Permit CITY ®F TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELR2011 00215
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 10/04/2011
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Project: Axiom Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Low voltage for voice & data.
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' 503 - 619 -3200
FAX' 503 -682 -2781
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/04/2011 $75 00
12% State Surcharge - Electrical 10/04/2011 $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 ATTENT regon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 - 001 -001 hrough 0 95 00 00 You may obtain a copy of the rules or direct questions to OUNC by calling 503 1987 or 1 800 332 2344
/ L Issue By: 1 r Permittee Signature. lC "f Lt—i
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 vo Ron:KT usv oim.,Y
IN Ci 0r Tigard - ,. e `
° 13 125SW Hall Blvd., Tigard, OR 97223 = 1 "� /O ' =�/� Permit No,; � 0i�/ /""�O j� ...._ i _ Pharr: 503.718.2439 Fax: 503,598.1960 REcEI j "" G(p/
Other Permi A g s
T i G An [) Inspection Line: 503.639.4175 q¢te Ready /Hy: Juris, fdi See Page 2 for
inteniiet. www.tigard -or.gov OCT 0 3 gdificd/Method. Supplemental information
I
TYPE OF' WORK I P AN 12EVIkW
CITY 01= TIGARD Please check oil tbat apply (submit 2 sets of plans w /items checked below);
[] New construction • j� Addition /alteration /reel
SING DIVISION ❑ Service dr feeder 400 amps or more Cl Building over three stories.
❑ Demolition ❑ Other: where th6 available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION ,; exoteds 0,000 amps at ISO volts or ❑ Floating buildings.
less to g und, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- famil}k dwelling 'Commercial /industrial 0 Accessory building amps fo other installations, buildings,
ID Multi-family ❑ Master builder ID Other: I] titre pump• p Installation of 73 KVA Or
- ❑ Emergency system, larger separately derived system,
Job no.:
1 • " JOB SIT E t INFORMATION AND LOCATION p Addino of new motor load of ❑' A' ' E" "1 - Z" "i s"
7` address: f 1005W oM I ro
Mo. occupancy.
.._ _..,- e, I ❑ Six or n re residential units, ['Recreational vehicle parka,
City /State /ZIP: r ay 1722.3 ❑ Health-clue facilities ❑ Supply voltage for more than
❑ Hazardo ss locations. 600 volts nominal.
Suite/bldg. /apt, noL. 1 Project name: Ay, ®,s ) `1G pAA ❑ Service Or feeder 600 amps or more
i.
FEE SCHEDULE
Cross street/directions to job site: Description I , Qtyj Fee. I Total I •
New residential single- or multi family dwelling unit.
Includes attached garage.
Subdivision: LOt no.: 1,000 sq. fd, or less 168.54 4
Tax map /parcel nd ; Ea. add'I S, sq. ft or portion 3192 1
Limited energy, residential
DESCRIPTION OF WORK (with abf ove sq. ft.) 75,00 2
Limited energy, rnuln- tamely 75 00 2
VIAL j = (Lig. 4 residential (with above sq, ft.)
Services dr feeders installation, alteration, and /or relocation
200 amps cIr tees _ 100 70 2
' ' 'U FRb EiRty!OWNER' , , ,; in, TENANT 20i amps ti, 400amps 133,56 2
Name; 1 401 amps ti? 600 amps 200,34 2
WI amps tb 1,000 amps 301 04 2
Address: Over 1,000 amps or volts 552.26 2
Tcmporar`y services or feeders installation, alteration, and /o
City /State /ZIP: relocatio
Phone: ( ) Fax: ( ) 200 amps dr less 59.36 I
Owner installntloh installation made on property that I own which is not 201 amps tb 400 amps 125.08 2
intended for sale, I o according to ORS 447, 449, 670, and 701. 401 amps tb 599 amps 168 54 2
Branch circuits new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with l
' ,�X ,"CONTACT PERSON above service or feeder fcc,
7.42 2
each brakch circuit
Business name: 13, Fcc for branch circuits without
service pr feeder fee, rust
56,18 2
Contact name: branch c
Each add'I branch circuit 7,42 1 2
Address: lbliacelfnneoue (service or feeder not included)
Ci /State /ZIP: Each manufactured or modula 67, g4 2
dwelling, s rvicc and/or feeder
Phone: ( ) Fax:: ( ) Reconnect Only 67,84 2
E -mail
Pump or irrigation circle 67 84 2
CONTRACTOR Sign or outlhne lighting 67.84 2
-- y R Signal circtdit(s) or limited -CnerRy
Business name: f a" panel, alterxltior� or extension, i Pale 2 'f' jo 2
I it/ A; I Each additional inspection over allowable in any of ire abov
Address: '
_ i _Additional i�ispectinn (1 hr mini 66.25 / hr
WPM City /Statc /ZIP: if L V1 It q 107 investtgaho t (I hr min) 66 25/ hr
d L / industrial pliant (1 hr min) 78,18/ hr
Phnna• i 0 II; ICI 6 Fax: y ) , 2 ` 1 lnspeettons For which no fee is
specifically rested (Y2 hr min) 90 00/ hr
CCB Lic.: 2 Electrica'ri i4 0 i ; Suprv. Lie.: 2 Lo, i , f. ETrECTRICAL PERMIT FEES
S _ _
Suprv, Electrician ilgttature, required: ubtotal; Plan review (25% of permit fee); 70.00 �
Print name: �� r 1
-_ I ) A I —1 _.. Dater ( oij t ! M ate surcharge (12 % o f perm fcc): Q \11 Authorized signatue: ( TOTAL PERMIT FEE $ 4 cvlt-M
This permit application expires if a permit is not obtained within 180
Print name: t , i , )> • r Date: days after it has been accepted as complete.
a. Lr a 0 " Number d inspections allowed per permit
1•1Buildmg \Permits \ELC- PermltApp,doc 07/01 /10 440.4615T(tI /05 /COM/WEB
Electrical J emit Application - City of Tigard
.Page 2 - Sup Information
LIMITED NERGY PERMIT FEES:
REsiDE 'IE CORK' ONLY: '
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar kjarrn
❑ Garage Door Opener*
❑ Ilcati % Veiadlacion and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL; WORK ONLY:
Fcc for ea01 cd $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio a d Stereo Systems
❑ Boiler C ntrola
❑ Clock Systems
/Data Telecommunication Installation
❑ Fire Alart Installation
❑ I-VAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ 7 iudscap : Irrigatiion Conrol*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting
❑ ProtectivJ Signaling
❑ Other _
Total number bf commercial systems: I
*No licenses arle required. Licenses are required
for all other in
►, Wudd 1 ngUbrmitAgte- Permi App doe 07/01/10