Permit 311 CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s • COMMUNITY DEVELOPMENT Permit#: ELR2012 -00060
Date Issued: 04/05/2012
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 360
Project: DiLorenzo & Company Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Fire alarm for TI.
Contractor: SAFE TECHNOLOGY GROUP INC Owner: LINCOLN CENTER LLC
6400 NE HWY 99 SUITE G375 BY SHORENSTEIN PROPERTIES LLC
VANCOUVER, WA 98665 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 360 - 699 -2130 PHONE: 503 - 619 -3200
FAX: 360 - 719 -1527
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04/05/2012 $75.00
12% State Surcharge - Electrical 04/05/2012 $9.00
Type of Use:
Class of Work:
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
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 ado. • • • the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR • - 001 -0090. You may obtain a • ..-4;11,..L„: ' • = :ons to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue • _� %�� 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.
•
1
Electrical Permit Application FOR OFFICE USE o'
.
City of Tigard Dat �� Permit No.: ,1 II— d ,
13125 SW Hall Blvd., Tigard, OR 97223 \� Plan Review
1 , p V\-"
\ • Phone: 503.718.2439 Fax: 5_9 f9C111 i `` j Date/By: Other Perini:
TIGARD Inspection Line: 'Iii I � \\ ,�, `\ J Date Ready Juris: ® See Page 2 for
Internet: www.tigard -or. rr \ " Notified/Method: 1-....4, J Supplemental Information
TYPE 1! )
N` PLAN RL VIEW
{ �
❑ New construction ® Addition /alteratjor►(r�p4
Please check all that apply (submit 2 se'; of plans w /items checked below):
iatli�
q G J t ' ❑ Service or feeder 400 amps or more ❑ Building over three stories.
e e �
❑ Demolition ❑ Other: CS 'N , ` :+ `'" where the available fault current ❑ Marinas and boatyards.
CATEGORY fit! J 9NSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. .
f� 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.
❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address: 10300 SW GREENBURG RD IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: TIGARD OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 360 Project name: DILORENZO ❑ Service or feeder 600 amps or more
FEE SCHEDULE
DULE I'
Cross street/directions to job site: LINCOLN 1 criotioo [ J"y. I Fee. I Total I •
New residential single- or multi -t., mily dwelling unit.
Includes attached garage. _
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential I4
75.00 2
DESCRIPTION OF WORK (with above sq. ft.) _ I
Limited energy, multi - family
75.00 2
FIRE ALARM residential (with above sq. ft.)
Services or feeders installation,, rcration, and/or relocation _
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps _ 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps _ 301.04 2
Address: Over 1,000 amps or volts 552.26 2
•
Temporary services or feeders i1, , tallation, alteration, and/or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 •
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 2 '
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 168 2 i
Branch circuits - new, alteration. or extension, per panel
Owner signature: Date: A. Fee for branch circuits with __ !
® APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: SAFE TECHNOLOGY GROUP INC. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: JASON SWEET branch circuit
Each add'I branch circuit 7.42 2
Address: 6400 NE HWY 99 SUITE G375 Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State /ZIP: VANCOUVER WA 98665 dwelling, service and/or feeder 67.84 2
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: SALES @SAFETECHNOLOGY.NET Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: SAFE TECHNOLOGY GROUP INC. — panel, alteration, or extension. I Page 2 75.00 2
Each additional inspection over ;,Itowable in any of the abov
Address: 6400 NE HWY 99 SUITE G375 Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr mm) 66.25/ hr
City/State /ZIP: VANCOUVER WA 98665 Industrial plant (I hr min) _ 78.18 / hr
Phone: (360) 699 - 2130 Fax: (360) 719 - 1527 Inspections for which no fee is
specifically listed (Y. hr min) 90.00 / hr
CCB Lie.: 173731 Electrical Lie.: CLE79 Suprv. Lie.: 4272LEA ELECTRICAL - PERMIT FEES
_
Suprv. Electrician signature, required: �
G� . Subtotal:
Plan review (25 %o aermit fee):
Print name: JASON SWEET Date: 4-4 -12 State surcharge (12 %01 permit fee):
�I‘ - TOTAL P1 ;:MIT FEE: C
Authorized signature: T his permit application expires if a : is not ob / /pined (within 180
days after it has been aL �epted as complete.
Print name: JASON SWEET Date: 4-4-12 • Number of inspections allowed per] . 'nit.
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
(RESIDENT WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
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❑ 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
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
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