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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2011 -00169 TlGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011 Parcel: 1 S 135AB01004 Jurisdiction: Tigard Site address: 10220 SW GREENBURG RD 220 Project: Lecroy Subdivision: Lot: Project Description: Data telecommunications system. 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 07/15/2011 $75.00 12% State Surcharge - Electrical 07/15/2011 $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 $84.00 Other Desc: Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 9 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. By:G% Permittee Signature: - OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease or rent. OWNER'S SIGNATURE: Date: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. JUL -13 -2011 WED 02:28 PM CHRIS . ..A;'i E virs,;ln NC FAX NO. 95034193695 P. 01/02 Electrical Permit Application JUL 132011 FOR OFFICE USE ONLY City of Tigard Received —7 Permit N g TTY OF TIGARD Date/Et : / 17# �i — _ I � 13125 SW Hall Blvd., Tigard, OR 9722 Plan Review t Phone: 503,639.x171 Fax: 503.598$ LDING DIVISIO DateB : Other Permit: F t c. A It [ r Inspection Line; 503.639.4I75 Date Rcady/By 65 Soo Page 2 for Internet; www,tigard or,gov Notified/Method: Supplomantat Information YP1' Oi WORK ❑ New construction /Z Addition/alteration/replacement Please check all that apply (submit a sets of plans w /items chneke4 below): 1:I Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition 0 Other: whero the available fault current ❑ Marinas and boatyards, 'C-'TE r O :• ';;CONSTRUCTION•,: • exceeds 10,000 Limps Lit 150 volts or ❑ Floating buildings. leas to ground, or exceeds 14,000 ❑ Commerciol.use aaricnll,(rul ❑ 1- and 2- family dwelling 7.11 Commercial/industrial ❑ Accessory building amps for all oilier installations. buildings, ❑ Multi- family © Master builder ❑ Other: El Fire pump, ❑ Installation of 75 KVA or JOB 'SITE:, I I VL O R117<ATIO N • AND LOCATIO " , ❑ Emergency system. larger separately derived system, • / . 1,, ❑ Addition of new motor load of El "A ", "D", "1-2", "1-3", Job not. p Eo 3 2, I Job Site address; 1 D 2iD \/ c,,,,,,,,b,„ . 5 S OOAP or more. occupancy. 1 ❑ Six or more residential units, ❑ Recreational vehicle perks. City /State /ZIP: 1 L : `� ❑ Health care fncilitice. Supply voltage for more thou t! �` _ ❑ Hazardous locations. Q 600 volts nominal, Suite/bldg. /apt. no.: P Project name: F--n c n - v ❑ 5ervico or teeder 600 amps or more, • Cross street/directions to job site: � . • , b�.E S�HEDULL `, . I Description QtX. ree. t Total l " '1 r New residential single- or multi- family dwelling unit. includes attached garage. Subdivision: lot no.: 1 sq. ft or less 168.54 4 Ea. add' 1 500 sq, tt, or portion 33.92 1 Tax map /parcel no,: Limited energy, residential 75.00 2 ' • , ;D SCRIPTION:' O WORK' • • • (with above sq, It) I Q � ! '�"� 9�� � � � Limited energy, multi-family residential (with above ily (l.) 75.00 2 \1y� 1{.l LJ C7C.I 1 5 01�+U5-J1.e1,J Services or feeders installation, alteration, and /or relocation r�irt� `` C ( c - 200 amps or less 100.70 2 '' ..• p PROPERTY .0 ER,' ' .. • : 17' T ENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 601 amps to 1,000 amps 301.04 2 Address: Oyer 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/o City/State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 59,36 I 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, per panel Owner signature; Date: A. Pee for branch circuits with • above service or feeder f C ❑ • PLICANT:;:, ❑ CONTACT PERSON. 7.42 2 _ _ each branch circuit Business name: ////���� fr.c t ./ B, Fee for branch circuits widow' "'� '-1'+ service or feeder fee, first 56,1 2 Contact name; branch circuit — - - Each ndd'I branch circuit • 7,42 2 Address: _ Miscellaneous (service or feeder not included) Each nranuf'actured or modular City /State/ZIP: ^� dwelling, service and/or feeder .� 67,84 2 Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E Pump or irrigation circle 67,84 2 r— Sign or outline lighting 67.84 2 . CONTRACTOR Signal Circuit(s) or limited - energy f ?1 1 Business name: �� /A. ,,,panel, alteration li , or extension. 1 Page') 2 Each additional inspection over allowable ink of the above Address: Ill CAU, 1 r• , �� /) Additional inspection (I he min) 66.25/ hr V , 1n v v �s..� ty .sL Investigation (1 hr min) 66,25 / hr City/State/ZIP: - ! I + 11_taa Industrial plant (1 hr min) 78.1 B/ hr _ Phone: A r — ... F Inspections for which no fee is 90,00/11r -- �/ specifically listed (4 hr min) ,(� 'CC13 Lic.: 4 ` 4i �_� Electrical Lic, 6 4 Su rv. Lic,5� 6 j ELECTRICAL RMIT tn'EI�CS VV�V '' Suprv. Electrician signature, required: 9 /y Subtotal: 75 ;x' / Plan review (25% of permit fee): Print name: Da `._ � � Slate surcharge (12% ot'permit tee): `� l,l TOTAL PERMIT FEE: t M Authorized Signature: . , �.1 �y This permit a ppl ic ation expires irn permit is not onwi • ,nun 180 days after it has been accepted as complete. Print name: Dale: • Number of inspections allowed per permit. — � / IARMldi \PWrnital.C- Prtmi due nilninn •1 -0n-- 16i Fr( I i m9 /t`ON.I/ 'Eli 77Zu 5 - 'e 6/