Permit top CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2009 -00233
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/31/2009
TICrA . • Parcel: 1S135AB01003
• Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 450
Subdivision: Lot: 0
Project: Credit Union Home Loan Center
Project Description: Installation of voice & data.
•
Owner: FEES
Description Date Amount
LINCOLN CENTER LLC
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 07/31/2009 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 07/31/2009 $9.00
PHONE:
Contractor:
NORTHWEST COMTECH INC
12807 NE 22ND ST
VANCOUVER, WA 98684
PHONE: 503 - 252 -1462
FAX: 503 - 252 -2343
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N 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 it is issued su•I- to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
b= 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 - ore the 180
•ays. ATTENTION: Oregon la ires you to follow the rules adopted by the Oregon Utility Notifi• .lion Center. Those ru s are set forth lt in OAR
952 - 001 -0010 thr•ugh OAR 9 -001-0)0q. ou may obtain a copy of the rules or direct questions to OUNC by calling ^6.6699 or 1.800.332.24•
Issued By: , V —■111‘► 4 ° Permittee Sign. • I�� •
OWNER INSTALLATION O
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.
Electrical Permit Application ` . FOR OFFICE USE ONL
n City of Tigard Da�eB be Q� Permit No.: 12,49009�Q7
P h
,. ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
TIGARD CARD Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
- Internet: www.tigard - or.gov Notified/Method: Supplemental Information
- - � t a - 4 « S"s' . ; '�.' m"ym.:�:,,�:x��a, r ,ni.�:. :.`_c . �:..:�° - ..:.'� • ' . ;ara °�5'�K' '=:E:Y va' >� ". .�. ":i - � ' _ ` " S
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�:�� r� �� .� �� v X OF �. t , c � '" s r �,„� ���;-„...�^ r.rPI�A NREV I FsW�
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❑ New construction ddition /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 jther: where the available fault current ❑ Marinas and boatyards
ii a''`` =°"F' 'd = -tit a - ��'"°'' eii. "'"�� ''"' ' `"" " ` "' ' * exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
t r<' „. r 4 .4.1 4- CATEGORY OF::CONSTI2YJ kI®1V , , _, }:, =P;`a , g s.
g
K a',. ,,, a'�:csu,.: - ;.s+;.:..v » &;z� ,,,. ,...�,. krv-- .._n „�,-; : -ten# :u;�� s.3�.;`�.. ,.- � :���- .a�.:�,.A':ta?
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.
El Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
;' .., x. * r, rye;:, >£` ,._ .: .; < % -- p ❑Emergency system. larger separately derived system.
” ' JOB girtwO C bwgi OCA�TTON � t
'. ffv,• � :, �-:a r c ��„ .,,,, . � a �.. ,, §.�. . w' ': 1 ❑ Addition of new motor load of ❑ „ <, ., 2 „ „ 3 „
Job no.: Job site address: � �,�'`�,,�y R IOOHPormore. occupancy.
o 300 5U3 `I ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: c NZ o (� C(7 Q Q 111 J ❑ Health -care facilities. ❑ 600v no Dinah more than
` t 1 ❑ Hazardous locations.
Suite /bldg. /apt. no.: 45o Project name: Cu l i ® , A Q 6,„,..s ❑ Service or feeder 600 amps or more.
1 = r a :' r , OE SC_ITEDL - CLt ' :SNiti
Cross street /directions to job site: Description I Qtv. I Fee. I Total I *
Ci LAk� 4 d. l -1 New residential single- or multi - family dwelling unit.
N 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
,> , - a.ys t. , r:; ;,v m -..: 75.00 2
(. ;DESCR ;# :° ' < R. WORK. ` a �.�;:kF; S rg ( q. )
°'c.? ., �` - �c�c , { « <.r „,�... ,�;z t, �)-�r with above s ft.
.c n;�t.'s `�. =:`:e :Y .t.� -' ,., L:. �.` tr��. ��. �., cs..., r. �vR, �.::.. i�,:. �,.,. a+ r�F „'s`{���..:,+.,�v:�:.- .�.:,,.,, a�». �. �aa. u. ? : :•?`-`:;?'`�,x..,,x�.z�,. >s >:S
■ Limited energy, multi- family
// \ \i0102. {' iaAttA CAS 1 tN residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
.,.. e"i' "n �nn ",ar^w: ^.:. �.x.._ . - <{ ��F�'•,,�:ii a�;�'S."a: .` .�,�' : '.^SHw;,:tl'W. : Y::e �r �+,.„
`' P ii5 fi OV NE RC W 1 `€ PE NAN T - 3'
'wi ro;� , h- ,T. vs.. -r � ,,m =,h: ., AWK „� n., . _ _ - .r, , w_ : _ �3 � a34 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
. p5, wa ,y rfif IM irinVANT c` t o deNtS } GTE PERSONNA { '' *^ above service or feeder fee,
... , , ..,,,a ; �„ .v 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each mien 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
"c "° . tt °: "r 1" °'`` Si g n or out li 40 2
53.
x:..t - ": M CO1TR4CT012 ., ' .
Business name: (\)pR \e.%i C j ,,,,,, ` Rs, p
l x
, _ Signal circuit(s) or limited -
energy panel, alteration, or
Address: l a5 1.1 C aa`= 5-1-- extensiot esr.ribe: P age 2 2
City/State /ZIP: q tAi .,1 CpLL J, 1 ` a CI �� l.
�, Each additional inspection over allowable in any of the above
t �i - � .� Per inspection 62.50
Phone: (�3) c .S ^ i y 6a
. Fax: (5e6 ) a• 4
5a • gti3 Investigation per hour (1 hr min) 62.50
CCB Lie.: 11 9 CAA O Electrical Lie.: e.LE ^ et Suprv. Lie.: 17 a LEA Industrial plant per hour 73.75
' i -5 ELECTRICAL ' ;
Suprv. Electrician signature, required: c.....� . Subtotal: — 76,4190 r r69-
Print name: _I A S V , S Date: " / revi t 1 J b 9 State surcharge (12% of permit fee): q „O Min
Authorized signature ` I TOTAL PERMIT FEE: . 4./ ,00
1 / This permi application expires if a permit is not obtained within 180
Print name: , k �, • a1q 1 S Date: —7/3 ! / b 9 days after it has been accepted as complete.
' Number of inspections allowed per permit.
1 \Building\Permits\ELC- PennitApp doe 05/23/06 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page Z Supplemental Information N
LIMITED ENERGY PERMIT FEES:
t.SYDENTIAI. WOgtWtli
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other: • •
'COMIVIERCTALkWOatIN:Y `� ,w.
Fee for each commercial $75.00
system •
r ,
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
. n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls • •
Outdoor Landscape Lighting* •
I Protective Signaling
❑ Other
Total number of commercial systems: •
*No licenses are required. Licenses are required •
for all other installations
•
I:\ Bwlding \Permits\ELC- PermitApp.doc 03/23/06