Permit „ CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00278
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2010
Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 360
Project: Ameriprise Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project Description: Low voltage for voice & data.
Contractor: DYNALECTRIC Owner: LINCOLN CENTER LLC
5711 SW HOOD AVE BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97239 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 226 -6771 PHONE:
FAX: 503 - 226 -7720
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/10/2010 $75.00
12% State Surcharge - Electrical 12/10/2010 $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: Y 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 cop e ru - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: . Permittee Signature: P_O �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.
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.
Y � CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00278
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2010
Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 360
Project: Ameriprise Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project Description: Low voltage for voice & data. 1/18/2011: Add (1) voice & data.
Contractor: DYNALECTRIC Owner: LINCOLN CENTER LLC
5711 SW HOOD AVE BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97239 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 226 -6771 PHONE:
FAX: 503 - 226 -7720
FEES
Description Date Amount
Specifics: Restricted Energy Permit 12/10/2010 $75.00
12% State Surcharge - Electrical 12/10/2010 $9.00
Type of Use: COM Restricted Energy Permit 01/18/2011 $75.00
Class of Work: ALT 12% State Surcharge - Electrical 01/18/2011 $9.00
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y 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 $168.00
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. Y. may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Kr .
Issued By: 4a, / Permittee Signature:
dA/ 91'f'G / e/9 - i70
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.
2010. DEG, 10.FRI 11:43 DYNALECTAIC SALEM FAX No. 503 P. 001/003
.
- -.. -RECEIVED . -... - _ __ - ----- -_-- -- ---- .....
Electrical Permit A_ pnlication 1 oa OFFICE liar ONLY
City of Tigard DEC 10 2010 Received ,
1111 a 13125 SW Hall Blvd., Tigard, OR 972 Plan R : %2 /o /0 , Permit No.: Ida - p0,' 78
Phone: 503.718.2439 Fax: 503 -598.1 T�' OF TIG Plan Review
ARD Aate/B : Other Permit:4PO4io 21oa1/8'
1'IGARn Inspection Line; 503.639.4175 BUILDING DIVISION Data R. ady/By: CI See Page 7 for
Internet: www tigard or,gov Notified/Method:
Supplemental Information
T�. � f
Q 'OI �'N,A'. ta} .,: 0' S rrl.rJ i' qt �:` n t'wrrc t; t u,¢jn i
Il b ii r .. 1' !,' „a, . , - t ,; ,0 1'. , i, ' ri! +' �� w �a ....• �TM12 7 11'7 .N':},f" ' 3. t' A ... 1 uN ,'^.P.
•
111 New construction 7 Addition /alteration /replacement Please chock all that apply (submit 2 sets of plansw /item3 checked below):
❑ I7emOlitiOR ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Otller
Floatin i the where e ava a ble fault current ❑
^^^ccc��� I Marinas and boa
�'`��` g t � ,�, I -� .t �� k, boatyards.
# � k. f ” 0 ® " w ; ; t } , 0 buildings.
_, ,�S4 V M 1 . � o „ - f ..l „r ,tl aI, �' S' . ` Iess nand, or exceeds 14,000 =coeds 10,000 amps at 150 volts or g
O 1 and 2-family dwelling `: Commercial/industrial [] Accessory buildin gr ❑ Commervial - use agricultural
❑ Multi - family building amps for all other installations. buildings.
y ❑ Master builder ❑ Other: Q Firs pump. 0 Installation of 75 KVA or
c')-'' t;, n�, t i E w on r � p i��{ . _ i . ❑ Emergeacy system. la
i 1 i ' : • 'f -r.' ,� a b, jt 1 rv. , , 1 0 . r . } 6' r8or separately derived system, ' � • .set, r �.�� o,,•`,, - •r � V r , }� ❑ Addition of new motor load of Q "A ", "E" "1 -2 ", "1 -3 ",
Job no.: tOb fl Job site address: i 0200 9.4 6 r M IOOEIP armorc. occupancy.
...A Q Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP! t" 1 AA A OW, 1 +, 2- ❑Health -care facilities. ❑ Supply voltage tar more than
i t) /�,�� 11 ❑ Hasat'dous locations, 600 volts nominal.
