Permit �' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
IN COMMUNITY DEVELOPMENT Permit #: ELR2010 00160
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/18/2010
TIGARD Parcel: 1S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project: Axium
Project Description: (1) access control
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:
STONER ELECTRIC
1904 SE OCHOCO
MILWAUKIE, OR 97222
PHONE: 503 - 462 -6500
FAX: 503 - 659 -4968
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: 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: Y
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 52- 01 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Y
Issued By: Permittee Signature: 0A/ €/' ' doh
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.
Aug. 16. 2010 3:14PM Stoner Electric Group No, 4201 P. 1
Electrical Permit Application . FOR OFFICE I ISE ONLY
Received
City of Tigard AUG 17 2010 Dawn,: /� /o • - -' p estN'e• z &0/0 - l a'
:1 ,- n 13125 SW Ha11 I)lvd., Tigard, OR 97223 Plan Review el Phone; 503,639A171 Fax; 503.598.1960, - Date/8y: OtherPermigitia — A7/9/
I n u D Inspection Lino; 503.639,4175 , . . , •- - -- Date ReadyBy. 1�im ® Sot Page 2 for
Internet twwvtigard- or.gov ' , 110tired/Method: 1 ( 5 Supp1emeatal Informal ion
`' i :.TYPE QF:WORK. ' :._. .` . '- x ..a: i j T i, - - A PY. 1 F iK! .
❑ New construction f Addition/alteration/replacement Please check all that apply (submit i sets of plans w/iiloms checked below):
❑Senieeor feeder 400 amps ormore ❑ Building over three stories.
❑ Demolition I_I V titer; where the available fault current
❑ Marinas and boatyards.
+r ,P" v; - exceeds 10,000 amps al 150 voles or ❑ Floating buildings.
.'l '1 &- ''''s''''' 6 " +::Q': � }- � t w '" - - ' leas to ground. or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installation. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
„ �.s - C,ncrgmscy
._::�t`?_r ,� „yp -y ��:- 5 _ system. larger separately derived system.
� ..:x - Srr . NrO17MAT1ON - AND LOCATiQIv
..,:.xr =' _,: a;;�:...:.•,a�-- 'lC..,�..._ . ., ---... .. .. _ . .. ❑ Addition of new motor load of ❑ ••n° • "1_2”, , •1_3 ".
Job no, : /7.v2 Job site address: JbiAp sit) 6,<zAja)46 /CAD t00HP or snore. occupancy.
❑ Six ormae residential units. ❑ Recreational vehicle parka.
City/State/ZIP ,D , 9 7 7,7,... ❑ Ilealt6 care facilities, ❑ Supply voltage for more than
❑ llemrdous locations. 600 volts nominal
&4dg. /apt.no.: ( I Project name :2i4JC_.o4N — ,/ 411..) VI4 ❑ amps or'norp
Cross street/directions to job site: Dereaoren 1
I Oct. 1 roe. 1 T otal 1
New residential single- or mulli- family dwelling unit.
Includes attached garage. _
Subdivision: I Lot no,: 1,000 sq. It or less 168.54
68.54 - 4
Ea. add'I 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
.... IIlrSCIiIpT1oN OF. 'Pi'OAIC, (with above sq. i).)
- . - — Limited energy, multi family 75.00 2
iJ/,eg cae if CCU A, -TreoG Sy r residential (with above sq. It.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
• _ - • . . ' : .QJ" R V
rV,:OWivER; . : .0 TENANT,: ` , : :: ;'' 201 omps 10 400 amps 133.56 2
401 amps 10 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301,04 2
Address: Over 1,000 amps or volts 552.26 2
' • Temporary services or feeders Installation, alteratton, and /or
City /State/ZIP:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59,36 1
201 turps 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: Dato: A. Pee for branch circuits with
above service or feeder fee
s [Q_APPLICAANT •, _,.. ,I:. =_' : : . C] CONTACT PERSON 7.42 2
each branch circuit
Business name; 13. Fee for branch circuits without
service or feeder fee. Ilrst 56.18 2
Contact name: branch circuit
Each add't branch circuit 7.42 2
Addross: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State/ZIP: dwelling, service and/or feeder 6784 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outlinelighling 67,84 2
' ' ' CONT1tA&OR ,. , :rr C >'j: :•: Signal circuit(s) or limited- energy
Business Hanle: STONER ELECTRIC, INC. panel, alteration, or extension. ' P - 76 � - 2
Each additional Inspection over allowable In any of the above
Address: 1904 SE OCHOCO Additional inspection (1 hr min) 66,25/ hr
CitylState/ZIP: MILWAUKIE, OR 97222
Investigation duiplant min) 78.28/ hr
- - - -- Industrial plant (1 hr min) 78.18/ hr
tone: ( 503) Fax: ( 503) 659 4968
I Electrical Lic.: 26 -122C Suprv. Lie.: 34968 Inspections for which no fee is 90,00 / hr
specifically listed (1/2 hr min)
C CB Lic. : 44823 ELECI*1 Y ::P1JRM1T. PEES .
