Permit re ,4,),
II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
q Permit #: ELR2009 -00279
C OMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/28/2009
. Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 350
Subdivision: Lot: 0
Project: Softsource
Project Description: Low voltage for data telecommunications.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit • 08/28/2009 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 08/28/2009 $9.00
PHONE:
Contractor:
CAPITOL DATA & COMMUNICATIONS
11401 NE MARX ST.
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: 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 -001 rough OA 52- 1 -0100 You may obtain a copy of the rules or direct questions to OUNC by calling r246.6699 or 1.800.332.2344. N.
Issued B (/`ir ,N. Permittee Signature!_' Mme"
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.
c%
* 278/27/2009 06:50 5032551966 CAPITOL ELECTRIC PAGE 02
Electrical Permit Application Mk OFFICE Usls i) NI,V
Received
g F 0 Date/By: 9 �a79
City of Tigard ' ;� r a? te Permi no,; ADD
•
13125 SW Ball Blvd., Tigard, O R, 932 '1 1 '' - 1'Ian Review
i Phone: 503.639.4171 Fax: 503,598.1960 Date /By: OthcrPcrmit:
TI ( AR I) Inspection Line: 503.639.4175 AUG 27 2009 Date Ready /By: _. see Page 2 the
Internet: www- tignrel- or.gov Nolified/Method: Cu lemenlnl lofarmotion
. ' rir T IAARD
TYPE OFWORK;',,, r„no,n t'si1 /1^Ir'1C\I PLAN REVIEW .--
L� cp 1) ° A td' `' °' •" Please check all that apply New construction Addition /altcrationli faric'mcnt ' poly (submh a sets of plans w /Itema checked below):
❑ Demolition ❑ Other: ❑ Service or fender 400 amps or more ❑ Building over three stories
CATEOORY OF CONSTRUCTION whore Iho available fault current ❑ Marinas and boatyards
U I- and 2- family dwelling H Conunercial /industrial Li Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi-family CI Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial -USO agricultural
1013 SITE INFORMATION AND LOCATION amps for all other inelanations U buildings
Job no,; C90141 .lob site address: 10220 Greenburg Rg El Fire Pump U Installation Of 75 KVA or
❑ Emergency system larger separately derived system.
City/State/ZIP: Portland Or 97223 ❑ Addition of new motor load of ❑ "A ", "B ", '1 -2 ", "1 -3 ",
100HP or more. ❑ occupancy
Suite/bldg./apt, 1)p,; 310 Project name' Softsource ❑ Six or more residential units L Recreational vehicle parks.
Li Health -care Facilities ❑ Supply voltage for more than
Cross Street/Directions to, job site; ❑ 1 -lac rdotis locations ❑ 600 volts nominal,
Li Service or feeder 600 amps or more
FEE SCHEDULE
Subdivision: Lot te.: Description I Qty. f Fee. ` Total '"
Tax map /parcel no.: New residential - single or multi - family dwelling unit,
DESCRIPTION OF WORK includes attached gat3c.
Network Cabling 1000 sq, ft. or less S 145.15 4
Ea, Acld'I 100 sq. ft or portion S 33.40 t
LI PROPERTY OWNER 1 TENANT T „imited energy residential
Name: (with above sq. ft.) $ 75.1)0 2
Limited energy, mufti - family
Address, ,residential (with above sq. ft.) 5 75,00 2
Service or feeders Installation, alteration, and /or relocation
City/State/ZTP 200 amps or less 5 80,30 - 2
201 amps to 400 snips 5 106.85 2
401 amps to 600 amps $ 160.60 2
Phone! -
Fax; 601 amps to 1000 amps S 240,60 2
Owner Installation: This installation is being made on property that I own which Is not Over 1000 amps or volts 5 454,65 2
intended ror,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 I $ 66.95 I
L I Ll CONTACT PERSON 201 steps to 400 amps $ 100.30 2
Business Name: 401 amps to 600 amps $ 133.7 2
Branch Circuits - new, elteraflon, or extension, per eanel
Contact name: A. Fee For branch circuits with
service or Feeder fee. each
Address: branch circuit $ 6.65 2
B. Fee for branch circuits
City/State /ZIP:
without service or feeder fee,
First branch circuit $ 46.95 2
Phone: Fax; Each additional branch circuit: $ 6.65 2
Miseclinneous (service or feeder not inchrder,
E -mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 90.90 2
Business Name: CAPITOL Data & Communications. Reconnect onl $ 66.135 2
Pump or irrigation circle $ 53.40 2
Contact name: Sign or outline lighting 5 53.40 2
Signal circuit(s) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
. extension, Describe; I T 1 Page 2 2
City/State /ZIP: PORTLAND, OR 97220-1041
Each additional inspection over allowable in any of the above
Phone: 505. 255 -9488 Fax: 503-257-7121 Pcr inspection $ 62.50
investigation per hour (I hr min) 5 62.50
CCB Lie.: 142457 'Electrical LI2 I CLEJ Suprv. Lie 2834 LEA /O�, 4 industrial plant per hour $ 73,75
Suprv. Electrician signature, required; , / ( � ELECTRICAL PERMIT FEES”
�- Subtotal $ 75.00
Print Name: Ray Y p tgf� ,, r � c: 08!261 9 Plan rcvicti125 °/a of pcmrit fee)
Authorized signature: 1 ( State surcharrc ( ]2% ofpennit fee) $ 9.00
L • TOTAL PERMIT FEE $ 84.00
Print Neme Ray Younger Thin permit nppticatIan erptrea le permit I, oat ehlatned within ISO
7- 1 -' / 1 tiny!, after It hen been accepted an complete,
• Number of inspections per permit allowed.
8/27/2009 06:50 5032551966 CAPITOL ELECTRIC PAGE 03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
72:k ,1 33 1 I F 1 3 7 - 73 031 I 313 R9
Fee for all residential systesrn combined $ 75.00
Check Type of work Involved:
El Audio and Stereo systems*
El Burglar Alarm
17 Garage Door Opener*
O Heating, Ventilation and Air Conditioning
System*
0 Vacuum Systems*
C Other:
ARMIgiglaraRRANIKERNRWINAB{777iiMPilliEMPRINE
Fee for each commercial sytem $ 75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
E Audio and Stereo Systems
E Boiler Controls
El Clock Systems
E Data Telecommunication installation
[:] Fire Alarm Installation
El HVAC
E Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
E Nurse Calls
C Outdoor Landscape Lighting°
El Protective Signaling
El Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations