Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I . COMMUNITY DEVELOPMENT Permit #: ELR2012 -00050
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/22/2012
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 555
Project: West Coast Careers Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Data telecommunications system.
Contractor: AMERICA'S PHONE GUYS Owner: LINCOLN CENTER LLC
PO BOX 873279 BY SHORENSTEIN PROPERTIES LLC
VANCOUVER, WA 98687 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 360 - 904 -6782 PHONE:
FAX: 360 - 254 -1967
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/22/2012 $75.00
12% State Surcharge - Electrical 03/22/2012 $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: Y Fire Alarm: N
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 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 OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By — =- i� Permittee Signature: � .ir � / .
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.
03/21 / 2012 11:25 3602541967 PHONE GUYS LLC PAGE 01 /02
Electrical Permit ApplicationRECEIVE. FoR onicE i O'1:
1 . 13125 SW Hall Blvd 1
City of Tigar Tigard, OR 97223 MAR 2 1 ZOIL d Received
n Dal : . ' ,fiff 411 Permit No.: ;"',. I ,. .
.3 0
., Plan Other Permit:
/... .. Phone; 503.7115.2439 Fa 503.598.1960 Datliv: ____-
.1. I • , ,, inspection Line: 503.639.4175 r) Date Ready/By! AIM. 1 a See Page 2 for .
,............ ...:;:,..:,::;.:.i::i....i:D.;::1.i,;,..1.;e:.i.,...:":.;...,,..i.:...7,...i..,..;,:i...:..:.37...,,i.tvitd..°.d.v.it to.:..niti., :ii:v.;, rati...tit,70,...4:../..:.re,.„.::..i.,a,...ce?fi..m.j....et:t''' '''''110:1'wscri,H.Teem:;h:cck'eth'or:aa;i:der:tin:lit:iiapig'c;:amy:751:17.ebm:t2: scie n' DI- sSumiarnPs.:dinw::11."g;:cioll.wei.e:634taboatyach:t:brectli.:st.taibda.:°711):'
CITY OF TIGA: ,,,,,„
--,
0 New construction
0 Demolition 0 Other:
7 i ,„ . ...,,,.,..„ ...- .,:..,r.,,. euc cds 10,000 antes at 130 volts or 0 Floating buildings.
: ;.M3f , i: : .: ; :.:''.:•:..;;?Ff,4!.,:.....,. ; ,.„ ,,,t yr.w,F,9F.,=y006:;:;! ,,,,,,,c,,,,„,d, or aceeds 14,000 I:Commercial-use apicultural
I:3 1 - and 2-family dwelling El Commercial/industrial El Accessory building amps for all other installations. buildings.
D Other: 0 Etre pump.
0 Multi,-.fa e.r.builde.r. ........... . ..... ,.. ....,.. ....... . .,--..,.. °Emergency system. 0 lattallation a 75 KVA or
larger separately derived system.
; .. ; , ; .! . , .., ; . i!i . „;. :„ . . ",., . coRKArnopmEactil,odigkiN.:.,':';:w•!. ',!'. ' r.: or load of 0A "V', "t •r, "1-3",
10074P or mnee, occupancy.
Job no.: Job site address; 10300 SW Greenberg Road ---- 0 Six or more residentiol units. 0 Recreational venue pants.
0 Hcalth•care facilities. 0 Supply voltage for more than
CI marardous ltions.
City/State/Z1P: Portland. OR 97223 600 volts nominal.
oca
Suite/bldg./apt no.: 555 Project name: West Coast Careers 0 Service or fader 600 amps or more. .
V:=2:JZ4Z....;:74..:...
Cron sweet/directions to job site: ': U3 i
A .! .. , / A / , ill Deurialion IMMOMII. Tom •
) New residential stymie- or multi dwelling unit.
Includes attached garage.
Subdivision! j Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. addi 5ta.I sq. fl or poniuu 33.92 1
Tax map/parcel no.: Limited energy, residential 75.00 2
• .....,,,,, „.; - • - • ,...--....-.... • • .........;-, .....,,,,,....,a,,u.. - - ...- - i...i., '',:; (with above . fl.
.: " CIV " .. ' v ' i " 51. *"' "; '''' ''' ' ." '''".":..: Limited enerig. multi family 73,00 2
Low voltage Cabling -. VO a a- CA Ci4-0.. residential (with above 9. ft.)