Suprv, Electrician signature, required: / .0 __ Plan Subtotal 7S, 0 0
Plan review (25 /o of permit fee): ,
Print name: MICHAEL FALCONER I Dote; f3Iup I 1,0 State surcharge (12 %of permit fco); 9,00
TOTAL, PERMIT PEE; 64, O C)
Authorised signature: Tbls permit applleadon expires itapermlt Is not oblalncd within 180 -
d ays a t t h as b een acecp as comp
Print name: I Date:
Number of inspections allowed per pcnnit
Melldineemtitsne- PaMdrAppeoc 07/01110 440- 4615T(r1 /COMAtrn
Aug. 16. 2010 3:14PY Stoner Electric Group No.4201 P. 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
talaNTIA. WORK UNLY: I
Pee for all residential systems combined.... , , , , $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ beating, Ventilation And Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL
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
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
[] Outdoor Landscape Lighting*
❑ Protective Signaling �"
OtherA=01.5 lo- r�KOL
Total number of commercial systems: ,_,
*No licenses are required. Licenses are required
for all other installations
zAamildiceemifatc- PermUApp.bc 07/01/10
•
Sep. 16. 2010 1:58PM Stoner Electric Group No. 7225 P. 1/1
Faxed 9/16/10
El P - -
t&O 300160
111 C al
omm unity Development
c
TIGARD Request for Permit Action DECEIVED
SEP 1 6 ZO1b
TO: CITY OF TIGARD CITY OF TIGARD
Building Division Services Coordinator BUILDING DIVISION
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 303.718 2430 Fax: 503.598.1960 www.tigard-or.gov
FROM: ❑ Owner ❑ Applicant ® Contractor n City Staff
(cheek one)
REFUND OR Name: Stoner Electric, Inc.
INVOICE TO: (Business Of Individual)
Mailing Address: 1904 SE Ochoco St.
Citv /State /Zip: Milwaukie, OR 97222
Phone No.: 503- 462 -5248
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ✓):
®
CANCEL PERMIT APPLICATION.
❑ REFUNTD PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
f t Permit #: ELR2010 00160
>S�e Address or Parcel #: 10200 SW Greenburg Rd., Suite 600
1 0/ T
Project Name: Axium
t'
4 4 4 Subdivision Name: Lot #:
EXPLANATION: Tenant decided to cancel installation before completion. The access
control system and associated wiring will not be finished or made operational.
A ref is not being requested. awe uurnimp
Signature: Dave Litzenberg: o " :a ""° Date: 9/16/2010
Dave Litzenberg
Print Name:
Re :ui:d Policy
1. The Director or Building Official may authorize the refund of:
a any tee which .apes erroneously pad or collected
b; not more than 8.0°.5 of the land use application tee when an application is withdrawn or canceled before any review effort has been expended.
cj not more than SCP of the land use application fee for issued permits.
d not more than 804 , of the building plan review tee when an application is canceled before any plan review effort has been expended.
e) not more than &i% of the building peunit fee for issued permits prior to any inspection requests.
2. Refunds still be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 week for processing refunds.
FOR OFFICE USE ONI.A - • .
•
Rte. to Svs Adtnin: Date By Rte to Blda Admin: Date 9A� Bt d »
Refund Processed: Date By 4. Invoice Processed: Date A/ ' By -: tea
Permit Canceled: Date - Parcel Tact Added: Date By
EMEIZMIIIIIII Dare Method Amount $
I:'; Building `, Forms \RegPerinitAcdon.cloc Rev 07126/07