Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
: . a ' COMMUNITY DEVELOPMENT Permit #: ELR2011 -00005
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011
Parcel: 1 S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 360
Project: Ameriprise Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project Description: Low voltage for fire alarm. Phase 2
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/05/2011 $75.00
12% State Surcharge - Electrical 01/05/2011 $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: y
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: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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 acc• : 'th 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. ATT ' ION: Oregon -w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0' 0 through OAR 952 -r 0 r - S. u may obtain a copy of the rules or direct questions to OUNC by callin 8 3 .1987 or 1.800.332.2344.
t � �
Issue• By: / / � 4 • Permittee Signature: / 4 f' - T G�‘.___,
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.
01/04/2011 17:25 5032551%6 CAPITOL ELECTRIC PAGE 01
Electrical P A iication RECEIVED Reemv
City of Tigard • Date/By; / t/ /il Permit no.: Ekk dot l _ 49 S`
rr 13125 SW Hall H1va„ Tigard, OR 97223 Review
' " Phone: 503,639.4171 Fax: 503.598.•1960 JAN 04 201 Date/By: OthcrPelntit:
T1 Ci A 1:, T? Inepcctibn Lira: 5fl3,639.417S
Internet: www.tigerd- or.gov . CITY OF T Date Ready/By: auras; ' Li gee Ono 2 ow
IS Noblicd/M - Sapplmnc a,fx,ryntian
TYPE OF WORK
PLAN R
r BVrf?W
U New conStruction LI Addition /alteration /replacement Please check all that a submit
apply ( Z secs of plans w(rtema checked below):
❑ Demolition ❑ (filter ❑ Service or feeder 400 or more amps
CATEGORY OF CONSTRUCTION p El Building as stories
where the available fault current ❑ Marinas and nd boatyards
Ll r • and 2- family dwelling U Commercial /industrial L.l Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
Multi-family ❑ Master Builder ❑ Oilier lees to grotlltd, or exceeds 14,000
100 SITE INFORMATION AND i.00A110N Commercl t1 USe agricultural
amps for all Other installations, ❑ buildings
Job no,: 101271.45 Job site address; ❑ Fire Pump
10200 ew Greenburg Road ❑ Installation of 75 KVA or
❑ Emargenoy system larger separately derived s tem.
City/State/ZIP; Tigard, OR 97223 n Addition of new motor load of ❑ "A'. "E", ^1.2 ", "1 -3
f 10OHP or more. ❑ occupancy
Suire/bldg./apt no,; Suite 360 !Project name: Amerlprlse T,I„ Phase II ❑ Six or more reeldentlel units ❑ Reoreatlonsl vnhlcle parks.'
l❑ Nealth -care facilities ❑ Supply voltage for more thin
Cross Strcet /Directions to job site. E.] Hazardous locations
U 600 volts nominal.
❑ Service or feeder 600 amps or more
Subdivision; Lot no.: FEE SCHEDULP
I Description Qy, Fan, Toni)
Tax map /parcel stn,; New residential ^ single or multi- family dwelling unit.
DESCRIPTION OP WORK includes attached garag
INSTALL FIRE ALARM CIRCUIT ^ (ij it i — d 9 ~ .1000 sq, ft or less - $ 19654 I 4
�� Ea. Add'I 500 , 11 or rtion
U PROPERTY OWNER L -�_ �' portion 3 3 t,g I . T Limited energy residential
Name: 3HORENSTEIN REALTY SERVICES (Willi above sq. R.) 5 67.54
2
- _ Limited energy, multi-family !
Address: residential (with above s, ft) S 67.84 �
q 2
Service or faders Installation, alteration, and/or relocation
City /State/ZIP: 200 amps or less f s 100.70 l _ 2
201 amps to 400 amps $ 133.56 2
Phone: Fax: 401 amps to 600 amps 5 200.34 L 2
_ 601 amps to 1000 amps S 301.04 L 2
Owner Installation: This installation is being made on property that 1 own which is not Over 1000 amts or volts S 552.26 2
intended for sale, reuse, rent or exchange, according to ORS 447. 449., 670, and 701 Temporary services or feeders Instollatloa, alteration, and/or
Owner signature: Date: relocation
j APPLICANT 200 amps or less S 59.36 I 1
1 L�CONTACT PERSON 201 amps to 400 amps S 125.08 I 2
Business Name: i 401 amps tq $99 amps 5 168.54 1 v
Oraach circuits • new, alteration, or extenaton, per panel
Contact name: A. Fcc for hmneh circuits with
service or (Ceder foe, each
Address; branch circuit
5 7.42 2
13, Fcc for branch circuits
I
City/State/ZIP: without service or fbeder fee,
first branch circuit S 56.18 I 2
Phone; F ah; Each additional branch circuit: _ $ 1.42 1 2
MlsceIIaneaup (service nr feeder not include
E-mail: Each manufactured or modular Il ( — '
CONTRACTOR _ dwelling, service and or feeder S 67,84 I T 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only $ 67.84 2
Pump or irrigation circle S 67.84 1 2
Contact name: DAN WILSON 503.262.0411 DIRECT Sian or outline lighting $ 67.64 1 2
Signal circuit(s) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or I
-- extension, Describe; Fire Alarm 1 Page $ fi7,84 2
City /State/ZiP: PORTLAND, OR 97220 -1041 l
F..ach additional Inyection over allowable In any of th e above
Phone: 503- 255 -9488 Fax: 503 - 257.7121 ?cr in spection S 66.25
Investigation per hour (I hr min) S 66.25
CCB tic.: 48748 Electrical Li,; 26-496C Su•rv.Li,; 3132-S Tndustrial plant per hour S 78,18
Suprv. lilectrician signature, rcqufredi/ ELECTRICAL PERMIT PEES"
Subtotal
5 _
Print Name: DARRELL Date: i 1/04/11 a ' ME Plan review (2$% of permit fee)
Authorized signature: r State surcharge ( 12% of permit fcc $ , 00
St , /
TOTAL PERMIT FEE $
Print Na; me DARRELL MC L - Date: 01/04/11 � ' c o
Thar permit nppticnllan esplr,M We pQmtr Is net nMnlnca within 1$e
days OWN hos been accepted as complete,
• Number of inspections per permit all awed.