Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
14 - COMMUNITY Permit #: ELR2011 -00214
DEVELOPMENT
Date Issued: 10/07/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 7182439 parcel: 1S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Project: Axiom 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 503 - 619 -3200
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 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 ATTE c • ! - •on law requires you to follow the rules adopted by the Oregon Utility Notification Ce•ter Those rules are set forth in OAR
952- 001 -..10 through OAR • -001-01•0 You may obtain a copy of the rules or direct questions to OUNC by calling 503 23 a 7 or 1 800 332 2344
g
Iss • d By: __ 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.
9
, Electrical Permit Application FOR:OFFICE USE ONLY
kr Received WE City of Tigard EC
Date /By: /rQ�y1/7Perml t no.. �/ c 2,0//.. �It/1�/
13125 SW Ball Blvd., Tigard, OR 97 3J Plan Review � /C• Cam/
Phone: 503.639.4171 Fax: 503.598.1960 4 �f}1� Date /By Other Permit
Inspection Line' 503 639.4175 n 4 t Date Read /B Juris: see page 2 for
TIGARD 0 Ready /By I/ ; • Supplemental info H
Internet: w vw.tigard- or.gov Notified /Method. td /(
TiG A D� �p L Enrol-mutton }I (1P t � S 94 �t U IM -4cr ll
TYPE OF WORK CIT V11�]Gn1� 1 PLAN REVIEW
SI0N
❑ New construction ❑ Addition /alteration /repla�5al#'t' Please check all that apply (submit 2 sets of plans whtems checked below)
❑ Demolition ❑ Other ❑ Service or feeder 400 amps or more ❑ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
LI I - and 2 - family dwelling H 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 111262 - 45 Job site address 10260 SW Greenburg Road ❑ Fire Pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system
City/State/ZIP. Tigard, OR 97223 El Addition of new motor load of ❑ "A", "E", "1 -2", "1 -3",
100HP or more ❑ occupancy
❑ Six or more residential units El Recreational vehicle parks
Suite/bIdg /apt no Stc-/inle Project name Axiom T.I.
❑ Health -care facilities ❑ Supply voltage for more than
Cioss Street /Directions to Job site ❑ Hazardous locations ❑ 600 volts nominal.
❑ Service or feeder 600 amps or more
FEE SCHEDULE
Subdivision Lot no. Description I Qty. I Fee. I Total I **
Tax map /parcel no ' New residential - single or multi - family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
INSTALL FIRE ALARM CIRCUIT 1000 sq ft or less $ 165 54 4
Ea Add'I 500 sq. ft or portion $ 33 92 1
U PROPERTY OWNER I H TENANT Limited energy residential
(with above sq ft.) $ 67 84 2
Name SHORENSTEIN REALTY SERVICES Limited energy, multi - family
Address residential (with above sq ft ) S 67 84 2
Service or feeders installation, alteration, and /or relocation
City/State/ZIP 200 amps or less $ 100 70 2
201 amps to 400 amps $ 133 56 2
Phone Fax 401 amps to 600 amps $ 200 34 2
601 amps to 1000 amps $ 301 04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 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 S 59 36 1
❑ APPLICANT I L I CONTACT PERSON 201 amps to 400 amps S 125 08 2
Business Name 401 amps to 599 amps $ 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 S 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 S 67 84 2
Business Name CAPITOL ELECTRIC CO., INC. Reconnect only $ 67 84 2
Pump or irrigation circle $ 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 I Page 2 $ 75 00 2
City /State/ZIP PORTLAND, OR 97220 -1041
Each additional inspection over allowable in any of the above
Phone 503 - 255 -9488 Fax' 503 - 257 -7121 Per nspecuon $ 6625
Investigation per hour (1 hr min) S 66 25
CCB Lie : 48748 I Electucal is : 26 -496C ISuprv. Lie.. 3132 -S Industrial plant per hour $ 78 If
Supry Electrician signature, fequire
zi r. 42 ELECTRICAL PERMIT FEES*
4 Subtotal $ 75.00
Print Name: DAR�.ELL MCNEEL Date. 0913011 "` Plan review (25% of permit fee)
State surcharge ( 12% of permit fee) $ 9.00
Authorized signature 11,111.\'2/147 TOTAL PERMIT FEE $ 84.00
Print Name. DARREL N This permit application expires if a permit is not obtained tt Rhin 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:
ik *,, Nip 1
Fee for all residential systesm combined $ 75]]0
Check Type of work Involved:
LJ Audio and Stereo Systems*
CI Burglar Alarm
CI Garage Door Opener*
E Heating, Ventilation and Air Conditioning
System*
O Vacuum Systems*
L] Other:
Fee for each commercial sytem $ 76.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
CI Audio and Stereo Systems
LJ Boiler Controls
CI Clock Systems
E Data Telecommunication installation
el Fire Alarm Installation
CI HVAC
LJ Instrumentation
CI Intercom and Paging Systems
CI Landscape Irrigation Control*
E Medical
• Nurse Calls
Ei Outdoor Landscape Lighting*
O Protective Signaling
Ei Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations