Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.14 COMMUNITY DEVELOPMENT Permit II: ELR2010 -00190
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/21/2010
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 200
Subdivision: LINCOLN TOWER Lot: 0
Project: ASCENTIUM
Project Description: Data telecommunications system.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 09/21/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 09/21/2010 $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
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
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 obta - - copy of the rules • r direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By. ice / 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' 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.
FOR OFFICE USE ONLY
Electrical Permit Application „ 1I n Ii) Received
City of Tigard 1v Date/By: 7 /7/11//0 il e . no.: ,_�DU (CJ — 06176
P lan Review
1 3 125 SW Hall Blvd., Tigard, OR 9722 � ' Date/By: Other Permit:
_
Phone: 503.639.4171 Fax: 503.598.1960
F, � � _
Y Date Ready /By: Juris: Lee Page 2 for
Inspection Line: 503.639.4175 ()�'•
T I G A R D ,,,, 0 otifled/Method: 77 _ Supplemental Information
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Internet: www.tigard-or.gov
OV V`' i�
. TYPE OF WORK CO 1 PLAN REVIEW
II New construction H Addition /alteration /replacement x t� Please check all that apply:
❑ Demolition El Other: Other: VV ❑ Service over 225 amps, comm'! ❑ Hazardous location
CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
❑ 1- and 2- family dwelling U Commercial /industrial Li 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 ❑ Building over three stories ❑ Feeders, 400 amps or more
Job no.: C10218 Job site address: 10260 SW Greenburg Rd. ❑ Occupant load over 99 persons ❑ Manufactured structures or
❑ Egress /lighting plan RV park
City /State /ZIP: Portland, Or. 97223 ❑ Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
Suite dad Project name: Ascentium -Temp
The above are not applicable to temporary construction service.
FEE SCHEDULE
Cross Street/Directions to job site: Description I Qty. 1 Fee. 1 Total 1 "
New residential - single or multi - family dwelling unit.
Subdivision: Lot no.: Includes attached garage.
1000 sq. ft. or less $ 168.54 4
Tax ncapiparcel no.: Ea. Add'l 500 sq. ft or portion $ 33.92 1
. DESCRIPTION OF WORK Limited energy residential $ 75.00 2
Installation of Data cables Limited energy, non - residential S 75.00 2
Each manufactured home or modular
. (J PROPERTY OWNER 1 U TENANT dwelling, Service and/or feeder $ 67.84 2
Service or feeders installation, alteration, and /or relocation
Name: - -
200 amps or less $ 100.70 2
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 $ 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 $ 59.36 1
Owner signature: Date: 201 amps to 400 amps 8 125.08 2
401 amps to 599 amps _ $ 168.54 _ 2
Li APPLICANT 1 U CONTACT PERSON Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
Business Naine:
service or feeder fee, each
branch circuit $ 7.42 2
Contact name:
B. Fee for branch circuits
Address: without service or feeder fee,
- each branch circuit $ 56.18 2
City /State /ZIP: Each additional branch circuit: $ 7.42 2
Miscellaneous (service or feeder not included)
Phone: Fax: Pump or irrigation circle $ 67.84 2
Sign or outline lighting $ 67.84 2
- E"-mail: Signal circuits(s) or limited-
CONTRACTOR energy panel, alteration, or
Business Name: Capitol Data & Communications, Inc. extension. Describe: Tele/Data 1 75 75.00 2
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 (I hr min) $ 66.25
Industrial plant per hour $ 78.18
City /State/ZIP: Portland, Oregon 97220 ELECTRICAL PERMIT FEES*
Subtotal 75.00
Phone: 503 - 255 -9488 Fax: 503- 257 -7121 Plan review (25% of permit fee)
State surcharge ( 12% of permit fee) 9.00
CCB Lic.: 14257 joectricai Lic.: 26 I045CLE 1 Suprv. Lic.: 2757LEA TOTAL PERMIT FEE 84.00
y This permit application expires if a permit is not obtained within 180
Suprv. Electricial ! ma ur , required:
days after it has been accepted as complete
Print Name: Terry Brasch Date: 09/16/10 • Fee methodology set by Tri- County Building Industry Service Board
Authorized signature: **Number of inspections per permit allowed.
I Print Name: Terry Brasch
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