Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 00094
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/31/2009
Parcel: 1 S 135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 500
Subdivision: LINCOLN CENTER /FIVE LINCOLN Lot: 0
Project: North Pacific Group
Project Description: Install low voltage for voice /data. Job No. 9912V
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 03/31/2009 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Restricted Energy 03/31/2009 $9.00
PHONE:
Contractor:
STONER ELECTRIC
1904 SE OCHOCO
MILWAUKIE, OR 97222
PHONE: 503 - 462 -6500
FAX: 503 - 659 -4968
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Y Fire Alarm:
HVAC: Instrumentation: Total $84.00
Intercom /Paging: Landscape /Irrigation:
Landscape Lighting: Medical: Required Items and Reports (Conditions)
Nurse Calls: Protective Signal:
Security Alarm: Other:
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 -001 -0100. You may obtain - copy of the rules or direct questions to OUNC by calling 503. .6699 or 1.800.332.2344.
/ 6
Issued By: ' � 4 1 — , - � S� ! ( Permittee Signature: 503.
0 I V( "' on
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'N 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.
03/30/2009 07:59 FAX L7j001
Electrical Permit Applicatic CENED <FOR USE ONLt+ `
Date /B : = / 0.0 i + %� +r. _ .
R ece ived at
City of Tigard ] �
l PenmtNo
v + l i 13125 SW Hall Blvd., Tigard, OR 9722 p R 3 13 L00 Plan Review
Phone: 503.639.4171 Fax; 503.598.1 60 Date/B : Other Permit:
'TI'GARD Inspection Line. 503.639.4175 j of TIGARD Date Ready /13y. la See Paget for
Internet. wvwv,ttgard- or.00v Cli + 1- li oN Notified/Method: WM Supplemental Information
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❑ New Construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition titer: ❑ Service or feeder 400 amps of more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
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xce s amps 150 vol
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- ' less to ground, or exceeds 14.000 ❑ COrttmercial -use a
❑ I- and 2- family dwelling al Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
- ' - •-u•' °� . 1,• a T .'r n'ntYei•ne :.•:r,ua:u;:: ra in ,;,, : m r. : ; ; • Emergency system. larger separately derived system.
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Job no.: 99/ 2 \/ Job site address: Af Zoo $ 6 h a� I or o errs. Recreational ❑ Six or more residential units. ❑ Recreational vetucle parks.
City /State /ZIP: - 7 w,+ p o/e 97Zz ❑ Health-care Facilities. ['Supply voltage for more than
�� / / ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. Project natne '/CAQ.i�F /✓IG 6",PavP.1 mcg ❑ Service or feeder 600 amps or more
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j ob site: Pe _ . ,i •.I:r::. T ns :::;:
Cross street/directions to
J .• Description I Qty. I Pee. 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
:e '- ,.. .,•. iJ " a'-`oo-vt:- f " " v'':;ti'.•c,,., .,. , , •ar „, l :,n '., ivkl ; . n.iinaiii. e-iIittti+do4; 75.00 2
Limited energy, multi- family
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� 75.00 2
%4 7PJQ nl- 04' fe -, r0� ease e ,,i,p residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
ieiliol:':41Il : %)iiiiiIiitiPl d';,:;t. IL ullji aii;e 1r: •r°:is°5(W11ilt`;:
,ie.t,,. ,,, OVfjNElt ;;:- t � ; alW +;xt:r: tAiilii ':: . . ., wit ,i 3 S 201 amps [o 400 amps
_..,��,,.:: .. t'';' 1..t,�l"I`. C?E\!i,. � 106.85 2
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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
S::s*_;x,,�'vt�a:F, :i•st2 ° pY - fl�'I' Siih;a;q:r;;'ss's;jku ='r',iil iii ;,„,:I,rn�, u: KO .3iF., above service or feeder fee ,._::._:, �,:::; a�•,., z: :,:t:Yp�pl�:�!,....,<�'.��.,w,. r � ..,..,.,..., f � ;: ,�;J,_�Div�' �tiCC�. P.:> ZtSt� �'��a ;
. m!�r ;ynaEr,at::c:i.h : ''•Iib:: •� ,, ,. ._ t• :ihlitilt;:?j; 7Cttt"i`� 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
Address: Each add'I 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
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Business name: STONER ELECTRIC Signal circuits) or limited -
energy panel, alteration, or p �
Address: 1904 SE OCHOCO extension Des, ibe: / Page 2 7 2
City /State /ZiP: MILWAUKIE, OR 97222 Each additional inspection over allowable in any of the above
Per
Phone: (503) 462 -6500 Fax: (503) 659 -4968 utati ntt 62 50
o
Investi per hour (1 hr min) 62.50
CCB Lic.: 44823 3104 Electrical Lic.: 26 -122C Suprv. Lic.: 3496S Industrial plant per hour 73.75
III IN 'c.:gigt E I:_ ,
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Suprv. Electrician signature, required: M #1,...1,,,„,,...... _ Subtotal f$ OD
Print name: MICHAEL FALCONER Date: g13,,162 Plan review (23% oi'pemtit fee): '•
State surcharge (12 %ofpermit fee): 9, 0 6
Authorized signature: TOTAL PERMIT FEE: ' PO
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
” Number of inspections allowed per permit.
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