Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' - 1 - COMMUNITY DEVELOPMENT Permit #: ELR2012 -00033
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/22/2012
Parcel: 1 S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 340
Project: PNW Telco Subdivision: METZGER, TOWN OF Lot: 9
Project Description: TI
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 255 -9488 PHONE:
FAX: 503 - 257 -7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 02/21/2012 $75.00
12% State Surcharge - Electrical 02/21/2012 $9.00
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
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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 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. ATT NTION: Ore on law re•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 10 through OAR 52 -I -009'. You may obtain a copy of the rules or direct questions to OUNC by calling 503.23 iiiii or 1.800.332.2344.
Issue By: ki l /11.,( 4 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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 ONLY
Received y
City of Tigard
'r 8 Date/By: t7/irfi, p�
ermit no.: g � )00
13125 SW Hall Blvd., Tigard, OR 97223 R 9 "'���444"' Fc� V Plan Review Other Permit: 01,1/7,61/— (�
IC Phone: 503.639.4171 Fax: 503.598.1960 � ' 4 � Date/By: , � 610k171 T I G A R D Inspection Line: 501.639.4175 Date Ready /By: Juris: L 1 See Page 2 for
Internet: www.tigard- or.gov • FEB e 1 2012
Notified/Method: TX& Supplemental Information
r' .'
TYPE OF WORK b�I/ t Lit- kr3„,,,D PLAN REVIEW
LJ New construction L./.1 Addition /alteration/replac t Please check all that apply (submit 2 sets of plans w /items checked below):
n
❑ Demolition ❑ Other: 1/ SIGN ❑ Service or feeder 400 amps or more ❑ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
LJ I- and 2- family dwelling U Commercial /industrial L] Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi- family ❑ Master Builder ❑ Other less to ground, or exceeds 14,000 Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations. ❑ buildings
Job no.: 120138 -45 Job site address: 10200 SW Greenburg Rd ❑Fire Pump CI Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City /State /ZIP: Tigard, OR 97233 CI Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
10OHP or more. ❑ occupancy
Suite/bldg. /apt. no.: Suite 340 Project name: PNW Telco T.I. ❑ Six or more residential units ❑Recreational vehicle parks.
❑ Health -care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site: ❑ Hazardous locations ❑ 600 volts nominal.
❑ Service or feeder 600 amps or more
Subdivision: Lot no.: FEE SCHEDULE
Description I Qty. I Fee. I Total ' M
• Tax map /parcel no.: New residential - single or multi - family dwelling unit.
DESCRIPTION OF WORK Includes attached garage.
INSTALL FIRE ALARM CIRCUIT 1000 sq. ft. or less $ 168.54 4
Ea. Add'I 500 sq. ft or portion S 33.92 1
U PROPERTY OWNER I Li TENANT Limited energy residential
Name: (with above sq. ft.) $ 67.84 2
SHORENSTEIN REALTY SERVICES Limited energy, multi - family
Address: residential (with above sq. ft.) $ 67.84 2
Service or feeders installation, alteration, and/or relocation
City / State/ZIP: 200 amps or less $ 100.70 2
201 amps to 400 amps $ 133.56 2
Phone: Fax: 401 amps to 600 amps $ 200.34 2
601 amps to 1000 amps $ 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 552.26 _ 2
intended for 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 S 59.36 1
LJ APPLICANT I LI CONTACT PERSON 201 amps to 400 amps $ 125.08 2
Business Name: 401 amps to 599 amps S 168.54 2
Branch circuits - new, alteration, or extension, per panel
Contact name: A. Fee for branch circuits with
service or feeder fee, each
Address: branch circuit S 7.42 2
B. Fee for branch circuits
without service or feeder fee,
City / State/ZIP: first branch circuit $ 56.18 2
Phone: Fax: Each additional branch circuit: $ 7.42 _ 2
Miscellaneous (service or feeder not included)
E -mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 67.84 2
Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only $ 67.84 2
Pump or irrigation circle $ 67.84 2
Contact name: DAN WILSON 503.262.0411 DIRECT Sign or outline lighting S 67.84 2
Signal circuit(s) or limited -
Address: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: Fire Alarm I Page 2 $ 75.00 2
City /State/ZIP: PORTLAND, OR 97220 -1041
Each additional inspection over allowable in any of the above
-
Phone: 503- 255 -9488 Fax: 503 - 257 -7121 Per inspection S 66.25
Investigation per hour (1 hr min) $ 66.25
CCB Lic.: 48748 'Electrical Lic.: 26 -496C ISuprv. Lic.: 3132 -S Industrial plant per hour _ $ 78.18
Suprv. Electrician signature, requir ELECTRICAL PERMIT FEES*
//Z�/�� i� Subtotal $ 75.00
Print Name: DAR LL M ` Date: 02/08/12 Plan review (25% of permit fee)
Authorized signature: \ / ' � J� A' State surcharge ( l2% of permit fee) $ 9.00
� T OTAL PERMIT FEE $ 84.00
Print Name: DARRE NE� J This permit application expires If a permit Is not obtained within 180
days after It has been accepted as complete.
• Number of inspections per permit allowed.
02/16/2012 16:32 5032551966 CAPITOL ELECTRIC PAGE 01
FAX COVER SHEET
Capitol
Electric Co., Inc. Date: 2/14/2012
11401 NE Marx St.
Portland, Oregon 97220 -1041 Time: 9:26 AM
(503) 255-9488 FAX 503- 257 -7121
www.capitolelectricco.com
Please deliver the following pages to:
Name: Building Department _
Firm: City of Tigard
From: Darrell McNeel
Comments:
Had mailed a set of plans with two electrical permits. Here is the Building Fire
Alarm permit application that we had not sent with the plans.
Thank you.
TOTAL NUMBER OF PAGES, INCLUDING COVER SHEET 3
IF YOU DO NOT RECEIVE ALL PAGES, PLEASE CALL (503) 255 -9488