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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT COMMUNITY DEVELOPMENT PERMIT #: ELR2008 - 00243 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/14/2008 PARCEL: 1 S 135AB -01002 SITE ADDRESS: 10220 SW GREENBURG RD 601 ZONING: R -12 SUBDIVISION: LINCOLN CENTER /THREE LINCOLN LOT: 009 JURISDICTION: TIG PROJECT: MATRIX Project Description: Installation of 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 AF TECHNOLOGIES ONE SW COLUMBIA ST #300 1418 HEMLOCK ST. NW PORTLAND, OR 97258 SALEM, OR 97304 Phone: 503- 412 -4800 Contact #: PRI 503 - 362 -2364 FAX 503- 362 -2382 FEES Reg #: ELE CLE10 LIC 167061 Description Date Amount [ELPRMT] ELR Permit 8/14/2008 $75.00 [TAX] 12% State Surch 8/14/2008 $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 Notific n Cen - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obt- • opies of these rules or d ct questions to S :t 51 .246.6699 or 1.800.332.2344. Issued y: I if/ Permittee Signature: � /.& 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. { J l r Elei'trical Permit Application FOR:OFFICE USE ONLY . City of Tigard /, / y Pen n tt No.: ^ ___0024/ �C� Z •J d Received 4 g Date/B 0 '/ b 0 II d, l - 9 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready /By: Juns: HI See Page 2 for Internet: www.tigard - or.gov Notified/Method: / (C I , Supplemental Information . - , • , TYPE OF ' WORK ` • ' , ,. • . _ ' • REVIEW ' . . ❑ New construction `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 ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or .JOB; 'SITE INFORMATION AND LOCATION` ❑ Emergency system. larger separately derived system. • . , , ❑ Addition of new motor load of ❑ `'A ", "E ", "1 -2 ", "1 -3 ", Job no.: Job site address: I ix or or more. occupancy. 492_21f:7 5 4 !"� LGY �J 0 or more residential units. ❑ Recreational vehicle parks. t (� ❑ Supply voltage for more than s City /State /ZIP: �^ 0 facilities. pp y olta '�� t�� 600 volts nominal. v 0 locations. Suite /bldg. /apt. no.: l e0 / Project name: ,4 7 V , I . X 4,� PN� ❑ Service or feeder 600 amps or more. FEE `SCHEDULE " Cross street/directions to job site: L Ce Nl�z. r /t te,, _,pescription I Qty. I Fee. I Total I " 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'l 500 sq. ft. or portion 33.40 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF ..WORK, (with sq ) 75.00 2 with above s ft. • Limited energy, multi - family 75.00 2 1/01 � e c- Cee%I 1 ivy' residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 . '_, ❑ PROPERTY' OWNER < . • , .' _ ❑ TENANT N T . : 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: ( ) I 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 ❑4 APPLICANT • ❑ CONTACT_ PE RSON ' ' , a serv or f fee, 6.65 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, 46.85 2 Contact name: first branch circuit Address: Each add'I branch circuit 6 65 2 Miscellaneous (service or feeder not included) City /State /ZIP: Each manufactured or modular dwelling, service and /or feeder 90.90 2 Phone: ( ) Fax: : ( ) Reconnect only 66.85 2 E -mail: Pump or irrigation circle 53.40 2 • CONTRACTOR ° . Sign or outline lighting 53.40 2 Business name: /J /- �, / Signal panel, or limited - /Tl 7e6 A),1 -� / 1 , /c ° S energy Panel, alteration, or /� Address: /jam //1 ,[[� / - 7 —., extension. De r : t er / Paget 79 2 City /State /ZIP: / 6�60 � 9 7 ?© e/ Each additional inspection over allowable in any of the above / Per inspection 62.50 Phone: (5 36a_ ,936 4• Fax: (52:9) ?3� a Investigation per hour (1 hr min) 62.50 CCB Lic.: /6 d */ 1 Electrical Lic.: // �I Su. Lie.: c l 4.�4 Industrial plant per hour 73.75 _ ELECTRICAL PERMIT :FEES Suprv. Electrician signature, required; ,`'� , � Subtotal: `7rj .00 8 Plan review (25% of permit fee): -'t� Print name: �e „--/ �� � � Date: �� State surcharge (12% of permit fee): ? 0c2 Authorized signature: TOTAL PERMIT FEE: qC �.00 � , ^� � ��� / ` This permit application s if a permit is co within 180 Print nae: / E.- Date: ! 4 days s after r it t has been accepted as s complete. * Number of inspections allowed per permit. i \ Building \Permits \ELC- PermitApp.doc 05/23/06 440-4615T(11/05/CO5/1/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: TOSIDENTIAL;WORKbNLYi: :', Fee for all residential systems combined $75.00 Check Type of Work Involved: n Audio and Stereo Systems* ❑ Burglar Alarm • n Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIA WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918 309 - 0000) Check Type of Work Involved: n Audio and Stereo Systems ❑ Boiler Controls n Clock Systems n Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical D . Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling n 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 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR2003g0�i3 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/14/2000 Phone: (503) 639 -4171 /omnvo ��p�l�' � ` Inspection Requests (24 Hrs.): (503) 639 -4175 "' I1. INSPECTION WORKSHEET FOR DATE: .10/30/2QO8 TIME: 7 :00AM PAGE: 24 SITE ADDRESS: 10220 SW CREENBURC RD 601 CLASS OF WORK: SUBDIVISION: LINCOLN CENTER/THREE LINCOLN LOT #: 009 TYPE OF USE: PROJECT NAME: MATRIX DESCRIPTION: Installation of low voltage for data. OWNER: SHORENSTEIN REALTY SERVICES, PHONE #: 503.412-4800 CONTRACTOR: AF TECHNOLOGIES PHONE #: 503-362-2364 Inspection Request Scheduled For: Date: 10/30/2008 Pour Time: Code # Inspection Description Confirm # Contact # Message 135 Low voltage 077358-0 ' ` 803.932-6657 N 19q R IV AL— Corrections/Comments/Instructions: . \ - . iv c p . , PAS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: G� N 661 - - 5 -.4 v 66 L Date: 1 0 10 Phone #: (503) 718- 1-V__L CITY OF TIGARD BUILDING DIVISION PERMIT #: ELR2008-00243 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/14/2009 Phone: (503) 639-4171 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 8129/2008 TIME: 7:00AM PAGE: 6 SITE ADDRESS: 10220 SW GREENBURG RD 601 CLASS OF WORK: SUBDIVISION: LINCOLN CENTERiTHREE LINCOLN LOT #: 009 TYPE OF USE: PROJECT NAME: MATRIX DESCRIPTION: Installation of low voltage for data. OWNER: SHORENSTEIN REALTY SERVICES, PHONE #: 503-4114800 CONTRACTOR: AF TECHNOLOGIES PHONE #: 503-362-2364 Inspection Request Scheduled For: Date: 8/29/2008 Pour Time: Code # Inspection Description r &nfirm # Contact # Message 135 Low voltage 074880-01 503-820-1109 Corrections/Comments/Instructions: t "El 04 0\ eqtAiWal K, PAS 0 PARTIAL APPROVAL 0 CANCEL pi NO ACCESS n FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: Crs NOES Lig Date: B. 2., ea Phone #: (503) 718- Pi , .