Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
.,
2 s COMMUNITY DEVELOPMENT Permit #: ELR2009 -00163
TIGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/23/2009
Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: GREENBURG RD 120
Subdivision: Lot: 0
Project: Ameriprise Financial
Project Description: data communication lines
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 06/23/2009 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 06/23/2009 $9.00
PHONE:
Contractor:
A BETTER ELECTRICAL COMPANY
16869 SW 65TH AVE STE 373
LAKE OSWEGO, OR 97035
PHONE: 503 - 753 -0836
FAX:
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. 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 throu h O 952 - 000100. You may obtain a copy of the rules or direct questions to OUNC by calling • . • - • • •9 or 1.800.332.2344.
Issued By: ( V A1 1. LQ 4JA ` I Permittee Signatt e: AMMINI•ma —141"
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 A li cat i on , r " ' '
�� t ' � t ( O FFICE U SE,OI\ Ll' • " •r `
Cit y of Tigard Received
Dale /13 r
��(
M illi
`
13125 SW Hall Blvd., Tigard, OR 97223 flan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /B Petnut No :r •
L p ,� G►.JI(+ =� y: Other Permit
TIGAR Inspection Line: 503.639.4175 Date Ready /13y: Juris: El See Page 2 for
Internet: www.ligard or.gov Notified /Method: Supplemental Information
•
T.Y,PE, OF "WORK - PLAN REVIEW'
epIacemcttf Please check all dial apply (submit 2 sets of plans whims checked below):
❑ New construction ❑Addition /alterat n/ iRY ^® ❑ Service or feeder 400 amps or more ❑ Building over three stories.
111 Demolition Other: � where the available fault cumin ❑ Marinas and boatyards.
' CATEGORY OF CONSTRUCTION- ; - exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to round, or exceeds 14,000
g ❑ Commercial-use agricultural
0 '1- and 2- family dwelling IN Commercial /industrial ❑ Accessory building amps fur all other installations, buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
- ' - . - - • .. . - � Emergency system. larger separately derived system.
JOB SI INFORMIO
ATN AND LOCATION . . d c i i I
° — - " .. - .: ' -- - ' - : ' ' .. ., Ac ton of new motor load of
Job no.: Job site address: 1021-0 �� (j,/.t,•Z,VA,1l�rq 100111'ormore. occupancy.
ptl 1 ❑ Six or more residential units. ❑ Recreational vehicle parks -
Cily /State /ZI • l A " j -- Tik I I I .41 o 'i 9l 7 2 , - 7 ❑ hteafdt -care facilities. . ❑ Supply voltage for more than
J1 ` �� J � ❑ I lazarclous locations. 600 votes nominal.
Suite /bldg. /apt. no I J U \ II Project name: �' ►•1,� i5 ❑ Service or feeder 600 amps or more.
C ���� )� SCHEDULE
Cross K
oss street/directions to job site: �3' te: . '\ v , Description I Qtv. I Fee. 'Tonal
V New residential single - or multi- family dwelling unit.
Includes attached garage. i
Subdivision: Lot no.: 1,000 sq. II. or less 145.15 4
Tax map /parcel no.: . •
Ea. add'I 500 sq. 0. or portion 33.40 1
Limited energy, residential 75.00 2
• I DESCRIPTION CRIPTION' :OF, WORK ,
(with above Sc!. 1).)
- it �� Limited energy, multi- family
ly < ^ a. D ws.k.J4xtCs� 'er o `•,./eS 75.00 2
--'t res (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
�� _ _ 200 amps or less 80.30 2
. ❑ ''PROPERTY OWNR E i TENANT'
r 201 amps to 400 amps 106.85 2
Name: A,Nk.c. c - c v " .• 401 amps to 600 amps 160.60 2
�P�1�2
l 601 amps to 1,000 amps 240.60 2
Address: (',,�
�ZZO 1J •�S �� � � Over 1,000 amps or volts 454.65 2
City /State /ZIP: 1 �� ` O � " J���� Temporary services or feeders installation, alteration, and /or
v relocation
Phone: (Gsy ;) 4 '6 0 17 . ' 46 I Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 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. Pee for branch circuits with
' ❑ APPLICAN ' • �l i CONTACT .•PERSON• above service or feeder fee,
• Business name:
each branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder lee, 46.85 2
first branch circuit
Address: Each addl branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwellin service and /or feeder 9090 2
Phone: ( ) I Fax: : ( ) • e '
Reconnect only 66.85 •
E - mail: Pump or in igation circle 53.40 2
'. CONTRACTOR ' - Sign or outline lighting 53.40 2
Business name: /94C/ / /J/ 6/evo l iZ/�J /v�j Signal cireuil(s) or limitcd-
�, lr fit 4 energy panel, alteration, or
Address: i ‘g6 9 ( S w 6 6"T- ' • 373 extension. Describe: / Page 2 2
City /State /ZIP:, i1 y f/ U e a C o je Q ( :),(Z ...., ? 76)3 5 Each additional inspection over allowable in any of the above pec I � � / ll t � 2 D Pcr inspection 62.50 � 0 �.
: Q
Phone3) 6 // Goo V ( Fax: 50) ) Z
Inv est i gat i per er hour (1 hr min) 62.50
/
CCB Lie.: j s?"./7g2_ El C p 86QS . Industrial plant p ectrical Lic.: y,�Z. Suprv. LiC.2 oo per hour 73.75
Suprv. Electrician signature, required: /
ELECTRLCAL PERMIT, AGES
''7 �� /l Subtotal: •
Print name: . 11/C , 4 e / l/ / 1 Date: 6/2/ 9 Plan review (25`Yu of permit fee):
State surcharge (12% of permit ice): .
Authorized signature: (! i
TOTAL PERMIT FEE: •1.0.," .0
Print (lame: Date: 'Phis permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits \LLC- I'erntitApp.doc 05/23/06 440- 4615'rt l /os /COM /wSit
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*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75,00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
❑ Fire Alarm Installation
❑ I-WAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ 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