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Permit CITY OF TIGARD ELECTRICAL PERMIT - RESTRICTED ENERGY DEVELOPMENT Tigard, SERVICES 1639 -4171 DATEESSU 1%R9/0 0360 13125 2004 SITE ADDRESS: 10260 SW GREENBURG RD 960 PARCEL: 1S135AB -03400 SUBDIVISION: LINCOLN TOWER -TOWN OF METZGER ZONING: C -P BLOCK: LOT: 014 JURISDICTION: TIG Project Description: Installation of limited energy for data telecommunications. 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: EQUITY OFFICE PROPERTIES TRUST HARDLINE CONSTRUCTION ONE SW COLUMBIA ST #300 PO BOX 1334 PORTLAND, OR 97258 SHERWOOD, OR 971.40 Phone: • Phone: 503 - 502 - 9461 Reg #: ELE 34- 557CLE LIC 146186 SUP 3552LEA FEES Required Inspections Description Date Amount Low Voltage Inspection [TAX] 8% State Surchart 11/19/2004 $6.00 Elect'I Final [ELPRMT] ELR Permit 11/19/2004 $75.00 Total $81.00 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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through ► • • 9 411-0100. You may obtain copies of these rules or direct questions t. OUNC at (503) 246 -6699. /0 ' Issue. by Permittee Signature X / • ( P 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 639 -4175 by 7:00 P.M. for an inspection needed the next business day Electrical Permit Application F01: OFFICE USE. 0 1..1 City if Tigard D e/By. / yiTAI - P erm i t No.: C ve _,.. /, a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Atb ,� )i mI +. . pate/g Other Permit: Inspection Line: 503.639.4175 .a_ - ''I 11 Date Ready/By: �_ ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information ' TYPE OF WORK PLAN REVIEW - ❑ New construction [Addition /alteration/replacement Please check all that apply: El Demolition ❑Other: ['Service over 225 amps, comm'I ['Hazardous location ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., CATEGORY OF CONSTRUCTION' of 1- and 2- family dwellings 4 or more new residential ❑ 1- and 2- family dwelling xi Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure El Multi - family ❑ Master builder ❑Other: ['Building over three stories ['Feeders, 400 amps or more ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION DEgress/lighting plan RV park Job no.: Job site address: / el a 60 s� 6r�br✓� ❑Health -care facility ❑Other. / Submit 2 sets of plans with any of the above. City /State/ZIP: • 0,_ 7�.7 a d - 3 The above are not applicable to temporary construction service. Suite/bldg. /apt no. Project name: / �. � //y! �A 1' FEE* SCHEDULE �'7 t f'�V� I Description I Qty. I Fee. 1 Total Cross street/directions to job site: New residential single- or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no.: Limited energy, residential 75.00 2 Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK • Each manufactured or modular n r dwelling, service and/or feeder 90.90 2 Lr7t t/ l�o , t� (s �' /` _.-, Services or feeders installation, alteration, and /or relocation • 200 amps or less 80.30 2 PROPERTY OWNER • 0 TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: F l ' / 6rc/ „ "p® 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or relocation Phone: ( ) 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 600 amps 133.75 2 Owner signature: Date: Branch circuits — new, alteration, or extension, per panel ' ❑ APPLICANT. ❑ CONTACT PERSON A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit 46.85 2 Address: Each add'I branch circuit 6.65 2 City/State/ZIP: Miscellaneous (service or feeder not included) Pump or irrigation circle 53.40 2 Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- CONTRACTOR energy panel, alteration, or extension. Describe: I Page 2 / 2 Business name: 1.J f (? .O L -t NE 6,A. s ;em Address: ©0 box / 1 33 Each additional inspection over allowable in any of the above / Per inspection 62.50 City/State/ZIP: 5-N 0 02 '7 4 110 Investigation per hour (l hr min) 62.50 Phone:( 505 ) 5d)._, q t J Fax: (, ) 6 g-S - s 3 33 Industrial plant per hour 73.75 NI I 1. ELECTRICAL PERMIT FEES* • o CCB Lic.: J 1 +'( Electrical Lic.: 39 _55 7 Suprv. Lie.: 33 5�- t`� Subtotal 7 : sN. l / / Suprv.•Electrician signature, required: _ J i ii (a ! (D. Plan review (25% of permit fee) `Print name: J OSt:�k E o 6I, Date: l J/l c�lilt State surcharge (8 % of permit fee) lv •de l� TOTAL PERMIT FEE R' 1 /l• Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board ** Number of inspections per permit allowed. is\ Building \Pennits\ELC- PermitApp.doc 12/03 440- 46I5T(10 /02/COM/WEB 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: El Audio and Stereo Systems* El Burglar Alarm ❑ Garage Door Opener* El Heating, Ventilation and Air Conditioning System* El Vacuum Systems* ❑ Other: 7 COMMERCIAL WORK ONLV: T - 1 Fee for each commercial system $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: El Audio and Stereo Systems El Boiler Controls ❑ Clock Systems N Data Telecommunication Installation El Fire Alarm Installation ❑ HVAC El Instrumentation El Intercom and Paging Systems El Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls El Outdoor Landscape Lighting* El Protective Signaling ❑ Other Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\ Building \Permits\ELC- PennitApp.doc 04/03