Permit - -. - ;. q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
,.' a COMMUNITY DEVELOPMENT Permit #: ELR2009 -00353
T t GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/08/2009
Parcel: 1S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 300
Subdivision: Lot: 0
Project: Forest City
Project Description: Low voltage for fire alarm.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 12/08/2009 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 12/08/2009 $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 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 O 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
t1I Q
Issued By: l9..` .� ,k..9 A Permittee Signature: �1Z't-(�'ir, L-�_S
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.
El- ctrica Permit Application kE � : t �1 O F'
FF ICE USE
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Ii �I� j`',r -fi , 1FORr ONLY t r y _ 1`2 l
Y �p A in K "'� City of Tigard , i ` DatDate/By. . ecetved I /��C/ / Permit No.: r +L•
■ a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
§ Phone: 503.639.4171 Fax: 503.598.1960 DEC 0 8 20 Date/By: Other Permit: iii I:
'' RD Inspection Line: 503.639.4175 Date Ready/By: Ions: 0 See Page 2 for
TIGARD
.. �'. Internet: www.tigard or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF WOIILDING 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 K \':\ or
. ❑ Emergency system larger separately derived system.
JOB SITE INFORMATION AND LOCATION • ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1-
1001IP or more. occupancy.
Job no.: 9 1- / Z Job site address: v Z 5 ° 5-,/ �% e. e r'j ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: P .,- l A /I A `� 2 2. 3 ❑Health -care facilities. 0 Supply voltage for more than
i ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 3 e c.. Project name: F v , 4..5 f C t Y ❑ Service or feeder 600 amps or more.
, FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with sq. ) 75.00 2
with above s ft.
Limited energy, multi- family
75.00 2
1 (. c- i t s r . ( a.. lfA i e, r rh tl J < , / 3' f- >i d b o 5 residential (with above sq. ft. )
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
• ❑ PRO PERTY ,OWNER • ❑ TENANT 201 amps to 400 amps 106.85 2
Name:
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration. and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 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,
each branch circuit 6.65 2
Business name: Safe Technology Group Inc B. Fee for branch circuits
Contact name: Jason Sweet without service or feeder fee
first branch circuit 46.85 2
Address: 6400 NE Hwy 99 Suite G375 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
CitylState/ZIP: Vancouver WA 98665 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527 Reconnect only 66.85 2
E - mail: sales @safetechnology.net Pump or irrigation circle 53.40 2
. CONTRACTOR , • Sign or outline lighting 53.40 2
Business name: Safe Technology Group Inc. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 6400 NE Hwy 99 Suite G375 extension. Describe: 1 Page 2 75.00 2
City /State/ZIP: Vancouver WA 98665 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 699 - 2130 Fax: (360) 719 - 1527
Investigation per hour (1 hr min) 62.50
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv. Lic.: 4272LEA Industrial plant per hour 73.75
ELECTRICAL _ PERMIT FEES
Suprv. Electrician signature, required: Subtotal: last
Plan review (25% of permit fee):
Print name: Jason Sweet Date: ., 2 /6 / o
State surcharge (12% of permit fee): .Wid g.t'S`
Authorized signature: SP TOTAL PERMIT FEE: c•ft
This permit application expires if a permit is not obtained within LW,
Print name: Jason Sweet Date: 12 /8') 01 days after it has been accepted as complete. C `
* Number of inspections allowed per permit.
1:\ Building \Pemtits \ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/COM/WEB
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•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
•
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n 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
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06