Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 • COMMUNITY DEVELOPMENT Permit #: ELR2010 -00175
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/23/2010
Parcel: 1 S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 125
Subdivision: LINCOLN THREE Lot: 0
Project: Hood River Distillers
Project Description: Low voltage for fire alarm.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTE1N PROPERTIES LLC, 555 Restricted Energy Permit 09/23/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 09/23/2010 $9.00
PHONE:
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360 - 699 -2130
FAX: 360- 719 -1527
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: Y
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 OAR 952- 001 -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: 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.
Cali 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 Aeplicatioll��CE1 V ED FOR. ohhl(I usl ONLY
i�
City of Tigard Received Date/B : 9 7 to Permit No.: f (,44criD 0t7 / 75
. V 13125 SW Hall Blvd., Tigard, OR 97223 c c p U 1 2010 Plan Review
Phone: 503.639.4171 Fax: 503.598.196 L I Date/B : Other Permit: A „,.. 5 -6„7 0 , 0 - 7 90,9-.. 7
I' I G 4 K D Inspection Line: 503.639.417 . T1G Da te ReadyBy: HI See Page 2 for
Internet: www.tigard- or.gov DC- OF DIVISION Notified/Method: Supplemental Information
TYPE OF WILMer --- - PLAN REVIEW
❑ New construction Addition/alteration/replacement 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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling . 121- 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 ",
Job no.: Job site address: /bU 100HP or more. occupancy.
s v M ,r9
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: r: sArd 6 g ❑ Health-care facilities.
❑ Hazardous locations. ❑ Supply voltage for more than
600 volts nominal.
Suite/bldg. /apt. no.: /?...5- Project name: i o ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Li A.W+ 3 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
6(v_ AlAfftt, residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ 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
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 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. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: $ 4 , T e c C B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: TOv S 0A SL eei _ branch circuit
Each add'I branch circuit 7.42 2
Address: c, -(VV /Y C f .. J , " „ v 4 5�, k 6 '� 7S Miscellaneous (service or feeder not inc luded)
�! Each manufactured or modular
City/State /ZIP: U44 LO IAilCi C q g /L s' dwelling, service and/or feeder 67.84 2
Phone: 3/ ) ("y R / 30 Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: s- TC ' p panel, alteration, or extension. J Page 2 2
Each additional inspection over allowable in any of the above
Address: ( Li 6 v N. /-h h , 9c St k C 3 7 S Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: OA A I O (4 I� (/)--A- ' �(UOS Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (30d) 131 Fax: ( ) specifically listed Inspections which
hr min)
is 90.00 / hr
Pe Y ( )
CCB Lic.: / "73 731 Electrical Lic.: GLE ?' Suprv. Lic.: y2 7 2c o ELECTRICAL PERMIT FEES
Subtotal: 7 j .0C)
Suprv. Electrician signature, required: � ��� �� P lan review (25% of permit fee): / ,_.0.
Print name: 3 ti56k Sl 4 Date: 9 —s io State surcharge (12% of permit fee): 9 00
TOTAL PERMIT FEE: W
/�
Authorized signature: This permit application expires if a permit is not obtai ithin 180
7 a S days after it has been accepted as complete.
Print name: � S OA - Date: / , !6 • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 4615T(11/05 /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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ 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
M - 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
1: \Building\Permits\ELC- PennitApp.doc 07/01/10