Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. COMMUNITY DEVELOPMENT Permit #: ELR2010 00233
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/26/2010
Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 487
Subdivision: LINCOLN ONE Lot: 0
Project: Farmers Insurance
Project Description: Data Telecommunications system.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 10/26/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 10/26/2010 $9.00
PHONE:
Contractor:
PROCOM COMMUNICATIONS INC
PO BOX 22288
PORTLAND, OR 97269
PHONE: 503 - 233 -8037
FAX: 503 - 233 -8052
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 obtain a y of the rule 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.
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.
Electrical Permit Application Folz OFFICE USE ONLY City of Tigard Received � r�
`J g Cj� DateB : � i d AG%r Permit No.: �.� i I U_`3�
a 13125 SW Hall Blvd., Tigard, OR 1 Plan Review y,
C . Phone: 503.639.4171 Fax: 503.598.1960 6 2 Date/B Other Permit: `(4 i vv( — t
T I G A It D Inspection Line: 503.639.4175 o C\ Date Ready/By: 7 See Page 2 for
Internet: www.tigard- or.gov OF rAG ° Notified/Method: B/ , Supplemental Information
TYPE OF Wt�i1 c ��y GD1 N j 1S PLAN REVIEW
El New construction .Addition /alte placement 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 El 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 ", "I - ", "1 - ",
Job no.: Job site address: 100HP or more. occupancy.
0 3r7 O ' t c L t ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Pp ,. t.Rtrt / �^ 'Z i / ❑ Health-care facilities.
❑ Hazardous locations ❑ Supply voltage for more'than
/ / 600 volts nominal.
.
Suite /bldg. /apt. no.: el 81 Project name: FAe tl S _ 4 k+-Lla r ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I our. I 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 j 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
00( a D�- - 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 1 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Y relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 1 2
Owner installation: This installation is being made on property that 1 own which is not
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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: R , 44,..... B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: P6 64 'Z 2-''.. Miscellaneous (service or feeder not included)
7 Each manufactured or modular
City /State /ZIP:
( 1k( / /? (2, ` ` f? ZCv Q dwelling, service and/or feeder 67.84 2
Phone: (Co .) 5 I._ fc f t(? / Fax: : (5o' j) Z `J 3 — 965 2 Reconnect only 67.84 2
7 Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension. _ I _ Page 2 15 2
54 Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
tQ�
O C'e( specifically listed (%2 hr min)
CCBLic.: 34. ElectricalLic.: 5- 3g7 Suprv.Lic.: ti i2 - 4rf} ELECTRICAL PERMIT FEES
'' ll
Subtotal: 1 5
Suprv. Electrician sigt ,required: o /
l/t 1.C. Plan review (25% of permit fee):
Print name: sm ‘, Date: f State surcharge (12% of permit fee): Q
TOTAL PERMIT FEE: g�(''
Authorized signature: , 4' ,
�_ This permit application expires if a permit is not obtained within 180
Print /� Date: days after it has been accepted as complete.
rint name:
g / z t — Z — P • N um b er o inspections allowed per permit.
I:\ Building ''ermits\ELC - PermitApp.doc 07/01/10 440- 4615T(1I/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
❑ Clo Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
O Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
O Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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1:\ Building \Permits\ELC- PermitApp.doc 07/01/10