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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT Permit #: ELR2011 -00179 TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07!28/2011 Parcel: 1 S135AB03400 Jurisdiction: Tigard Site address: 10260 SW GREENBURG RD 610 Project: New York Life Subdivision: METZGER, TOWN OF Lot: PTS 7 -8 Project Description: Data telecommunication Contractor: TECHNOCOM INC Owner: LINCOLN CENTER LLC 7929 SW BURNS WAY STE. F BY SHORENSTEIN PROPERTIES LLC WILSONVILLE, OR 97070 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 682 -4195 PHONE: FAX: 503 - 682 -2781 FEES Description Date Amount Specifics: Restricted Energy Permit 07/28/2011 $75.00 12% State Surcharge - Electrical 07/28/2011 $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 9522 ' •r.90. 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: ( i ' Permittee Signature: 0/V /% ' / / C�77a' ,� 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. Electrical Permit ApplicatI0nRECEIVEED FOR OFFICE USE ONLY s - City of Tigard Received "' 13125 SW Hall Blvd., Tigard, OR 97223 JUL 2 7 () Dale/By: 74. f// Permit No.; EL/Wd // el D /79 Phone; 503.718,2439 Fax: 503 "598,19 Plan Review TIC; A R I) Inspection Line: 501639.4175 P iIIe /B : Other Permi6U /Ve4 eta/ C OF TIGARD Late Keady/By: luris: Internet www.ligard- or,gov BUILDING DIVISION see pace 2 for Notified /M ethod: Su lentent>,I Inform ll'ion . PP • TYPE OF WORK PLAN RE VIEW ❑ New construction Addition /alteration/t•eplitcement PlCaae check all mill A pP y I (: submir 2 sets of plans w/ilems checked below): 0 ❑ Demolition u Other; ❑ Service or feeder 400 amps Or more ❑ Building over three stories. Where the availnhle fault currant 0 Marinas and Ouatyltrds. , : cATE,OORY OF CONSTRUCTION , • exceeds 10,000 amps at 1 S0 volts or P ❑ Floating buildings. ID I - and 2 dwelling I Commercial/industrial ❑ Accessory building less to ground. or exceeds 14,000 ❑ Comme - use agricultural amps fur an other installations. buildings. 0 Multi family ❑ Master builder _ El Other: 0 Fire pump. Q Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑Emetgencysyslem. larger separately derived system. 2 ID of 15W ll OtOr load or Job no.: • Job site address: O IOnHt or more. / I J . ''_L/ R ecr atio - Ci ty /St ate /Z IP: �i, � ❑Six or more res un ❑ Recreational vehicle parks. 0 He alth - care facilities. Il • _ ! ` ❑Supply voltage for more than r. ' ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt.no.• ' 0 rrojcotniune; 1--.C) , tJ Service orfeeder600a,apsormore. Cross strect/directlte; FEE SGItEllUGE _+` Dibrriuliun IM Fee. Milli • New residential single. or multi - ! dwelling unit. Includes attached garage. Subdivision: t " ' [ Lot no.: i 1 t. or less 168,54 q Tax map /parcel no.: ha. add'! 500 sq. R. or portion 33,92 1 DESCRIPTION OF WORK Limited energy, residential 75,00 2 _(with above sq. ft.) In I, �� jJ , 1"� Li,uitzU energy, multi - family -- .,/. I, residential Swith above sq, ft,) 75.00 2 Services or feeders installation, alteration, and /or relocation _ 200 amps or lace 100.70 2 � . '© PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 Name: 401 amps to 600 amps 200.34 2 — 001 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City /State /21P: ---- Temporary services or feeders installation, alteration, and /or _ relocation Phone: ( ) i Fax: ( ) 200 amps or less 59.36 l Owner installation: This installation is being made on property that I own which is not ' amps to 400 amps 125.08 intended tar 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 _ Date: A. Fee for branch circuits with APPLICANT L ..i-tr-CONTACT PERSON above service or feeder lee, 7 42 2 each branch circuit Business name: B. fee for branch circuits without cervico or feeder fee, first 56,18 2 Contact name: branch circuit Address: im — Each add branch circuit 7,42 2 , 1 . Miseellanrnus tservi,• or feeder not included) City /State /ZIP: 11,� Each manufactured or modular _ dwelling, service and/or feeder 67,64 2 Phone: ( ) p ax: ; ( ) Reconnect only 67.84 2 E-mail: �� ` � Pump or irrigation circle 67.84 2 CO I ' A 0' 1 , / I i` , Sign or outline lighting 67,84 2 Slenal circuit(s) or li nirnri energy Business name: 0 , • noel, alteration, or Cx[enbi Pp e 2 2 r , ' Each additional insyeetion over allowable iu any ul'tile above Address: I its. , 1.._,, V. �r Additional inspection (1 hr min) 66.25/ hr .y +fr v - 6Y r M � • investigation (I hr min) 66.25/ hr Y T Industrial plant (1 hrmin) 78.18/ hr Phone: (' r 1 / lax: d € 1 nSpeCtions for which nn Pre is J , r EleciriCal Li r _ Y - specifically listed (A hrmin) 90 ,00! hr r r..y pry. L,c.: ELECTRICAL PERMIT FEES 1 / $uprv, Electrician sign pure, required: /N to l /� S ubtot al: i� 4' Plan review (25% of permit fee); Print name: r Date: b 1 I State surcharge (12% of permit fcr); t� d lj r Authorized signature: 6 TOTAL PERMIT FEE; y Ths permit applitin expires if a permit is not obtained within 180 Print name: �� days tiller it has been accepted as complete. �... - I / • Ntunber of inspections allowed per permit. / 1: 16uhdinuTcrmit4ELC- PemlitApp.doc 07/01/10 44.46IST(I V08/C061M'ED Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: 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 SysLeue' ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire AIarm Installation ❑ I-IVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling Z O ther ` Total number of commercial systems; a 4 'No licenses are required, Licenses are required for all other installations lAeu11dio PormicADD,doc 07/01/10