Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
``"1 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00067
T I G AFL D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/18/2011
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 800
Project: Mortgage Express Subdivision: LINCOLN TOWER Lot: 0
Project Description: Data telecommunications system.
Contractor: AF TECHNOLOGIES Owner: LINCOLN CENTER LLC
PO BOX 6551 BY SHORENSTEIN PROPERTIES LLC
BEAVERTON, OR 97005 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 466 -2900 PHONE:
FAX: 503 - 466 -2922
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/18/2011 $75.00
12% State Surcharge - Electrical 03/18/2011 $9.00
Type of Use:
Class of Work:
Total Number of Systems:
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: 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 c• • • • - rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: By: ������= - -_ •ermittee Signature: _ — / — -
• WNER 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.
Mar, 18. 2011 10:24AM Tri logy Custom Homes No.1368 P. 2
Electrical Permit Application FOR OF ' I'C'E I'SF ONI.l
City of Tigard Received ,
• M / .il4 Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 DatelB ► [ ,i �� — 0 0 04
t Phone: 503.718,2439 Fax; 503.598.1960 DateB : Other Perini : 4 Plan Review
i I e 0 ! / ,_ r
TIG ns a on
npt� P Line: 503.639.4175 8 201
MA 1 Date Reedy/By: Page 2 for
Internet: www,tigard- or.gov Notified/Method: _WM Supplemental Information
f , t
.New construction CI Addition /alteration/replacement Please check all that apply (submit /Buts of Atm w /ftoass checked below), ^
LI Service or feeder 400 amps or more ❑ Building over three stories
Q Demolition ❑ Other;
where the available fault current 0 Marinas and boatyards
,,,,N,.:::,11, , „ exceeds 10,000 amps at 150 volts or la Floating buildings.
El 1 - and 2-family dwelling :4 Commercial /industrial ❑ Accessory building amps all other installations. ns. ❑ buildings.
. agricultural
❑ Multi family ❑ Master builder amps for a!1 other itstallationa. Inta
❑ Other: 0 pump.
: t ;;. v ❑ lorgee separately t ly KVA or
.. ❑ > m enc stem.
......, •• l s 4.. ._ . . , i : '?4. 1+ 8 : .,N , ih 5 i r •a i W „ a y larger se derived CID.
a
.,.�,. ` „” ., ., x...s *, ;; ❑Addidou of new motor load of ❑ "A ", °'E';'•1 -2 ", "1 3
100HP w m ore, occu -'
Job no,. 1 p 0 Job site address:
102 bD 8W G reg , r. eanon-
❑Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: -701.1Act.noi ("AZ 4 2:7— ❑ Health-cart facilities. El Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: t Projec name: L } amps or more
Project M e � + � ❑ Serv ice or feeder 600
Cross street/directions to job site: ' ; .�, + s •
Perri. 'on Qty. Fie. Total
New residential single - or multi- family dwelling unit.
In c l u d es attach g arage .
Subdivision: 1,000 `
Lot no.: sq. ft. or less 16$
Tax map /parcel no.: Fa. add'! 500 sq. ft or portion 33.92 ;
0. . 1 c t ix s �t Lilted energy, residential
.. ,...' : ...:„... . ,.., s. :l 7inz 'r" 14i i „lI3! 0l ? ... i�.i^tisc r ,_ ,l : i
va, + ?, ,,i 73,00
(with above
lir �1.y��p � Limited energy, multi - family
If t + lii residential (with above sq. ft.) 1 75 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100,70
2
.'c �r, < ... •:. ,, t , ..;', , ,; , ? :.„::',i,,,
, � $ 1 1 � r `� . i ` ','1,...:3S.7.-7, 1 ' r ,i:,,,,:;,;.,2; t""ti -- ,, S'rr 1,-„ l amps to 400 turps 133.56
Name: r . .,',, W,;, 401 amps to 600 tips _ 200.34 2
Address: 601 amps to 1,400 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders Installation, alteration, and/or
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 135.08 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: Date: Branch circuits— new, alteration, or extension er panel
w m A, Fee for blanch circuits with
?,. ! . ...�... >, : ...— .., ,;. -.. ' c..2....,, » .W, 1
above branch cran Sei e irc or feederibe.
t�_.. .- ea circ
7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 2
Address: Each add'1 branch circuit 7,42 1 2
Miscellaneous (service or feeder not included)
City/State/ZIP: manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: ; ( ) Reconnect only 67.84
E -mail: Pump or irrigation circle 67.84 2
r I i r � eJ ,? l Sign or outline lighting 67.84 2
. � a r L ,.. u---- ..� -.. > % r` Signal circuit(s) or limited-energy
Business name: a F -'r_ c �� _ _ panel, alteration, or extension. Page 2 2
Each additional ins r ection over allowable In an of the above
PO Address: ff' _55 1 Additional inspection (1 hr min) City /State/ZIP: n V+ TQ � Q a Investigation (I hr min) MI 66,25/hr 6625/ hr
;... �•,.
Industrial fo w in) 7$18/hr
Phone: 503 1 466 , � t J �� Fax; �v� � _ � �gZrL inspections specapcctionsons fm which h no fee is ,
hr CCB Lic.„ ,7 Electrical Lic,: (j ID Suprv. Lic. L er ,t , s om.. ,. tfica listed Si hr mm) A'h 90
_ . A . .a..... . i. ,'v��.�. I,,r , :.n
Suprv. Electrician signature, required: Subtotal:
IAA. Plan review (25% of permit fee):
Print name:
f 0 ._ i
'� i Dat $ Q ,� ��
a L State surcharge (]2 % of permit fec): q—
_
Authorized signature: , TOTAL PERMIT FEE: Q &I ...
� �++IFA r F This permit application eapi a if a permit is not obtained within 180
•
L _ Date d+3 • )'d- I l da after it has been accepted as complete.
Number of inspections allowed per permit.
f ,PermitApp, 07 /0I 110 aetrua,eTnsmrrrnmnuco
Mar. 18. 2011 10:24AM Trilogy Custom Homes No. 1368 P. 3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
0 Vacuum Systems*
❑ Other:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
0 Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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