Permit ELECTRICAL RESTRICTED ENERGY PERMIT
1,
CITY OF TIGARD
2 - -- COMMUNITY DEVELOPMENT Permit #: ELR2010 -00132
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/23/2010
T 1 Gtl R1J g Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 280
Subdivision: LINCOLN ONE Lot: 0
Project: FX Global
Project Description:
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 07/23/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 07/23/2010 $9.00
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 $84.00
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 OUNC by calling 503.246.6699 or 1.800.332.2344 /
Permittee S i nature: eA/ '/ L- / £` / � a' `,
Issued By: 9
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.
2 ..."...,..,„ ,. .. - ' , 0 R OFFICE USE�,ONE .']. .,a . ,! : -;.
Electrical Permit Application Received _
Cl of Ti a nd � ��� Date /By: .2A—;A 'a/0 -i9 _y�
g
■ 13125 SW Hall Blvd., Tigard, OR yI'';{o r Plan Review
[/ (/
�,� Date /By: Other Permieu��10 'o f6 y
r ,,,
k _ • • • Phone: 503.639.4171 F ax: 503.5 •N; .. 960 9.4 L Date Ready /By: Juris: 7 (�cc Page 2 for
t! Inspection Y ine: 503.634.4
I nternet: wwtn 175
T ,�� R� Notified /Method: l SupplcmenSupplemental Information
. tigard or -gov S1 rj�' ,�
TYPE OF WORK r 0 3 \ ) ,l1 PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement .t`` L'Cly Please check all that apply:
El 4iv Demolition ❑ Other: CJ Service over 225 amps, comm'I ❑ Hazardous location
• CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
❑ 1- and 2- family dwelling H Commercial /industrial ❑ Accessory building of 1- and 2- family dwellings 4 or more new residential
❑ 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.: C10172 Job site address: 10300 SW Greenburg Rd ❑ Occupant load over 99 persons El Manufactured structures or
❑ Egress /lighting plan RV park
City /State /ZIP: Portland, Or. 97223 E] Health -care facility El Other:
Submit 2 sets of plans with any of the above.
Suite/bldgiapt. no.: 280 Project name: ox n erns tonal The above are not applicable to temporary construction service.
FEE SCHEDULE
Cross Street/Directiol site: , )C 6 -64 6 e9-L-- - Description I Qty. I Fee. I Total I
New residential - single or multi - family dwelling unit.
Subdivision: Lot no.: Includes attached garage.
1000 sq. R. or less $ 168.54 4
Tax map /parcel no.: - Ea. Add'l 500 sq. ft or portion $ 33.92 1
DESCRIPTION OF WORK Limited energy residential $ 75.00 2
ItZ ;`.Z/f — lf/ /' . T7 j ('- T /aAr3 Limited energy, non residential $ 75.00 2
Each manufactured home or modular
..._, PROPERTY OWNER 1 Li TENANT dwelling, Service and /or feeder $ 67.84 2
Name: Service or feeders installation, alteration, and /or relocation
200 amps or less $ 100.70 2
i Address: 201 amps to 400 amps $ 133.56 2
401 amps to 600 amps $ 200.34 2
City /State /ZIP: 601 amps to 1000 amps $ 301.04 2
Over 1000 amps or volts $ 552.26 2
Phone: Fax: Reconnect only .. . S 67.84 2
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 - -- : " 'S. - 59.36 1
Owner signature: - Date: 201 amps to 400 amps ' - • ' "
n.' }, ;'$ : 125.08. 2
401 amps to 599 amps .. • - ' :. . ` $' 168.54' - ' 2 -.
• ❑ APPLICANT - 1 ❑ CONTACT PERSON - Branch circuits - new, alteration, or extension; per panel, - A. Fee for brancli circuits with •
- - - Business Name:
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: $ 7.42 2
City /State /ZIP:
.. Miscellaneous (service or feeder not included)
Pump or irrigation circle $ 67.84 2
Phone: . —
:... Sign or outline lighting — $ 67.84 2 -
_ E =mail: Signal circuits(s) limited-
CONTRACTOR energy panel, alters ion, or ____
1. 'i:'r,• extension. Describe: Tele /Data 1 75 75.00 2
:: Business Name: Capitol Data & Communications, Inc.
Page 2
Contact name: Each additional inspection over allowable in any of the above
, : Per inspection $ 66.25
Address: 11401 NE Marx Street Investigation per hour (1 hr min) $ 66.25
- Industrial plant per hour $ 78.18 -
• City /State /ZIP: Portland, Oregon 97220 ELECTRICAL PERMIT FEES*
Subtotal 75.00
Ph 503 - 255 -9488 - Fax: 50 - 257 -7121 Plan review (25% of permit fee)
_wiser State surcharge ( I2% of permit fee) - 9.00 • /
CCQ Lic::" ' '' Electrical Lic.: 26- 19A9CLE Suprv. Lic.: 2757LEA TOTAL PERMIT FEE 84.00 ✓
.••:,.. rv. E t IuI o /
Su r natur . ee , re q ui red: - � / . • . . . /� /6/// / I This permit application expires if a permit is not obtained within 180
a it5r / ` 1' r �_ days after it has been accepted as complete
Print Name: Terry Brasch ` Date: 07115110 * Fee methodology set by Tri- County Building Industry Service Board
Authorized signature: * *Number of inspections per permit allowed.
• Print Nanie: Terry Brasch