Permit r �
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I"-! ; COMMUNITY DEVELOPMENT Permit #: ELR2009 -00160
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/16/2009
Parcel: 1S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD, STE# 750
Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project: Western Architectural
Project Description: Install low voltage for voice & data.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
•
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 06/16/2009 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 06/16/2009 $9.00
PHONE:
Contractor:
WEST COAST BUSINESS COMMUNICATIONS
INC
11134 NE HALSEY ST
PHONE: 502- 465 -9222
FAX: 503- 257 -0028
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 Total $84.00
Intercom /Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ENTION Ofe9Rn law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 - 001 -0010 through OAR 952 -' 0 1 -6 100 ' •u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: _ /$i _LL - ' Permittee Signature: A - 1),77.... /
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 an inspection that business day.
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.
r lee "ical Permit Application , FOR OFFICE USE ONLY ` ,R
City of Tigard Date/By: / cif Pe rmit No.: �� eaev f%Q�
y: Ilvo
i llq q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review it)?00 s y�
' 0 • Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit
T I GA R D Inspection Line: 503.639.4175 Date Ready /By: Juris. 63 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
' TYPE OF WORK • " ` . .. a PLAN. REVIEW
❑ New construction p Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION . ' . .. - exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 114 Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
" JOB SITE - INFORMATION, AND LOCATION" ❑ Addition system. larger separately derived system.
-- - ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Zp0 1001-11 or more. occupancy.
Job no.: Job site address:
I $UJ �l2 -�e'V g Vac. Rd ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: I i �fl' _o 0 t2 q -' -z...--L.4 ❑Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: - 7 5 Project name: >,).€51 - .e... 1 7_,0 A tz. ct4 t -f e_CT ❑ Service or feeder 600 amps or more.
FEE SCHEDULE - "
Cross street/directions to job site: LoCC.. ,T -+- �tZCQti4 o Description f Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRII'TION OF .WORK (with above sq. ft.)
A Limited energy, multi- family 75.00 2
• v O IC.-e___ ± PA residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' 'IN PROP OWNER. .: ❑' TENANT , _ ; . 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A Fee for branch circuits with
- " . - ❑, APPLICANT , . : . E ❑ CONTACT PERSON . above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR ' • v ' ' -•• Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: W e_.5-c Co,AST 1 3 2 5 /ti 9$ Co ■ t . energy panel, alteration, or
extension. Describe:
Address: 1 1 \5 Page 2 -- 2
4 102. 1-3,A (—S ST- 75
City/State /ZIP: 1 / Oz_ 9 - 7"LZn Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (563 ) 4 GS — / ZZZ Fax: (563) ZS 7 - ooZ$' Investigation per hour (I lir min) 62.50
CCB Lie.: 1 - 1 , 4 1 S® Electrical Lie.: C LE g 1 Suprv. Lie.: 3 Z.OL .A Industrial plant per hour _
/ ELECTICAL P ERMTI'.FEES_
C( Suprv. Electrician signature, required: 7 /4t /1( le (4t( Subtotal: 25 —
• V n" D�f�/ s Date: , /� O Plan review (25% of permit fee):
Print name: 57 -
/ / State surcharge (12% of permit fee): 9
Authorized signature: ` TOTAL PERMIT FEE: U p 7 1 v'2
D This permit application expires if a permit is not obtained within 180
Print name:
Sj �v� , "6 vj b//(:,09 days after it has been accepted as complete.
* Number of inspections allowed per permit.
C\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T( I I /05 /COM/WEB
Electrical Permit Application - City of Tigard �° • . �.
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
rvRESIDENTIAlJ'WORKQNLY , . , �. �` °`, �'
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIALVoit ON I,Y:'' ,,, 7.
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
• Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
PI Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Building \Permits\ELC- PermitApp doc 03/23/06