Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN `a'` CO MMUNITY DEVELOPMENT Permit #: ELR2009-00346
Date Issued: 12/01/2009
T [ G ARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 300
Subdivision: Lot: 0
Project: Forest City
Project Description: Install restricted energy for voice /data.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 12/01/2009 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 12/01/2009 $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
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 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- 001 -0100. You may obtain a copy of the rules or direct questions to (DUNG by calling 503.246.6699 or 1.800.332.2344.
■
Issued By: ' y ' A ,r t, `- � LtC k 1� Permittee Signature:
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' `C�' n n "ATOP 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.
,:
1.x/30/2009 11:49 5032551966 CAPITOL ELECTRIC PAGE 03
E V ' FOR ectirica� e�r�ml4 A��lucat� D / E (2OG '33 3 (4
Permit no.:
. , , B ` Date /By:
` City of Tigard Pl Review A .
4 '' n ' '/009 Other Permit: ,•y' ( /1 I.ee� .d?
} 13125 SW Hail blvd Tigard. OR 972230 V Date /By:
a Phone: 503.6394171 Fax: 503.598,1960 Datc Ready /By: 7uris: I _ k« Pau 2 mr
Inspection Line: 503.639.4175 F G ,/� R � n
�T.I:G \ItU CITY TI�tAa�tJ Notified/Method: nal - SomnlcmenttIhrnrmndnn
r+ 'r•a I nternet: www.tignrd- cw.gov 1
TYPE OF WORK F'L?t \ :1 riiv • •-
t- RI�!(1
PLAN RL•VIL \V
I_I New construction 1 :d Addition /alteration /replacement Please check all that apply:
Demolition ❑ Other: ❑ Service over 225 amps, comm'I ❑ Hazardous location
CATEGORY OF CONSTRUCTION I. Service over 320 amps - rating ❑ Building over 10.000 sq.ft.
I,. -f I- and 2-family dwelling I . 1 Commercial /industrial Li Accessory building of 1- and 2- family dwellings 4 or more new residential
Li Multi. fam 11 ily ❑ Master Builder Other 7 t System over 600 volts nominal units In one structure
JOB SiTE INFORMATION AND LOCATION LI Building over three stories ❑ Feeders. 400 amps or more
Job no.: C90313 Job site address: 10250 SW Greenberg ❑ Occupant load over 99 persons El Manufactured structures or
egress /lighting plan RV park
City/Slate/41 P: Tigard OR 97223 L Health-care facility Other:
Submit 2 sets of plans with any of the above.
Stlitc/bldg. /apt, no.: 300 Project name: Forest City Trading The above are not applicable to temporary construction service.
FEE SCHEDULE
Cross Strcct/Directions to jnh Site: Description I Qty. I Fee. I Trot _. 1
New residential - single or multi - family dwelling unit.
Subdivision: Lot no.;
includes attached garage.
1000 sq. ft. or Icss 5 168.94 4
Tax map /parccl_no.: Ea. Add'1 500 sq. ft or portion $ 33.92 1
D ESCRTPTION OF WORK Limited energy residential 6 67.84 2
Network Cabling Limited energy. dolt- reSidential 5 67,84 2
Each manufactured home or modular
L PROPERTY OWNER 1 L TENANT dwelling, Service and /or fccdcr 5 90.90 2
Service or feeders Installation, alteration, and /or reInoslInn
Name: T -
200 amps or less 5 teu.7u 2
Address: 20] amps to 400 amps , S 132.56 2
401 amps to 600 amp$ 5 200.34 2
City/State./ZIP: 601 amps t0 1000 amps S ?01.04 2
Over 1000 amps or volts $ 552.26 2
Reconnect only 67.0 2
Phone: Fax:
Temporary services or feeders installation, alternfnn, and /or
Owner installation: This inaWliation is being made on properly rl;at f own which in not relocation
inlendccl for sale. lease. rent or exchange, according to ORS 447. 449.670, and 701 200 amps or Icss $ 50.39 1
Owner signature: Date: 201 amps to 400 amps 5 1 25.05 2
401 amps t0 599 amps 5 168.54 2
L APPLICANT J L CONTACT PERSON Branch circuits - new. alteration. or extension. per panel
Business Name: A. Fcc for branch circuit with
service nr fccdcr fcc. each
Contact name: branch circuit S 7.42 2
B. Fee for branch circuits
without service or fccdcr rec.
Address:
cash branch circuit 5 56.18 2 _
City/State/ZIP: Each additional bench circuit:: 5 7.42 2
Miscellaneous (service or feeder not Included)
Phone: Fax: Pump or irrigation circle $ 67.84 2
Sign or outline lighting 3 07.84 2
ii-mail: Signal circuits(s) or limited-
CONTRACTOR energy panel. alteration. or
Business Name: Capitol Data & Communications, Inc.
extension. Describe; 1 Page 2 2
Network Cabling
Contact name: Ray Younger F,ach odd :t /onal inspection over allnwahle In any of the above
Per inspection 5 66.25
Address 11401 NE Marx Street investigation per hour (1 hr min) $ 66.25
industrial plant per hour S 78.15
City /State /ZiP: Portland, Oregon 97220 ELECTRICAL PERMIT FEES*
Subtotal
Phone: 503.255.9488 Fax: 503,257 -7121 Plan review (25% of permit foe)
State surcharge ( 1256 of permit feel
• CCB Lic.: 14257 jElcctricnl Lic.:261054.. fl7 1 Suprv. Lic.: 2834 LEA TOTAL PERMIT FEE 1' y8
Suprv. Electrician signature, required: _. -.. Thin prrmlt nppllearinn in pipet it n permit to nor inhumed within 166
(nyn after 15 hm hexn screwed nn cumplrle
Prins Name: Ra Y ..,tt.9S l 09 • Fee methodology set by Tri- County Building industry Service Board
Authorized sigrlahtra: . "Nunhe - inspections per permit allowed.
Print Nanlc: Ra Youn- _,'
e iorc C I C)1.11i1. ( Q
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