Permit CITY OF TIGARD
ELECTRICAL RESTRICTED ENERGY PERMIT
:1 i : . . COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00298
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/20/2008
PARCEL: 1 S135AB -00900
SITE ADDRESS: 10200 SW GREENBURG RD 700 ZONING: C -
SUBDIVISION: LINCOLN CENTER /FIVE LINCOLN LOT: JURISDICTION: TIG
PROJECT: FARMERS INSURANCE
Project Description: Install low voltage for data.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
SHORENSTEIN REALTY SERVICES SAFE TECHNOLOGY GROUP INC
ONE SW COLUMBIA ST #300 6400 NE HWY 99
PORTLAND, OR 97258 SUITE G #375
VANCOUVER, WA 98665
Phone: 503- 412 -4800 Contact #: PRI 360 - 699 -2130
FAX 360 -719 -1527
Reg #: ELE CLE79
FEES LIC 173731
Description Date Amount SUP 4272LEA
[ELPRMT] ELR Permit 10/20/200E $75.00
[TAX] 12% State Surch 10/20/200€ $9.00 REQUIRED ITEMS AND REPORTS
Total $84.00
•
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. Yo may obtain copies of these
rules or . ct ques is , • at 503.246.6699 or 1.800.332.2344.
Issued By 0 . .j i L ' Permittee Signature:/k
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.
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Dale /By: o 'O O� Permit No.. 1�2 '''9/�/ g
III - '� 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I Phone: 503.639.4171 Fax: 503.598.1960 Date/B . Other Permit
TI G ARD Inspection Line: 503.639.4175 Date Ready/By Win 13 See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK • ' PLAN 'REVIEW .
❑ New construction El 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 fg Commercial/industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi- family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system, larger separately denved system.
. JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: / � / / /,, �/ 10oHP or more. occupancy.
1 £ C� ^ )O S U (Jb , e' f IA 1" - 41 El Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: i7 r •, 3 / ❑Health -care facilities. 0 Supply voltage for more than
/ ri/. , I G� �7 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: l 00 Project name: j� r , (5 (y , i - cif �i ❑ Service or feeder 600 amps or more.
/ ' , V 1 / FEE SCHEDULE
Cross street/directions to job site: Description 1 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'1 500 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
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY O\i{VER, ❑ 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
- 0, APPLICANT. ' ❑ . CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: 5a.rC I el 01 oh,y &vvup iC , B. Fee for branch circuits .
''( I ,1"
without t branch service or feeder fee,
Contact name:
V G S50,,, 6 v�+ nw/ first branch circui t 46.85 2
Address: b (lob Ng' A iii cm Sit - l 6.3 7S Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: U� A 9 g � ( S Each manufactured or modular
t� � � dwelling, service and/or feeder 90.90 2
Phone: (3(,o) L qq, a- i 3 d Fax: : (3t ) 7 I Gj - I S?-7 Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Gi t � , Iv, Signal circuit(s) or limited -
Business name: S ��i� n 0 U (' - l C • energy panel, alteration, or pU
Address: V L/bo /V H i iy qq s : k, 3 7 5- extension
De sc : Page 2 �� 2 DI
City /State/ZIP: V4i1 t O uvv' (AM 1 S� 6 „5 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (36o ) (y yq - f 3 v Fax: (3ip U ) "7/cf. I S a• 7 Investigation per hour (1 hr min) 62.50
CCB Lie.: / 7 3 7 3) Electrical Lic.: G (,, E 7 9 Suprv. Lie.: yd7a L EH Industrial plant per hour 73.75
ELECTRICAL, PERMIT FEES
Suprv. Electrician signature, required: .9St -s, Subtotal: 75
Print name: 'a svin 5 J' e Date: �Q -�3,-. 0 g Plan review (25% of permit fee):
3-
State surcharge (12% of permit fee): 9,00
Authorized signature: TOTAL PERMIT FEE: I 0
This permit application expires if a permit is not obtai thin 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(I1/05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION re
PERMIT #: ELR2008-00298
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10120/2006
Phone: (503) 639-4171 a a 111 1144 I ii\
Inspection Requests (24 Hrs.): (503) 639-4175 .4 - AL,
INSPECTION WORKSHEET FOR DATE: 11/6/2008 TIME: 7 PAGE:
SITE ADDRESS: 10200 SW GREENBURG RD 700 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER/FIVE LINCOLN LOT #: TYPE OF USE:
PROJECT NAME: FARMERS INSURANCE
DESCRIPTION: i l voltage for data.
OWNER: SHORENSTEIN REALTY SERVICES, PHONE #: 503-412-4600
CONTRACTOR: SAFE TECHNOLOGY GROUP INC PHONE #: 360-699-2130
Inspection Request Scheduled For: Date: 11/60008 Pour Time:
Code # Inspection Description J Confirm # Contact # Message
135 Low voltage 077757-01 136-099-1358 N
Corrections/Comments/Instructions:
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\1 \1\ n
V
X : ) ASS n PARTIAL APPROVAL L 0 CANCEL 0 NO ACCESS
FAIL El CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Gm N 6€1 Le" Date: Vt10 Phone #: (503) 718- 24%
CITY OF TIGARD .
id - --
BUILDING DIVISION PERMIT #: ELR2006-00298
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2008
Phone: (503) 639-4171 _IIINIIIT\
Inspection Requests (24 Hrs.): (503) 639-4175 ,.,—tiw- ''' I1.
INSPECTION WORKSHEET FOR DATE: 11/5/2008 TIME: 7•01AM PAGE: 18
SITE ADDRESS: 10200 SW GREENBURG RD 700 CLASS OF WORK:
SUBDIVISION: LINCOLN CENTER/FIVE LINCOLN LOT #: TYPE OF USE:
PROJECT NAME: FARMERS INSURANCE
DESCRIPTION: Install low voltage for data.
OWNER: SHORENSTEIN REALTY SERVICES, PHONE #: 503-412-4800
CONTRACTOR: SAFE TECHNOLOGY GROUP INC PHONE #: 360-699-2130
Inspection Request Scheduled For: Date: •1/5/2008 Pour Time:
•
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 077668-01 360-699-2130 N
Corrections/Comments/Instructions:
1 t 0 ‘1...* A AAA LL co.
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"I' t clkAl • ) ALL l'o i as it\Ct. i-oo 6 C ,
it■((c'. 1.6 0,B \liti_Z i 40 To k ) s 1 Si Pk S •
C ikE r 03„ ' 1 1111in el.L. s c v\ruct kKe
0 PASS 7 PARTIAL APPROVAL 0 CANCEL I I NO ACCESS
FA FAIL \ CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
. N 66 L-‘
Inspector: Date: t Phone #: (503) 718- 1--
_ - _