- - Services or feeders instanation,rperation, and/or relocation
200 srspe or less 100.70 2
:•:';',::•...'::!i.:•i:!':::!:1::140iitiiikiti*INEIC:'..;;f';;;:::i.:'':: f."1,.: ■:;,.;+ WitigOit;5::Ya;:.!.;::i: 201 am t° 4 ° ° amPs 133.56 2
401 amps to 600 amps 200.34 2
-
Name: West Coast careers 001 Mule' iu 1,000 amps MI .04 2
- _ _
Address: 10300 SW Greenburg Road _____ I ,000 amps or volts 552,26 2
City/State/ZIP Portland OR 97223 ______
Temporary services or feeders installation, alteration, and/or
: relocation _ -.
_
1
Phone: (503)200-5200 Fax: ( ) 200 amps or less 59.36 - ' 2-
-- 201 amps to 400 amps 125.08
Owner installation: This installation is being made on property that I own which is not
9 168.34 2
intended for sate, lease, rent. or exchangc, according to ORS 447, 449, 670, and 701. 401 amps to 59 amps
Breach circuits- new. alteration, or extension, per panel
Owner signature:__,-------- . Date: A. Fee for branch circuits with
• above service m Cceder fcc.
liefitiaiiiiittlti*Eitit*.::. :(.%!:'...'::::! :.'.. h . . 742
8. Fee for branch circuits without
Business name: America's Phnne Guys earvice or feeder fee. firal 56.1B 2
branch circuit
____CalCIL------Contact name 1 i S Each addi branch circuit 7.42 . 2
Address: PO Buz 873279 Miscellaneous (service or feeder not Included)
---- Each manufaettimd or modular 67.84 2
City/State/Z1P: Vancouver dwelling, service and/or feeder
Phone: (360) 904.6782 Fax. . (360) 254.1967 Reconnect only 67.84 2
Pump or irrigation circle 07.84 2
E-mail; lois@americasphoneguys.com Sign or outline lighting 67.84 2
....„,. ... ,
'5::::..:.::'...:•.'::::;:5::;:;:7:::':":::'K'T.I.:::.;:.::1,:.::.01Nitl*Wrvi:"!'"::rj;.':!::P:::,.:.:,' .'..:. sienal circuit(s) or iimled-citergy i 75.00
enel, alteration, or extension. _ I flirc 2 q
,s..
Business name: America's Phone Guys
Each additional inspection over allowable in any of the ahov
-
Address: PO Box 873279 Additional inspection (1 hr min) 66.25/ hr
- -
Investigation (1 hr min) 00.23/
City/State/ZIP: Vancouver WA 98687 Industrial plant (1 hr min) 71).18/ hr
Phone: (360) 904.6782 I Fax: (360) 234.1967 Inspections for which no fee is hr
s. areal listed ii hr min) 90.00/
CCB L.ic.: 174014 Electrical ' .: CLE82 Suprv. Lic.:. 35411.EB .1 gC1Cit1 PE11M1r IfifEla..::;. , .....;.
s u p rv. Ei signature, required: oo.%
*1 4! „) Subtotal
____---- ; 75.00
____----- ...-, ____ Plan review (25% of permit fee)'
-----:----
Print name: Bertram Alvaro Date: 3/21/2012 State surcharge (12% of permit fcc): 9.00
, TOTAL PERMIT FEE: 84.00
Authorized signature: This permit application expires if a permit is ont obtained within 180
- days after it has been accepted as complete
Print name: Lots Cook Date: 3/21/2012 • wimther of inspections allowed per permit.
--
RetrildIngWerrnitIAPLC•Verm1tApp.d0c 07/01/10 . 4404615TO irosicOM/WEB
03/21/2012 11:25 3602541967 PHONE GUYS LLC PAGE 02/02
Electrical Permit Application - City of Tigard
Page 2- Supplemental Information
LIMITED ENERGY PERMIT FEES:
FilathEISTMVOM<MY-iM
Fee for all residential systems combined... $75.00
Check Type of Work Involved:
• Audio and Stereo Systems
El Burglar Alarm
O Garage Door OpenerP
• Heating, Ventilation and Air Conditioning System*
O Vacuum SysteMS*
Other:
Fee for each commercial $75.00
system
(SEE OAR 918
Check Type of Work Involved:
• Audio and Stereo Systems
El Boiler Controls
O Clock Systems
1E1 Data Telecommunication Installation
0 Fire Alarm Installation
• Ti'VAC
Instrumentation
Lii Intercom and Paging Systems
O Landscape Irrigation Control*
O Medical
0 Nurse Calls
fl Outdoor Landscape Lighting*
fl Protective Signaling
fl Other _
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
IABuilditypennits\ELC-PerrnItApp.doc 07m111 n