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Permit r , CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT Ill COMMUNITY DEVELOPMENT Permit #: ELR2011 -00143 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/21/2011 Parcel: 1 S135AB01004 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 220 Project: Lecroy Subdivision: METZGER, TOWN OF Lot: Project Description: Low voltage for data. Contractor: CHRISTENSON ELECTRIC INC Owner: LINCOLN CENTER LLC 111 SW COLUMBIA ST BY SHORENSTEIN PROPERTIES LLC STE 480 555 CALIFORNIA ST 49TH FL PORTLAND, OR 97201 SAN FRANCISCO, CA 94104 PHONE: 503 -419 -3300 PHONE: FAX: 503 - 419 -3695 FEES Description Date Amount Specifics: Restricted Energy Permit 06/21/2011 $75.00 12% State Surcharge - Electrical 06/21/2011 $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: 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 ordance ' appr. -d 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. AT NTION: Oregon re. ir:. you to follow the rules adopted by the Oregon Utility Notificatio enter. Those rules are set forth in OAR 952 -001 010 through OAR 95. 01-00•0 Yo may obtain a copy of the rules or direct questions to OUNC by callin 3.2 .1987 or 1.800.332.234•. k 9 t / / / Issu Permittee Signa re: ( � `A 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. JUN -20 -2011 MON 01:13 PM CHRISTENSON ELECTRIC, INC FAX NO 95034193695 P. 01 � R Electrical Permit Applic� D . FOR 'OFFICE USE ONLY Ci{� of Ti and 2011 Received II ��� &tee A op/ 3 `� g' 4_ l l[ ` 1 [lj Re t / Permit No.: • � 14 13125 SW Hall Blvd., Tigard, OR T 23" Plan Review Phone: 503,639.4171 Fax: 5019j>p,..,I, D a`� ' Other Permit: Peon ot! o�f T I t: i A lt. r) Inspection Line: 503,639.4175 lujt Data Ready /13y; 7» rls: li1 Sec Page 2 for Internet: www.tigard- or.gov BUILDING DIVISION Notiftad /Method; Supplemental Information • . d:. ' 14 ' OF WORi1; • i ,'.. , 7 ;, • ' ❑ New Construction dition/alteration /replacement Please check all that apply (submit 2 sets of plans w license checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition Other; whore the available fault current ❑ Marinas and boatyards. CA' 'E(y less to ground, or exceeds 14,000 En Commercial-use agricultural ¥'iQ16 QNST.RUCTION, . • r exceeds 10,000 amps at 150 volts or ❑ floating buildings. El 2-family dwelling Commercial /industrial ❑Accessory building amps for all other installations. buildings. ❑ Multi- family El Master builder © Other: ❑ Fire pump. ID Installation of 75 KVA or ❑ Emergency system. larger separately derived system, JOB SITE;. Tf�ThORI1A ION AND LOCATION ❑ Addition of now motor load of ❑ "A" "E" "1 -2" "1-3", , or Job no. ► LIM Job site address: 0.y , / AF . 10011P , occupancy. 1 � AI IA • r ❑Six or moore re resoeidenGsl s nits, ❑ lzecrrstionsl vehicle pastes. City /State /ZIP O fte, 1' q by, ,,I J a . I O Hoalth -cu ❑ re facilities, Supplyvoltageformorethan l I ]lazardons locations. 600 vole nominal; Suite/bldg. /apt- no.: r Project name: mZ /L ll , ❑ Service or feeder 600 amp; or more. ' FOE ` S411CDULE :. :' Cross streeUdirectians to job site: la 1 � , _ � ;►t „ Aurcriatiun �� � I Qty. I Fee. I Tnt ul l • New residential single- or multi - family dwelling unit. 71 de - * f i Includes attached garage, , Subdivision: Lot no.: 1,000 sq, ft, or less 160,54 _ 4 - Ea. add' 1 500 sq, ft, or portion 33,92 1 Tax map /parcel no.: _ . Limited energy, residential U E � "+C.CtII"IYON, O R WORK (with about sq, R,) 75.00 