permit fee)
. State surcharge ( 12% of permit fee) 8.14
CC13 Lic.: 14257 (Electrical Lic.: 26 - - CLE 1 . Suprv: Lic.: 275 TOTAL PERMIT FEE 75.98
This permit application expires if a permit is not obtained within 180
Suprv. Electrician signature, required: 1 ,------)------- .
.. days after it has been accepted as complete
Print Name: Terry Brasch • Date: 02/24/10 • Fee methodology set by Tri- County Building Industry Service Board
' "Number of inspections per permit allowed.
Authorized signature: ..----,---"--
Print Name: Terry Brasch