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Permit ' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT `� ` COMMUNITY DEVELOPMENT Perm it #: ELR2010 00267 :TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2010 Parcel: 1S135AB01002 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 601 Project: Matrix Absence Management Subdivision: LINCOLN THREE Lot: 0 Project Description: Low voltage for access control. Contractor: PIXEL LLC Owner: LINCOLN CENTER LLC 4647 SW HUBER ST BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97219 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 608 -7595 PHONE: FAX: FEES Description Date Amount Specifics: Restricted Energy Permit 12/03/2010 $75.00 12% State Surcharge - Electrical 12/03/2010 $9.00 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 Intercom /Paging: N Landscape /Irrigation: N Landscape Lighting: N Medical: N Nurse Calls: N Protective Signal: N Security Alarm: N Other: Y Total $84.00 Other Desc: Required Items and Reports (Conditions) This permit ' ue• • ••-ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done ' 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. . TENTION: Oregon law '\re..ires' you • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -01 -0010 through OAR 952 -00 '090. ou . ay obtain a copy of the rules or direct questions to OUNC by calling 503.23 987 or 1.800.332.23' •. Iss ■ ed By: - / /�L_.i.L . Permittee Signature: IO �.S/,Pa) / / J 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 the next available inspection date. 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 FOR OFFICE USE ONLY • City of Tigard Received 2 Permit No.: EL y � 07010'2 7 g Plan Re 131 SW Hall Blvd., Ti Tigard, OR 97223 Plan Re : �,'Z /✓ /e) view Other Permit: ,8u�aoio - o d53 Phone: 503.639.4171 Fax: 503.598.1960 Date /By: 1' I G A R D Inspection Line: 503.639.4175 Date Ready/By: turfs: Ef See Page 2 for Internet: www.tigard- or.gov Notified/Method: Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction r gt . 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 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 ", t n I 100HP or more. occupancy. parks. Job no.: Job site address: 1 �0 © G ('CCVI �Ui2_ ❑ Re creational vehicle 74 ❑ Six or more residential units. P City /State /ZIP: Ctou4A � c 3__D_-5 ❑ Health -care facilities. ❑ S nomenfor more than 19 (L ❑ Hazardous locations. O 1 rW n /bldg. /apt. no.: O 1 1 Project name: i` C4 \ x ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: 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 Tax map/parcel no.: Ea. add' 1 500 sq. ft. or portion 33.92 1 Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi - family 75.00 2 • at.,(2 -s o ' � (,Ut v t Vt-C residential (with above sq. ft.) Services or feeders installation, alteration, and /or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ 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 extension, 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: 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: Miscellaneous (service or feeder not included) Each manufactured or modular City /State /ZIP: dwelling, service and/or feeder 67.84 • Phone: ( ) Fax:: ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E - mail: Sign or outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited - energy panel, alteration, or extension. Page 2 2 Business name: ()• I,>z � 1 LI Each additional inspection over allowable in any of the above Address: 4 (Q41 CAA h V btK s4-- • Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: _ { d a I Investigation (1 hr min) 66.25/ hr �t7W ' 1!>u t I Industrial plant (I hr min) 78.18/ hr Phone: (50 3) Wdt 1 c Fax: ( ��l t Inspections for which no fee is 90.00 / hr ��� specifically listed (' /: hr min) CCB Lic.: I ti(Q g . . 0 0 1 Electrical Lic.: Ci Z' '- ' Suprv. Lic.: tit (14-Lot ELECTRICAL PERMIT FEES qq,,,,�� / / to / 6 o Subtotal: ''S. Suprv. Electrician signa l 'e,'required: j(�vt_N. � ;.� Plan review (25% of permit fee): Print name: atn d_g- Date: (a - 3._.I O State surcharge (12% of permit fee): q r (9t7 ' — I '/// TOTAL PERMIT FEE: bkk . C1'C� Authorized signature: / s A4 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: r r ii - a ( �jt,t/j, r� � Date: I 3 ` 0 • Number of inspections allowed per permit. I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440- 46I5T( l 1/05 /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: n Audio and Stereo Systems* n Burglar Alarm n Garage Door Opener* n Heating, Ventilation and Air Conditioning System* n Vacuum Systems* n Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: n Audio and Stereo Systems n Boiler Controls n Clock Systems ❑ Data Telecommunication Installation n Fire Alarm Installation n HVAC n Instrumentation n Intercom and Paging Systems n Landscape Irrigation Control* n Medical n Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling Ni Other (�Q,BJ celn.lvt4 Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I:\Building\Permits\ELC - PermitApp.doc 07/01/10