Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
n COMMUNITY DEVELOPMENT Permit #: ELR2011 -00213
Date Issued: 10/07/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Parcel: 1S135A603400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 1180
Project: NSKB, LLC Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Low voltage for fire alarm.
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE 503- 255 -9488 PHONE:
FAX 503 - 257 -7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/05/2011 $75 00
12% State Surcharge - Electrical 10/05/2011 $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: N Fire Alarm. Y
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 i cor.an - , ith 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 • ENTION Orego law r-quires you to follow the rules adopted by the Oregon Utility Notification r Those rules are set forth in OAR
952 -00 0010 through OAR 95 le Olt You may obtain a copy of the rules or direct questions to OUNC by calling 503 or 1 800 332 2344
Issue By: k / � .L lL��i� Permittee Signature: r �--
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 Application , , /o F OFFICE ,u aD / 'OD Permit Cat Qf lgiir � Received
Dale /By. �� /3
"i ° 1312,5 SW Hall Blvd., Tigard, OR 97223 6 � ➢/ Plan Review-
s Phone: 503.639.4171 Fax. 503.598 1 IV °:�
Date/By. Other Permit.
Inspection Line' 503.639.4175
Ins
T I G A R D D a t e R eady /Bye. Juris ❑ See Page 2 for
Internet: www.tigard- or.gov _, notified /Method. MN 11 Supplemental Information
TYPE OF WORK e rA PLAN REVIEW
❑ New construction H Addition /alteration /replacement �`` � G 1 ,� Please ch all that apply (submit 2 sets of plans w /items checked below)
❑ Demolition El Other VA ❑ Service or feeder 400 amps or more ❑ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
❑ I- and 2- family dwelling U Commercial /industrial ❑ Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi - family ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations ❑ buildings
Job no. 111267 - Job site address 10260 SW Greenburg Road El Fire Pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system
City/State/ZIP Tigard, OR 97223
El
of new motor load of ❑ "A", "E ", "1 -2 ", "1 -3 ",
100HP or more. ❑ occupancy
Sine /bldg /apt no Ste 1180 Project name. NSKB T.I. ❑ Six or more residential units ❑ Recreational vehicle parks
❑ Health -care facilities ❑ Supply voltage for more than
Cross Street/DU ections to job site. ❑ Hazardous locations ❑ 600 volts nominal
❑ Service or feeder 600 amps or more
Subdivision Lot no FEE SCHEDULE
Description I Qty. I Fee. I Total
- fax map /paicel no : New residential - single or multi - family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
INSTALL FIRE ALARM CIRCUIT 1000 sq. ft. or less $ 168 54 4
Ea Add'I 500 sq. ft or portion 5 33 92 1
❑ PROPERTY OWNER I ❑ TENANT Limited energy residential
Name (with above sq. ft) $ 67.84 2
SHORENSTEIN REALTY SERVICES Limited energy, multi family
Address residential (with above sq ft.) $ 67 84 2
Service or feeders installation, alteration, and /or relocation
City /Slate /ZIP • 200 amps or less $ 100 70 2
201 amps to 400 amps S 133 56 2
Phone Fax.
401 amps to 600 amps $ 200 34 2
601 amps to 1000 amps 5 301 04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts 5 552 26 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature. Date relocation
200 amps or less $ 59 36 1
❑ APPLICANT I ❑ CONTACT PERSON 201 amps to 400 amps $ 125 08 2
Business Name 401 amps to 599 amps S 168 54 2
Branch circuits - new, alteration, or extension, per panel
Contact name A Fee for branch circuits with
service or feeder fee, each
Address branch circuit 5 7 42 2
B. Fee for branch circuits
City /State /ZIP without service or feeder fee,
first branch circuit $ 56 18 2
Phone Fax. Each additional branch circuit' $ 7 42 2
Miscellaneous (service or feeder not included)
E -mail. Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 67 84 2
Business Name CAPITOL ELECTRIC CO., INC. Reconnect only $ 67 84 2
Pump or irrigation circle S 67 84 2
Contact name DAN WILSON 503.262.0411 DIRECT Sign or outline lighting $ 67 84 2
Signal circuit(s) or limited -
Address 11401 NE MARX ST. energy panel, alterations, or
extension Describe Fire Alarm 1 Page 2 S 75.00 2
City /State /ZIP PORTLAND, OR 97220 -1041
Each additional inspection over allowable in any of the above
Per inspection $ 66 25
Phone 503 255 - 9488 Fax 503 257 - 7121
Investigation per hour (I hr min) 5 66 25
CCB Lie.' 48748 IElectricalLic, 26 -496C ISupry Lic • 3132 -S Industrial plant per hour $ 78 18 _
Supry Electrician signature, required ELECTRICAL PERMIT FEES*
�dfO Subtotal $ 75.00
Print Name. DARRELL MCN�EL Date: 09/30/11 Plan review (25% of permit fee)
Authorized signature ` yam State surcharge ( 12% of permit fee) $ 9.00
1 " 1" °/ /� G 4r TOTAL PERMIT FEE $ 84.00
hint Name DARRELL MC E This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections per permit allowed
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
■
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL.INORK;®N x °' '
Fee for all residential systesm combined $ 75.00
Check Type of work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
..�,,. �� ro w, .,��; E
'COMMERCIALWORK:_O,NLY' , A;ML, � x�_ ,.
Fee for each commercial sytem $ 75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication installation
El 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: 1
*No licenses are required. Licenses are required
for all other installations