Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
f COMMUNITY DEVELOPMENT Permit #: ELR2010 -00136
Date Issued: 07/27/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 120
Subdivision: LINCOLN ONE Lot: 0
Project: Genex
Project Description: Data and Telecommunications.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 07/27/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 07/27/2010 $9.00
PHONE:
Contractor:
A -REBS COMMUNICATIONS INC
5855 SW TARALYNN AVE
BEAVERTON, OR 97005
PHONE: 503 - 520 -0625
FAX: 503- 641 -5216
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 the Oregon Utility Notification Cent- hose r les are set forth in OAR
952 001 - 0010 through OAR 952 - 001 -0100. You ma ob -'. - • • • • - .: s.to OUNC by calling 503.246.6699 or 1.8t iv. 2344.
Issued By: /_ � �� Permittee Signature: lI� 1 rl
agra.w.
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.
Electrical Permit Application �� TN I OR t)i l lcl tit ONl
City of Tigard ECEI Received permit No.: 6
114 Date/B t .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
10 ® Phone: 503.639.4171 Fax: 503.598.1960 7 2 0 \4 Dat : Other Permit: 41 , 0 ��
`r1 (.rA RR,n Inspection Line: 503.639.4175 .0 \L-. -4 Date Ready/By: ® See Page 2 for
Internet: www.tigard - or.gov % Ti Notified/Method: B� Supplemental Information
TYPE OF WORK C • . . PLAN REVIEW .
❑ New construction Addition/alteratiot> ment 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.
Tess 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 KVA or
JOB SITE INFORMATION AND .LOCATION ❑Emergency system. larger separately derived system.
. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
L E, JOO G f or more e more. Recreational
Job no.: Job site address: (0
300 S� 6R �� • 0 or more residential units. ❑R vehicle parks.
City /State /ZIP:. RTLAJ9 OR g 7 3 ❑ Health -care facilities. ❑ Supply voltage for more than
�� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: i). 1 Project name: ❑ Service or feeder 600 amps or more.
job site: ± / _ C ( FEE SCHEDULE •
Cross street/directions to
J � L�nJt t.) 6 9,-_-,,,-.., J"'t'C .� �O Description 1 Qty. 1 Fee. 1 Total 1 "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
• DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
L OLA) V a! i,( s c. w f I residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
' 0, PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
n relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT . I ❑ CONTACT PERSON, above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /State /ZIP: Each manufactured or modular 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR . . • Signal circuit(s) or limited - energy co
Business name: _RE N C panel, alteration, or extension. Paget 2
p 6 Each additional inspection over allowable in any of the above
Address: G g SS S(,) (Af.AL�l/Jl4 A,k/ Additional inspection (1 hr min) 66.25/ hr
� - w t 'gyp 1V /l l Investigation (1 hr min) 66.25/ hr
City /State /ZIP:
k Jr1'�V ' J V J 7 0 U 5 Industrial plant (1 hr min) 78.18 / hr
Phone: ( ) Fax F Inspections for which no fee is
90.00 / hr
! ^ d specifically listed (%: hr min)
CCB Lic.: yy ( Electrical Lie.: Y - t-cc Suprv. Lic.: LE$ 2Y30 ELECTRICAL PERMIT FEES .
Suprv. Elecerlbla l gnature, required: 7 / t / fl - 7 /t )tl o Subtotal: 7S
Plan review (25% of permit fee):
Print name: j 6 . - V ,\} 6. Date: 0 , �3 . / o State surcharge (12% of permit fee): q ( tic)
TOTAL PERMIT FEE: Fy
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Num of inspections allowed per permit.
1: \ Building \Permits\ELC- PermitApp.doc 07 /01 /10 440- 4615T(1I /05 /COM /WEB
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:
❑ Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n 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:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
n 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
C\Building\Permits\ELC- PermitApp.doc 07/01/10