Permit II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
0 COMMUNITY DEVELOPMENT Permit #: ELR2010 -00194
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/22/2010
Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Subdivision: LINCOLN CENTER/FIVE LINCOLN Lot: 0
Project: Axium
Project Description: Security system.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 09/22/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 09/22/2010 $9.00
PHONE:
Contractor:
SOUND SECURITY INC /SONITROL
8220 N. INTERSTATE
PORTLAND, OR 97217
PHONE: 503 - 223 -5822
FAX:
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: Y 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 O: R 952 - 001 -0100. You ma • • - • - - • . • - rules direct questions to OUNC by calling 503.246.6699 or 1.800.332. 44.
Issued B _ — �� Perm Signature: � � cam �.�
Iy� , ,
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.
SEP -22 -10 08:02 AM SONITROL— PORTLAND 9737773 P.01
C) H
Electrical Permit Apnlicatlon C dw v I-t,t� e ll l It 1. t .�l. ON�I , -11
1 Received ��� ) I City of Tigard l c� ` _Received : �7 Q�1n _Pam" - i-Ovid- c2ola'1
I lil
13125 SW l 1011 Itivd., Tigard, OR 97223 r Plan Review _ ,
Nhone. 503.634.4 171 Fax: 5113 598.19G G latetfty Other Permit: i t (r,(I1 0 -- OU k C(� 1
1 t d :nut) Impecliun Line: 503.639.4175 O 1l . ' S\ Y atu Rca dy/By : Jurii ® Sre Page 3 for .i
Internet: www.tigurd- or.guv 4 a% Notificd/Methcd• _ 716 Supplemental Information
• — T%PF; (I WO PLAN REVIEW
• Q New construction Additionhtltcr,tlion /replacement Please check all that apply (submit 1 acts of plane w /noes checked below):
❑ Sc:vicc nr feeder 400 amps or murc ❑ Building over three stories. i .:1
❑ Demolition ❑ Other: where the available fault current Q Marinas and boatyards. •
• • CA_ OF CONSTRUCTION cords 10,000 amps at 150 volts or In Floating buildings.
O • lust to wound, nr Oseced4 14,000 ❑ Conunereial•ute agrIculmral
1• and 2•fumily dwelling Commercial /industrial ❑ Accessory building amps for all oilier installations buildings.
[] Multi - fancily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
'"•'° 0 Emergency iystem Jai gm separately derived system. .
❑ Addition of new nmrnr lard of ❑ "A ", "E " "l -2" "1.3
Job nn.. 1 OM Si ]oh site tddross: 10220 s� WWW t� 1Aa
❑ 1011111' ur more, occupancy, 1
�I , Six or more residential units, d Recreational vehicle parks.
City/State/ZIP: : rd �i 3 ❑ Ilcahh•carcfculitics.
❑ }inzardnus lca•annng. ❑ Supply .ohayefor more thin '
600 volts nominal. '
x ___
Suite/bldg./apt, no.: Project name: u /{/♦ _ - F SCIiF.
Service ar feeder 600 wups or more
Cross street /directions to jab .site: Jf L.� arscrlptinn 1 4t• Fl I . 1.1 1 Yse. 1 TOW 1 ' ' ';
1
-' "'— New residential single- or multi- family dwelling unit. ;
includes attached garage,
Subdivision; lot no.; 1,000 sq. 11. or less 168 54 4 ' i
F•a, add'I 500 sq. Q. or portion 33.92 1 • ''
Tax map /parcel no.; '
Limited energy, residential
with above s It. 75.W 2
DESCRIPTION OF WORK ( 9 ) — ..
2145"117i—M l energy, muhi- family
hh �w .� residential (with abtveso. (1J
75.00 2
w. s e i e Servlcen or feeders Installation, alteration, and/or relocation
201) amps OT Iris ` 100.70 2
1 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 1 33.56 2
401 amps to 600 amps 201134 3 .i
. _
Name: — _ ` _ ,00
601 amps to 10 amps _� 301.04 2 i
Address: Over 1,000 amps or volts 552.26 2 i i 1.
•
Temporary services or feeders installation, alteration, and/or ■
n
City/Slute /Zl P: relocation
1 i
Phone: ( ) ( ) 200 amps or Its _ 59.36 1 i
Fax: 1 .i
201 amp: to 400 amps 135 08 2
Owner installation: This installation is being rnnde on properly that 1 own which is not qUl amps to 599 amps — 160 54 2 + l
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701.
