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Permit . CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT '' '! COMMUNITY DEVELOPMENT Permit #: ELR2009 -00158 TICARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/08/2009 Parcel: 1 S 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 fire alarm. Owner: FEES LINCOLN CENTER LLC Description Date Amount BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 06/08/2009 $75.00 CALIFORNIA ST 49TH FL 12% State Surcharge - Restricted Energy 06/08/2009 $9.00 PHONE: Contractor: SAFE TECH 6400 NE HWY 99 SUITE 375 VANCOUVER, WA 98665 PHONE: 360- 699 -2130 FAX: 360 - 719 -1527 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 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 i . -. - . •'ect to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be don- ' accordance with - • •roved 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 .0 • follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 601 -0010 thro gh OAR 952 - 001611.. You •btain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. -sued By: `�� L _ • Permittee Signature: / J__ __ 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. Electrical Permit Application FOR OFFICE USE ONLY Received o (o City of Tigard Date/By: 0 D / H Permit No - AO , 0 , 1 10 /51 1111 11 " 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: Ions: El See Page 2 for Internet: www.tigard or,gov Notified/Method. Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction 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 (, Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or . ❑ Emergency system. larger separately derived system. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ", Job no.: Job site address: 1 0 Z 0© S W L I e.4- 1,✓ c 100HP or more. occupancy. IN 0 g F CA . ❑ Six or more residential units ❑ Recreational vehicle parks. City / State/ZIP: r �' G ^`� ❑ Health -care facilities ❑ Supply voltage for more than ❑ Hazardous locations 600 volts nominal Suite/bldg. /apt. no.: -75 t7 Project name: w e 4 v r / ❑ Service or feeder 600 amps or more. T\. f t" c� t c c ( FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I * 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'! 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 ' Limited energy, multi - family 75.00 2 S , s E r, r( .F' `, r .r A 1 c e - yh 1ef o r yx i f 't z - t& L) residential (with above sq, ft.) 1 Services or feeders installation, alteration, and /or relocation Q d- 16 -Qts- S "✓h or.c. pa_ tf r5 200 amps or less 80.30 2 ❑ PROPERTY 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 Branch circuits — new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with 01 APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2 each branch circuit Business name: S ca■ ∎ f,. �' t 1,, n v ,/ v s y G f J f B. Fee for branch circuits •n I without service or feeder fee, Contact name: A t714 M 5 w e.. L e first branch circuit 46.85 2 Address: i Each add'l branch circuit 6.65 2 (p�00 NL H R9 sv, k L. S 6 A37 y Miscellaneous (service or feeder not included) City /State/ZIP: v «A e . v v„ - r k/, - ( Each manufactured or modular 90.90 2 dwelling, service and/or feeder Phone: (34„ o ) 0 9 5 _ - 24 3 d Fax: : (3y. 0) --? _ i 5 e z 7 Reconnect only 66.85 2 E -mail: c1 S - 4 a. E ee Sc k' o." E a, CA ft o / o e , , r7 (` Pump or irrigation circle 53.40 2 CONTRACTOR Sign or outline lighting 53.40 2 Business name: !�' Signal circuit(s) or limited - S i s Clt 6t::, 1 0 C1/ J C. f a V .,J energy panel, alteration, or Address: 1 extension. Describe: 1 Page 2 f -- ' o ° 2 ���© 1.0 Hwy 99 .5%.. c,, # 375 City /State /ZIP: v 4 q . 0 ,,, y c - , W A ' (a 10 5' Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (36 0) 4,, ct J "11 3 o Fax: (so c — 7/ 9 - 152 7 Investigation per hour (I hr min) 62.50 CCB Lic.: i - 3 1 Electrical Lic.: c L E 7 c Suprv. Lic.: p..7, _ Industrial plant per hour 73.75 Suprv. Electrician signature, required: y Subtotal: i t '7 ELECTRICAL PERMIT FEES Su p g q // �,�GJYi6 S. D / Plan review (25% of permit fee): Q Print name: �G S � t pn1" Date: & - 3 ...6 ` � j (N State surcharge (12% of permit fee): 9' Authorized signature: Cr` . d.� x )c TOTAL PERMIT FEE: Fel, 00 (� / Fr / o , days a This permit application expires if a permit is not obtained within 180 Print name: _..I { M 5 vt/ ,t. t Y e. Date: after it has been accepted as complete. / * Number of inspections allowed per permit. l' \Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB 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* n Burglar Alarm ❑ Garage Door Opener* n Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* n Other: COMMERCIAL WORK ONLY: 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 n Data Telecommunication Installation Fire Alarm Installation n HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* n Medical ❑ Nurse Calls n Outdoor Landscape Lighting* n Protective Signaling n Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations I.\ Building \Permits \E LC- PenffiApp.doc 03/23/06