2 T. ` _ n n t / _ }� �� /�� - e_. . Limited eat rgy, it ha b o ve i q, t( '�j(Ll,)(,l�J � (,�f I (, ` (J 1 residential (wit a bove sq, ft.) 75.00 '- - Services or feeders installation, alteration, and/or relocation _ 200 amps or less 100.70 2 ' ❑ PROP.1tRTY OWNER'...' ' .i' :':.: • .:a TENANT 201 amps to 400 snips 133.56 - 2 Name: 401 amps to 600 amps 2 00.34 2 - 601 amps to 1,000 amps 301,04 2 Address: Over 1,000 amps or volts 552.26 2 City /State/ZIP: Temporary services or Feeders insinuation, alteration, and /or _ relocation Phone: ( ) f ( ) 200 amps or less 5936 1 Owner installation: This installation is being made on properly that I own which is not 201 amps to 400 ramps 125,08 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 160.54 2 Branch circuits - new, alteration, or extcnsinnaer E,'tnel Owner signature Date; A. Fee for branch circuits with ❑ APPLICANT . , • ' • '. ' ❑ CONT PERSON above service or feeder fee, 7.42 2 each brooch circuit Business name: � � c � _ , ,,.� t 13. Pee for branch circuits without ...� service or feeder fee, first Contact name: branch circuit 56 2 leach add'l branch circuit 7,42 2 Address: • Miscellaneous service or feeder not includ _ City /Stott /ZIP: Each manufactured or m o d u lar 67 , 84 2 dwelling, service and/or feeder _ Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E -mail: Pump or irrigation circle 67,84 2 �. Sign or outline lighting 67.04 2 CONTRACTOR Signal circuits) or limited- energy Business name: War _panel. alteration, 01 extension. n wahie P an � 2 ail ^ Each additional inspection over o in any of the above Address: 1 \` AI iii w1 II J - . , j ` V Additional inspection(1 hr min) 66.25/ hi' City /State /'ZIP: • , k - ko yyA. ` r I ar investigation ( hr min) 66.25/ hr Industrial plant (1 hr min) 7R, I R/ hr Phone: 1 r t,' inspections for which no tee is "4111 , � ` y j - --�� specifically listed (1/4 hr min) 90,00/ Its � CCB Lie.: - Ai. l lectrical Li r -� i� v. Lic : , 5 $ ELECTRICAL:.PERMIT' 1?E ES' . • • Suprv, Electrician signature, required: Sub f�l �iA l _ _ t __ ,• - Pi an review (25% of permit Pee): Print name: _ IV l.:� A 1 k _._,.... Dale: I • 1 L i... State surcharge (12% of permit fee):__ - Authorized signature: TOTAL PERMIT FEE: This permit application cxpires if n permit is not obtains Min 180 Print name: days after it has been accepted as complete. Dine: • Nuinboi of i,tspucllnnx nlluvve l per permit, h1l3uildinl :lpurmit0Fld'- runnilApp.doc 4171011 LA 74a•I5ril /09rC01v1AVEn JUN -20 -2011 MON 01:13 PM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P. 02 Electrical Permit Application - City of Tigard .......... . Page 2 . Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIA.L:WORIONLY :. ' Fee for a residential systems combined........ $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* n Burglar Alarm ❑ Garage Door Opener* ❑ Ileating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORT{ ONLY: Fee for gm i commercial $75,00 sys tern (SEE OAR 918 - 309 - 0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls i.. ❑ 'lock Systems Data Telecommunication Installation ❑ Fire Alarm Installation n IIVAC • ❑ Instrumentation . ❑ Intercom and Paging Systems ❑ I andscape Irrigation Control* ❑ Medical n Nurse Calls ❑ Outdoor Landscape Lighting* n Protective Signaling ▪ Other Total n timber of commercial systems; *No licenses are required. Licenses are required for all other installations TABoilding lPem,itc1HIf.PermitAppdac 07/0 MG