Permit a
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
Air' COMMUNITY DEVELOPMENT Permit #: ELR2009-00259
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009
tIG �1F I 9 Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 1165
Subdivision: LINCOLN TOWER Lot: 0
Project: Bucher /Greenspan
Project Description: Install restricted energy for fire alarm.
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 08/05/2009 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 08/05/2009 $9.00
PHONE:
Contractor:
SAFE TECH
6400 NE HWY 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. 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 -0010 through • • R 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 6699 or 1.800.332 2344.
,` I
Issued By: \� a_. L� , L A Perm ittee Signature: U
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.
A ___ : ( o •
v Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard
Received � PermitNo. ,� • - 06� 89
I N " 13125 SW Hall Blvd., Tigard, OR 97223 P lan Review 'W i — C � M
Phone: 503.639.4171 Fax: 503.598.1960 Date /By Other Permit: rf j:::C n. Y ,0 U` 1 A
TIGARD Inspection Line: 503.639.4175 Date Ready/By. ` Juts: l See Page 2 for OP
Internet: www.tigard or.gov Notified/Method: C • 0 t . C Supplemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below).
El New construction ® Addition/alteration/replacement
❑ 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 agncultural
❑ 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.: 825 Job site address: 10260 SW Greenburg Rd or more. occupancy
El S Six ix o or r more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard OR ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: 1165 Project name: Bucher & Greenspan ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Lincoln Tower Description I Qty. I Fee. I Total I *
New residential single- or multi - family dwelling writ.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Fire alarm modifications residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER . ❑ TENANT 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: ( ) 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
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Safe Technology Group Inc. B. Fee for branch circuits
without service or feeder fee,
Contact name: Jason Sweet first branch circuit 46.85 2
Address: 6400 NE Hwy 99 Suite G375 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Vancouver WA 98665 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527 Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: Safe Technology Group Inc. energy panel, alteration, or
Address: 6400 NE Hwy 99 Suite G375 extension. Describe: I Page 2 75.00 2
City /State /ZIP: Vancouver WA 98665 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (360) 699 -2130 Fax: (360) 719 - 1527 Investigation per hour (1 hr mm) 62.50
CCB Lic.: 173731 Electrical Lic.: CLE79 Suprv. Lic.: 4272LEA Industrial plant per hour 73.75
R- ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Jason Sweet Date: 7 -27 -09
Plan review (25% of permit fee):
/�r� State surcharge (12% of permit fee):
Authorized signature: i � d rA _ [/� TOTAL PERMIT FEE: F340 F 0 0
This permit application expires if a permit is not obtained within 180
Print name: Jason Sweet Date: 7 -27 -09 days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building \ Permits \ELC- PennitApp.doc 05/23/06 440- 4615T(11/05 /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:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
® Fire Alarm Installation
n IIVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building \Pecmrts \ELC- PertnitApp doe 03/23/06