Su itc /bldg. /apt, no.: ..�+ jo Project name: / 11 pr se r ❑ Service or feeder 600 amps r more o
f ' l� �1LI ffU31 iM f }
Cross street/directions to job site:
Descrt, 1 `l �, , 'SGFF �> ®1® ,' ,
Ifoa a'
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 S. ft. or lass 168.54 1 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
L �o, it n ''� Limited energy, residential
Is . t. , it pe �:. 2?r,' a tea n i n .1. ., : v ,,,,,« (with above sq. ft.) 75.00 2
` n , ��� Limited energy, multi= family
v ( /�
t 1C _ / / (L0 residential (with above sq..ft.) • 75.00 • 2
t Services or feeders installation, alteration, and/or relocation
• i z 200 amps or less 100.70 12
&./S "gi iii1 ti „::1017,i) , � + .♦ : .' � I ,: '' i iSx rtr{�� 0 � 6 ,Sfx �i i..s , i'1 r t.. •- ': 201 amps to 400 amps 133.56 2
Name: 4 z ( it i - Fi M to / 401 amps to 600 amps. 200.34 2
O Z fa o ‘.A.1 �-,,,^ 601 amps to 1,000 amps 301.04' 2
Address: I
Cal reel � 1 R U c . Over 1,000 amps or volts 552.26 2
City/StAte/2IP: Gi 9 Temporary services or seeders Installation, alteration, and /or
— f relocation
Phone; (.t '7_, ) 20. y 54 Ca . Fax. ( ) • • • • 200 amps or less - • 59.36.
1
Owner installation: This installation is being m ade on property that I own which is not 2 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
Owner signature: Branch circuits -, new, alteration,'or extension, per panel
•
� '�,,qq kk Date A. Fee for branch circuits ,
r� iwE; ,.i LN!I -V �� �� A}t,S p'ylit ;��i;� �- S�+Y�� t b' `"a { lt } f e e,
1Q 4dfr. i . ,. I,.. a's11;' u i6rt, t�'Ai.',., r, � , .14 -n �,� , VT Fri,, , Y ov;•. ° r11 • 14°' .�w°Yi, each circuit fee, 7.42
- each branc circuit 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: brar(ch circuit 56.18 2
•
Each add'l branch circuit 7.42 2
Address: _ Miscellaneous service or feeder not included
City/State/ZIP: Each manufactured or modular
dwellin service and /or feeder 67.84 2
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
t T '' r, 0 0 " r,. �s } t' r . „. Sign or outline lighting 67.84 2
t
t :13,1 ist r. ` : tt+T�.40 - i '� . ; P1.,,, ,r tl 'w .. .. A 4.'; Signal circuit(s) or limited- ener
Business name: / 1a Le 0.,-1-0. j 0. ,panel alter ation, or exte t Page 1 {] G
Each additional Inspection over allowable in any of the above
Address: 5711 W
Q o t prveo li t. _ Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP; P(/r t'to VI 0 / Investigation (1 .hr min) 66.25/ hr
�
, f - Industrial plant (Ihrmin) 78,18/hr
Phone: (95) 1i
"i - Li w L e Fax: (5b3) Li- a2-3 3 inspections for which no fee is
t p! At�q ! Electrical Lie.: 7 ( recrfically listed y h r min
CCB Lic.: (/ l p p 1r
- Su rv. Lie.: —
. ; � , . ?�i^�; °w`;� , -.g a...- L.,..i,RM ''*�`.�,��i
s
Suprv. Electrician signature, required: YLIL L( kV Subtotal: s (j ` 4 .4 Flan review (25% of permit fee): i er
•
Print name: 14 S p te: , �Q t b State surcharge (12% of permit fee); - 1- 0 0
Authorized signature;
TOTAL PERMIT FEE: 'EH , G 0
Thls permit application expires if a permtt Is not obtained within 180
r Print name: 1 ') _..� `/ Date: 1 2 a 1 0 as complete. .
JI 0 a Number of inspections allowed per permit.
r\ Buifdtng \Pennit4Ot,C- PernitApp.doc 07/01/10 44&- 4615T(t t /03/COM/Wao •
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2010. DEC. 10. FRI 11:44 DYNALECTRIC SALEM FAX No, 503 P. 002/003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RiggIngg:10.0a`Tg 17,0"... .
Fee for all residential systems combined $75.00
Check Type of 'Work Involved:
0 Audio and Stereo Systems*
n Burglar Ala=
fl Garage Door Opener*
1-7 Heating, Ventilation and Air Conditioning System*
7 Vacuum Systems*
fl Other:
770 9 :iv r BMW:cM).17.1ffrii 247ffori
Fee for each commercial $75.00
system
(SEE OAK 918
Check Type of Work Involved:
r7 Audio and Stereo Systems
fl Boiler Controls
Lj Clock Systems
< Data Telecommunication Installation
[=I
Fire Alarm Installation
I 1 HVAC
El Instrumentation
0 Intercom and Paging Systems
[1 Landscape Irtigation Control*
fl Medical
fl Nurse Calls
7 Outdoor Landscape Lightirig*
0 Protective Signaling
7 Other
Total number of commercial systems:
*No licenses are required. Licenses are requited
for all other installations
1 1111111ding1Permits W-LC-PermItApp doe 07/01/10