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Permit ' , 71 - . , CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 2 . COMMUNITY DEVELOPMENT Permit #: ELR2010 -00161 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2010 TIGARD, Parcel: 1S135AB01004 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 410 Subdivision: LINCOLN CENTER/TWO LINCOLN Lot 0 Project: EXTERRO Project Description: (1) data telecommunications FEES Owner: LINCOLN CENTER LLC Description Date Amount BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 08/18/2010 $75.00 CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 08/18/2010 $9.00 PHONE: Contractor: COLUMBIA TELEPHONE CO. INC. 9860 SE EMPIRE CT CLACKAMAS, OR 97015 PHONE: 503 - 230 -8899 FAX: 503- 239 -5516 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 OA 52 -0 1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: i� Permittee Signature: d/1f PL / ( - 7 O Y f 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. 08/16/2010 08:53 5032395516 COLUMBIA TELEPHONE PAGE 01/02 Electrical Peet Ap ho 3 V City of Tigard AUG 17 2 010 , c.-- zY �a ,, Patetnmez.2a i, ono i lli 13125 SW Hall Blvd., Turd, OR 97223 503 ,; Phone: 503.639 -4171 Fa 14/W0/0 —40 /23 Far .5983960 / .-, r • rt .: , E 1,i; h Insp lane 503.639.4t 7s °' e ' w ;; I>+ o xaadyn3, el see Page 2 for btetnek www.tigar4^0r,8ov DU IL '- I D Notified/Method: snpptemmtaltffiotmatlon TYPE OF WORK PLAN REVIEW ❑ New construction Addition /aster at io o/re placement Please cheek all that apply (mot g set"s"or plans whims cheated below): ' O Steins or Radar 400 steps OF more 0 Building ova three stteies. ❑ Demolition ❑ Other; where the available fault custrent 0 Marinas mu/ boatyards. CATEGORY OF CONSTRUCTION ION =ne s 10900 amps et 150 volts er 0 Floating buildings. 01- and 2-family dwelling III Commercial/industrial D Accessory building less to ground, or 14 ,000 [] t:,pp tm ose agricutmral amps fbr all other installations. tmiidiags. gu. © Multi - family 0 Master builder © other: DF;re poop. D lnstefdhtion of 75 EVA or ms SITE INFORMATION LOCATION °E r tam y derived system. of ID Addition new motor load of a "A" "E„ "1-2 ", "1-3", Job no.: J Job site address: 10210 S W Gee ,1 1001i1" or more, occupancy. D six or mote residential units. O Reureatizusl vehicle parks. City/State/ZIP: P or V‘cl / OR l 9 72z3 ©HcatihCM facilities. D supply voltage for more than Hazardous locations. 600 vas nominal. Suite/bldg./apt no.: N, Pro"ect name: C18tarvice or feeder 600 or mom. J fro � FEE Sahli �t1X.E Cross street/directions to job site: 1 I 0 " p rle! 1 Air. 1 Fee 1 Tenth 1 • New residential single- or malts- family dwelling unit. Winder attached gunge. Subdivision: 1 1.01 no.: 1,000 sq, tt, or l 168.54 1 4 Fax leap /parcel110 -: Ea. addl. 500 sq. ft or portion 3392 1 Limited corny, residential 75.00 2 DESCRIPTION OF WORK • (with above sq. ft.) Limited energy, multi- family 04 OSVA m residential (will above act ft.) 75.00 2 �~ ( Services or feeder's installation _ altera$on, and/or relocation 200 amps of less 100.70 2 0 PROPERTY OWNER ❑ TENANT 201 amps to 400 and 133.56 2 Name: 401 maps to 600 amps 200.34 2 601 amps to 1,000 amps _ 301.04 2 • Address: Over 1,000 amps or volts 55226 2 City /StatelZl P: Temporary services or feeders inaiallation, altcxatfon, and/or relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 . [ 1. Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 'mil > to 599 amps 168.54 2 Branch circuits — new, alteration, or extension, , • r panel Owner signature: Dam' A. Fee Sur branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or teedar Ore, 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 sdd'1 Mauch circuit 7.42 2 Address: Miscellaneous (service or feeder not ;Waded) Each manufbetracd City/State/ZIP: or modular 67 2 - .. dwellin, service and/or feeder _ Phone: ( ) I Fax; : ( ) Reconnect otdy . 67.84 2 E-mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or amide lighting 67.84 2 Signal circuit(s) or limited-clergy i - r Business nettle: ill, alteration, or extension. Page 2 r*-�•' 2 O1 i b; 9 l _ e 4p 7tv 4 Each additional inspection aver allowable in any of the above - Address: ' , . l+ Additional inspection (1 hr lain) 66.15/ hr lmeati83 (1 66x5 /hr City/State/ZIP: C 1QckCi s I 0 r J q 7C 5 ) . F C tl pla nt (t br mitt 78.18/ hr Phone: ( 3 ) 2 O 9'( ' � ) 971-2s3 -- / 6 i which » See is _ 90.00/11, o.ao/ 1tr vecificajlY CB Lie.: on lecmical ><,ic.: !�' " •, stlprv. I ic_: / .1 FJ�+CPRICAL PERMIT ES y • Suprv. Electrician si:•r� r rbcjuired: � ' ►' .' /d �/ I /.s`1 yVJ Subtotal: 5; 4. Plan review (25% of i • it fee): Print name: -1 ( ## , . Date: K.-/6'.- /0 State surcharge (12% of petnut fee): _— , °� w TOTAL PERMIT FEE: Authorized signature: R EA/E l�l4-«SCIIL C- This permit application expires if a permit is not obtained within 180 ✓ Print na me: Date: • days after it boa be accepted as complete. t Number of inspections allowed per permit. (�r OX 14 t i:\aelerkerpenottatcreweaaisp.aor ammo 440 - 46151(1 tro5/COM/WEn