Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2011 -00010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/12/2011
Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 360
Project: Ameriprise Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
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Project Description: Install CCTV
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Contractor: COOK SECURITY GROUP Owner: LINCOLN CENTER LLC
5841 SE INTERNATIONAL WAY BY SHORENSTEIN PROPERTIES LLC
MILWAUKIER, OR 97222 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 974 -5784 PHONE:
FAX: 503 - 786 -3792
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/12/2011 $75.00
12% State Surcharge - Electrical 01/12/2011 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: Y 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: 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 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: J � Permittee Signature: e,�. �Z 9- ' 7 2 V
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 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.
From: 01/12/2011 11:59 #026 P.001/002
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Electrical Permit Applica ion �' Fcllz of n c r US O NI l
Received
City of Tigard JAN
13125 SW Hall Blvd., Tigard, OR 97223
I:9 1 2011 Date/B : ■ ��� d� Permit N�f ...."0‘)/0 Plan Revie
Phone: 503.639.4171 Fax: 503f�' �3 ARG Date/By: Other Perm /O i6a
F TIGARD I Ins pection Line: 503.639.417. Date ed/Met o Judy ® See Page 2 for
Internet: www.tigard -ocgov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE :OF, WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w/items checked below):
❑ New construction c'Addition/alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ 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 e'Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
El Multi- family ❑ Master builder El Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB S ITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 3"
Job no.: Jo L.4 (05 Job site address: ( p Z. CC) 5 W erten �" , m Six 11P or e re s. occupancy.
e
"`"" � 0 or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: -1 2,.'Z 3 ❑ Health -care facilities. ❑ Supply voltage for more than
' 7 ❑ Hazardous locations. 600 volts nominal.
Suite/bld _'. /apt. no. oJeet name: Y v1 pvi cue. ❑ Service or feeder 600 amps or mote
FEE?,SCHEDULE
t Cross street/directions to ob site:
J Description I Qty. 1 Fee. I total -
/� New residential single- or multi - family dwelling unit.
G'V e- e.VIOLUrgs 1 Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
C. G"T1/ Lt m 1 € e,n air s ly residential (with above sq. H.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80,30 2
❑ PROPERTY OWNER : ❑ TENANT . 201 _ amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not ?01 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 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,
n _ � each branch circuit 6.65 2
Business name: ( `_ 5e .„Xi u _ B. Fee for branch circuits
Contact name: '(fit .) firs wi n c h service or feeder fee,
""��'' ` '�� -'�� first branch circuit 46.85 2
Address: 5L.4 ( 8 £, "Th- x ma+i Each add'I branch circuit 6.65 2
` � ' Miscellaneous (service or feeder not included)
1 �
City /State /ZIP: 1 ► 1 N/1 , r ,� ID. , 9,-7 2.. Z Z Each manufactured or modular 90.90 2
�l Fax: ; r, dwelling, service and/or feeder
Phone:
(503.) C 1L . 5' 1 gy (603 `l ' 3-79 Reconnect only 66.85 2
E -mail: ka 'n( yr) , r cDok seri- - ii J • Gtr Pump or irrigation circle _ __ 53.40 2
CONTRACTOR Sign or outline fighting 53.40 2
Business name: Signal circuit(s) or limited-
�71�.(Ylr, Q,. y . energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
f y 9 Per inspection 62.50
Phone: ( ) r �l j Fax: 3 �l0 .3 7 1 2._ Investigation per hour (I hr min) 62.50
CCB Lie.:1GJ 15 5 2 Electrical Lic.:3 -•�j lC(.� Suprv. Lic.: 41 f g LEA Industrial plant per hour 73.75
v •'.•:ELECTRICAL - . PERMIT FEE S; '
S uprv, Electrician signature, required: /1-- M !�' Subtotal: - 1 l'j
Plan review (25% of permit fee): -! 11
Print name: -3--c__,,,0 ps 1 n Date: ( t ` ( t /
State surcharge (12% of permit fee):
Authorized signature: )9 � cif -Z TOTAL PERMIT FEE: 1 ° D
/'� This permit application expires if a permit is not obtained within 180
Print name: Date: / ( '1 I 1 This days after it has been accepted as complete.
1 0" ' Number of inspections allowed per permit.
I:\ Building \ermits\ELC- PermitApp,dec 05 /23/06 940 --l6 15T(I 1/05 /COMiWEB