Branch circuits - new altcrallnn, or rstension. per panel
Owner signature: _ Date: Pee for branch circuits with
❑CONTACT PERSON APPLICANT service or feeder fe'<,
•"'' J _ Seal. each or circuit
— 7 42 2 •
Aus inea +name: ' . B. v for bran hroncd circuit without without se
_ s[rviCC or feeder feeder fee, first • ,i
Contact name: - r tC branch circuit i _ 56 2 !
..�.�,.,� Pesch o dd'l br circuit 7.42 2 :
Address: . ' ' - . t • •d ` — � Aflveella (service or feeder not Included) '
City/Stine/ZIP: ' /State /L.11': i� „ • • each manufactured or modular — 67.94 2
_ s � dwscrvicc and/or feeder
1
s� 1 _ . 3 Reconnect only 67 R4 2
Phone' ' 1y AX I S • S: -
tux:: f 7 I �_
w --J or irrigation circle 67.84 2 • ;
E-mail: '"1 r 0 A : J s 111 11 r C ' V Signor outline lighting 67.84 2
• ONTRr Signal circuits) u r limnt�l•cn�r
Business name: � panel, alteration, OT extension. ,. I Page 2 75 _ 2 '
�, - . Each additional Inspection over allowable in any of the above
Address :$ , i Additional inspection (I hr min) 66.25/ hr
/ investigation (I hr min) 66.151 hr
City/State/7 1. t0 _, . ) In dustrial plant (1 hr min) 78.18/ hr
Phone: eel 2Z gar ' n Fax: as r 3-1113 Inspections for which no fee is — 9000 / hr 1- -•-- --
stxxiftt:ally listed (h hr :nin)
CCB Lic63 366 1 Electrical 1•ic. • .. . . Suprv, Lie,: — 1 1 ECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: —
_ 1'Inn review (25% of rLcrmif fee): i
■
1 rani name: 6a 5•/frl 1 Date: C 7I22/ ) /0 - Stun vurcharge (12% orpernrit fee): •
- - -' _— � This prrmii uppliraliun mitres �' hIRM H er: � g
Authorized signautre: ires if a permit is not uh Tip•""
with in IRO
Print name; Gtl r / • days offer It has been accepted as complete, r
1 — s l 0 Number of inelreetiuns allowed per l>rm il.
MullemirrermlisFi r.r n nitApp ilia 07411.1f) 440.401111 UO,tC011 WEO '
SEP -22 -10 08:03 AM SONITROL— PORTLAND 9737773 P.02
r I
i :t
Electrical Permit Application - City of Tigard
Pagc 2 - Supplemental Information
: l
LIMITED ENERGY PERMIT FEES:
•
1
. RESIDENTIAL WORK ONLY:
Fee for Ill residential systems combined $75.00
i
• j.
Check Type of Work Involved:
❑ Audio and Stereo Systems* . i
l: Burglar Alarm .t
.1
❑ Garage Door Opener* . •
❑ Heating, and Air Conditionin S
�,, K stem* y
i
❑ Vacuum Systems* i
t
El Other; :
} •
` WORK ONLY:
Fee for cagli commercial $75.00 i t
system • - I
(SEE OAR 918- 304 -0000) i
Y
Check Type of Work Involved: `
.4
❑ Audio and Stereo Systctns
❑ Boiler Controls • -1
t
❑ Clock Systems l
❑ Data Telecommunication Installation .I
�
❑ Fire Alarm Installation
• 1
❑ IiV.�C: l
i
.1
r
❑ Instrumcnauicm t
i
❑ Intercom and Paging Systems r i
❑ Landscape Trrigatioi .Coptrol* i
t
• 1
❑ hfedical i
i
❑ Nurse Call,
❑ Outdoor 1,andsc.ape Lighting* : l • ❑ Protective Signaling • 1
P Othrr ge-Ca r fr
Total number c1 commercial systems: i 1
*Nu IiccnscR arc required. Licenses are required
fur all other installations i
I
i
? Auildinq 'P.•rmil*'d ?Ll'.PrrmiIApp Ii I7.0lr It)
1