Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 00246
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/09/2010
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 500
Subdivision: LINCOLN CENTERTPNO LINCOLN Lot: 0
Project: Concero
Project Description: Data telecommunications system.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 11/09/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 11/09/2010 $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
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 co. of the ru_;.0 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By�_��_s. 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.
� 1 FO12 OFFICE USE ONLY Permit Application M �,111p� Received
Permit no.: _ r
City of Tigard �L� EN ED dM Date /By: 11 i t3 ,H _•1• C.) — .I • •
1114 III Plan Review
13125 SW Nall Blvd., Tigard, OR 97223 NO V 2 410 Ot her Permit:
g 5 Date /By: /L fA• 10 -" • 0 1
Phone: 503.639.4171 Fax: 503.598.1 dry Date Ready /By: Juris: 1 ce Page 2 for
T1GARD Ins Line: 503.639.4175 B U ( �� OI'i �'j / � tT_ Notified/Method: ) Supplemental Information
Internet: www.tigard -or.gov jCDI
TYPE OF WORK N j S j �N PLAN REVIEW
U New construction U Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑ Service over 225 amps, comm'l ❑ Hazardous location
CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
U 1- and 2- family dwelling U Commercial /industrial U 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 Li Feeders, 400 amps or more
Job no.: C10262 Job site address: 10220 SW Greenburg Rd. ❑ Occupant load over 99 persons CI Manufactured structures or
❑ Egress /lighting plan RV park
City /State/ZIP: Portland, Or. ❑ Health -care facility • ❑ Other:
Submit 2 sets of plans with any of the above.
Suite/bldg. /apt. no.: 500 Project name: Concern Tech The above are not applicable to temporary construction service.
FEE SCHEDULE
Cross Street/Directions to job site: Description I Qty. I Fee. I Total I
New residential - single or multi - family dwelling unit.
Subdivision: Lot no.: Includes attached garage.
1000 sq. ft. or less $ 168.54 4
Tax map /parcel no.: Ea. Add'I 500 sq. ft or portion $ 33.92 1
DESCRIPTION OF WORK Limited energy residential $ 75.00 2
Relocate and istallation of voice and data cables Limited energy, non - residential $ 75.00 2
_ Each manufactured home or modular
U PROPERTY OWNER 1 U TENANT dwelling, Service and/or feeder $ 67.84 _ 2
Name: Service or feeders installation, alteration, and/or relocation
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 _ 5 67.84 2
503- 295 -5555 Temporary services or feeders installation, alteration, and/or
Owner installation: This installation is being made on property that 1 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 $ 125.08 2
401 amps to 599 amps $ 168.54 2
U APPLICANT 1 Li CONTACT PERSON Branch circuits - new, alteration, or extension, per panel
Business Name: A. Fee for branch circuits with
service or feeder fee, each
Contact name: branch circuit $ 7.42 2
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)
Pho e: Fax: Pump or irrigation circle 1 $ 67.84 1 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: Tcic /Data 1 75 75.00 2
Page 2
Contact name: Scott Zadow 971 - 533 -6821 Each additional inspection over allowable in any of the above
Per inspection $ 66.25
Address: 11401 NE Marx Street Investigation per hour (1 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 'Electrical Lic: 26 CLE 1 Suprv. Lic.: 2757LEA TOTAL PERMIT FEE 84.00
/ �'t This permit application expires if a permit is not obtained within 180
Suprv. Electrician signature, required: // ,— Oil__
i
days after 11 has been accepted as complete
Print Name: Terry Brasch Date: 11/04/10 • Fee methodology set by Tri- County Building Industry Service Board
Authorized signature: "Number of inspections per permit allowed.
Print Name: Terry Brasc