Permit - CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
�' COMMUNITY DEVELOPMENT Permit #: ELR2009 -00281
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2009
TI GARD Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 350
Subdivision: Lot: 0
Project: Softsource
Project Description: Low voltage for fire alarm.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 09/01/2009 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 09/01/2009 $9.00
PHONE:
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HVVY 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 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. ATTENTIO • : -g• -w requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 rough OAR 952 -00 s '0. ou ...y obtain a copy of the rules or direct questions to OUNC by calling 503. . . • or 1.800 .0.2344. ,
Issued :y: / I /4 :y: / Permittee Signature: 4. f C lit
IN. 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:
CONTRA T ►R INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 'Or( ibt ; ' i r 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 Applicatio1hC
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Cit o f Tigard El 3 A,,v (i ".I1 kueuiv y y g a� 09 , , iennit No.: 2� �a�
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naterAy: 13125 SW Hall Blvd,, Tigard. OR 9722' '-a tin k S eview
_ Phone: 503.039.4171 Fax: 503. f�f G' 611 �+ Other Permit
t 1 C ;n 1(i i Inspection Line: 503.639.4175 2009 Ibue. Ready/By: hm ' ® See Page 2 for
Internet WWW.ti5al'd- iw.gtLv C,< Nattifed /Method. � Supplementallnrurnmtlon
TY�?� rr^ ///
TYPE 074.auCfdw flr� (1U PLAN REVIEW
® l 1 eafellt /V t'Iim. che a ll that apply submit se or I
❑ New construction A ddition /alteration /re) a � 1 Pp y ( � pans w /items checked below):
❑ Ser zee in coder 401) amps nr mitre ❑ Building over three stones
❑ D4.hrICIliti011 -- ❑ Other: where the available fault current ❑ Marinas and hnntyardh.
CATEGORY OF CONSTRUCTION exceeds I '1,11/(1 amps at 1511 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agm:onur:al
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps Sir all other installations buildings.
❑ Multi-family ❑ MuSter' builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE I1Vl?URMATION AND LOCATION ❑ GMIlclgcncy system larger separately derived system,
❑ Addn\on of new motor load or ❑ 'A" "ft' "I - 't" ;
Job no.: 1155 Job site address: 10220 SW Greenberg Rd IUI /NI in more occupancy.
❑ Six ur more residential units. ❑ kuc fvntional vehicle parks
City /State! %II': Tigard OR Di ealth - eare facilities. ❑ Supply voltage tin more than
_ ❑ H8Car'doua lucatinns. GM volts nominal
Suite/bldg./apt. no.: 354) Project name: Softsou 0 Sumter ur feeder 5(111 ;lmp.n or mare.
FEE SCHEDULE
Cross stfeet/duections to. job site. 2 Lincoln n.rrripNon J Qn- I rte. i Total I •
New residential single•, or multi family dwelling mail,
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145,15 4
Tax map/parcel no. Fe add'' 500 sq. n. or portion - 33.40 I -
Limited energy, residential 73.00 2
DESCRIPTION OF WORK u (with above sq. R.) _
Limited energy, multifamily
Fire alarm _ residential (with above sci tt.) 75.00 2
Semler. or feeders installation, alteration, and /o: rclocatlon
T- 200 amps or less 110.30 2 _
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.145 2
Name: 401 amps to 600 :turps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: ,
over 1,000 amps or voles 454.65 2
City /Stater/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.115 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 signatlU'c, _. Date: A. Fee for branch circuity with
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business naive; Safe Technology Group Inc c ....,
13. Fee for branch circuits
Contact name: Jason Sweet without service or (ceder tor,
first branch circuit 46.115 2
Address: 6400 NE Hwy 99 Suite G375 Each add'l branch circuit 6.65 2
- ' Miscellaneous (service or feeder not Included)
City/Stater/JP: Vancouver WA 98665 Each manufactured or modular
dwelling, service and/or loader 90.90 2
Phone: (360) 699 -2130 _ Fax: : (360) 719 -1527 - •
Reconnect only 66.85 2
E -mail: salessatfctechnoIogy.net Pump or irrigation circle 53.40 2
(d)
CONTRACTOR Sign or outline lighting 53.40 2
Ht.t irlens name: Safe Technology Group Inc. signal circuit(s) or limited
energy panel, alteration, or
Address: 6400 NE Hwy 99 Suite G375 extension. Describe: 1 Page 2 75 2
Oily /Staic/Z1P: Vancouver WA 98665 Each addition inspection over allowable In any of the above
Phone: (360) 699 -2130 _
'- Per inspection 62.50
Fits: ( 360) 719 -1527 investigation per hour (I hr man) 62.50
CCI3 Lic.. 173731 Electrical i.ie.: CLE79 Suprv. Lis: 42721EA Industrial plant per hour 73.75
St)prv. Electrician signature, required: l/�
ELECTRICAL PERMIT FEES
Subtotal: 75.00
Print name: Jason Sweet Date: 4- 19 -09 Plan review (25'Ni of permit fee):
Stale surcharge (12% of permit fee); 9.00
Authorized signahire: )214,/ - I'oTAI.PF.RMI'1' FEE: 114.00
Print name: Jason Sweet I Date: 8 -19 -09 This permit application expires if a permit Is not obtained within 180
days after It has been accepted as complete,
t Number of 1nSprCtiuns allnwtd per permit
t\t twldingWermits \hLt'- NomntAp5.duc 05)23) /s 1 I 5T( I 1/DS/COM/WEB
Electrical Permit Application - City of Tigard
I >age 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n C;ara l)cxn Opener*
n I leating, Ventilation and Air Conditioning System*
n Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY
Fee for each commercial $75.00
sys tem
(SHE OAR 918 109 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ (:luck Systems
n Data Telecommunication Installation
® Dire Alarm Installation
❑ IIVAC:
n Instrumentation
7 Inlercum and Paging Systems
n landscape Irrigation Control*
❑ Medical
Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ (.)Iher
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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