Permit I I J~
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. '' - COMMUNITY DEVELOPMENT Permit #: ELR2009 -00127
Date Issued: 05/11/2009 •TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 320
Subdivision: Lot: 0
Project: Ameriprise
Project Description: Low voltage for fire alarm
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 05/11/2009 $75.00
CALIFORNIA ST 49TH FL - 12% State Surcharge - Restricted Energy 05/11/2009 $9.00
PHONE:
Contractor:
CAPITOL ELECTRIC CO INC
11401 NE MARX STREET
PORTLAND, OR 97220
PHONE: 503 - 255 -9488
FAX: 503 - 257 -7121
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: Boiler Controls:
CCTV: Clock Systems:
Data & Telecommunications: Fire Alarm: Y
HVAC: Instrumentation: Total $84.00
Intercom /Paging: Landscape /Irrigation:
Required Items and Reports (Conditions)
Landscape Lighting: Medical:
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 don n accor ance with approved plans. This permit will expire if work is not started within 180 of issuance, or if work is suspended for more
the 180 ys. ATTENTION :''Ore! • equires you to follow the rules adopted by the Oregon Utility No ifiration Center. Those rules are set forth in OAR
952 -001' 0010 through OAR 952ir01 -0101. Yo may obtain a c•py of the rules or direct questions to OUtIC by calling 503. , 6.6 9 or 1.800.33 . 344.
Issu By: 7. d °(---1 Permittee Signatur-. _ L /P' / (d---.---- ,
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 CEIVED Date/By: 5 /I 09 _, Permit no.: <2ag�11 .D / 2 7
III 13125 SW HaII Blvd., Tigard, 0 7 23 Plan Review
G _ ' Phone: 503.639.4171 Fax: 503.598. 9 0 n Date /By: Other Permit:
TICARD Inspection Line: 503.639.4175 MAY ] 1 2 00 J Date Ready/By: Juris: ❑ See Page 2 for
Internet: www.tigard- or.gov / lemental Information
CITY OFTIG Notified /Method: c / Su pp
TYPE OF WOR�UII .DING V DIVISION PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
❑ 1- and 2- family dwelling H Commercial /industrial ❑ Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi- family ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial - use agricultural
JOB SITE INFORMATION AND,LOCATION amps for all other installations. ❑ buildings
Job no.: 290652 Job site address: 10220 SW Greenburg Rd. ❑Fire Pump ❑Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City /State /ZIP: Tigard, OR 97223 ❑ Addition of new motor load of ❑ 'A ", "E ", "1 -2 ", "1 -3 ",
100HP or more. ❑ occupancy
Suite/bldg. /apt. no.: Suite 320 Project name: Ameriprise Financial T.I. CI Six or more residential units ❑ Recreational vehicle parks.
❑ Health -care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site: 2Lincoln Center ❑ Hazardous locations ❑ 600 volts nominal.
❑ Service or feeder 600 amps or more
Subdivision: Lot no.: FEE SCHEDULE
Description I Qty. I Fee. I Total I .•
Tax map /parcel no.: New residential - single or multi - family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
Install Fire Alarm Circuit 1000 sq. ft. or less $ 145.15 4
Ea. Add'I 500 sq. ft or portion 6 33.40 I
H PROPERTY OWNER I ❑ TENANT Limited energy residential
Name: (with above sq. ft.) $ 75.00 2
Shorenstein Realty Services Limited energy, multi- family
Address: residential (with above sq. ft.) $ 75.00 2
Service or feeders installation, alteration, and /or relocation
City /State /ZIP: 200 amps or less $ 80.30 2
201 amps to 400 amps $ 106.85 2
Phone: Fax: 401 amps to 600 amps 5 160.60 2
601 amps to 1000 amps $ 240.60 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 454.65 2
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, alteration, and /or
Owner signature: Date: relocation
200 amps or less 5 66.85 1
❑ APPLICANT I ❑ CONTACT PERSON 201 amps to 400 amps $ 100.30 2
Business Name: 401 amps to 600 amps 5 133.75 2
Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
Contact name:
service or feeder fee, each
branch circuit $ 6.65 2
Address:
B. Fee for branch circuits
without service or feeder fee,
City /State /ZIP: first branch circuit $ 46.85 2
Phone: Fax: Each additional branch circuit: $ 6.65 2
Miscellaneous (service or feeder not included)
E -mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 90.90 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only $ 66.85 2
Pump or irrigation circle $ 53.40 2
Contact name: Sign or outline lighting $ 53.40 2
Signal circuit(s) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: 1 Page 2 75.00 2
City /State /ZIP: PORTLAND, OR 97220 -1041 Fire Alarm Circuit
Each additional inspection over allowable in any of the above
Phone: 503 - 255 -9488 Fax: 503 - 257 -7121 Per inspection $ 62.50
Investigation per hour (1 hr min) 5 62.50
CCB Lic.: 48748 'Electrical Lic.: 26 -496C ISuprv. Lic.: 3132 -S Industrial plant per hour 5 73.75
Suprv. Electrician signature, required: /� L_PERMIT FEES*
��/f /�/f/j/�fJ,[��`V"' � ELECTRICA Subtotal $ 75.00
Print Name: DARRELL MMCN Date: 05/08/09 Plan review (25% of permit fee)
Authorized signature: /
J �� 44 ���� J� Me' ! State surcharge ( 12% of permit fee) $ 9.00
l J / , TOTAL PERMIT FEE $ 84.00
Print Name: DARRELL MCNEEL Date: 05/08/09 This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections per permit allowed.