Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELR2012 -00073
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2012
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 285
Project: Crump Insurance Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Low voltage for data.
Contractor: CHRISTENSON ELECTRIC INC Owner: LINCOLN CENTER LLC
111 SW COLUMBIA ST, STE 480 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97201 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 419 -3300 PHONE:
FAX: 503 -419 -3695
FEES
Description Date Amount
Specifics: Restricted Energy Permit 04 /19/2012 $75.00
12% State Surcharge - Electrical 04 /19/2012 $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 accoe . - • 'th 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. ATTE ON: Orego law requires you to follow the rules adopted by the Oregon Utility Not cat'• • enter. Those rules are set forth in OAR
952- 001 -001 through OAR 95. -1 . -' 090. ou may obtain a copy of the rules or direct questions to OUNC • • x.1987 or 1.800.332 ' 344.
Issued = : / Permittee Signa • -
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 Ina 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.
APR -17 -2012 TUE 12:19 PM CH "ni'`\ •,n I DIC, INC FAX NO 95034193695 P. 01/03
iiC AP 1 FO OF iICE USE ONLY
Electrical Permit Ap.p ation 2012
City of Tigard CITY OF TIGARD. -.060 73
Received Pcmtit No.: Ete •
ty : 4 _ . _ .i
n 13125 SW Nall Blvd.. Tigard. OR ING DIVISION Plan Review Other Permit: /5 / - 0 3
t 5 Phone: 503,718'L439 9 .►9e+u Fax: 503,59k I�'��
Date Ready /By: bele: See Page 2 for
TIGARD
Inspection line: 503. 639.4175 Notif Method: Supplemental Information
Internet: www,tigarJ- or.gnv
• • ' -- PLANS K F I W s wliien�4 checked below): -,
.. TY . P . L" . UF WORK
' • • t'Icasc cllw:k all that apply (submit : ::efs of p
❑New construction IAddi[ion /alteration /replacement ❑ Sarvice or feeder 400 amps or more ❑ Buldin6 over three stories.
❑ Demolition ■ . Other: • or l use agricultural
: °CAT trONS;1'Ri . ,:.:.. • ',�„ ':,'.: • ::: '�' less u r.+
, , . .. �, � � where the available fault current 0 Marinas and �to ground. 0 or n cxceeds I14 o ❑ Com ' mer ci buildings. O ric
❑ 1- and 2- family dwelling ommercial /industrial ❑ Accessory building arms foroll outer installations. • ❑ buildings.
ol'75 K ur
in ❑ Multi-family
builder CI Other: "1-2". 1 y em.
. 0 ',�T10 :AI�1D' �1 :Q4A
motor l a.ul of
JU.H: 1iiN N T1OiN' °..,i.' ❑ Ad 0 i p ump sys larger a o 71 KVA V derived x
of new , ....., �, • ; .. , . • . ,. occupancy.
Job address:
,.., • ..., ..... 1 O Uli P or more
,� 39 J o site 000 sVSI 6f r� • 5• ❑ Six nr mare nsidcntinl units. ❑ Recreational vobicic parks.
Job no.: Supply voltage for more than
� � ❑ Hc -Care focl ❑ • pP volts nominal.
b
.. ' r - t r� 400 un
City/State/ZIP: , � „G ❑ Hazardouslnca t ions ,
( ] Service or feeder GS10 amps or ntbre.
Suite/bldg./apt. no.: $ Projcct name * 1... �� . .. 1:11.41 %. ., .., . I :..
J ob sit ` l {Al � K 1 02 Dweripdan I liv. • t Fun F
Cross snect /directions to Lr3 'T New residential single -or multi-family dwelling unit.
AO — i — Includes attached garage.
1.000 sq. R. or leas 168.54 4
Subdivision: Lot no.; 33.92 • 1
Ea. add'1500 9q• 11, 0r rtion
no.: Limited anew, residential 75 2
Tax map/parcel . ..' • 1. • • , •, (with above sq. R,) � ,
DF,.S RIP.TI'0�1;`: ' " . . . Limited cner6y, multi- family 75,00 2
' . • � � residential (with above sq. R.)
, i � � Services or feeders installation, alt eration, and/ relocation
200 amps or less 100.70 2
2AI amps to 400 amps 133.56 2
IQPROPER'fl' ^` ., ':Di:TENANl.,;',. w600am _ 2 2
_ 1 amps ps 00.34
301,04
- - Name: 601 amps to 1,000 amps _
Over 1,000 amps or volts 552.26 2
Address: Tempurary services or feeders tallation, alteration, and /or
City/State/ZIP: ins
relocation
3 00 am ps or less 59.36 1
Phone: ( ) Fax: (. ) 201 amps to 400 amps - l25.011 2 ^
Owner installation: This installation is being made on property that 1 own which is not 401 amps to Sys amps 16R.54 ?
intended for Sale, lease, rcpt, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits -new. alteration, or oitensloo, per panel
Owner signature; circuits with
service ,.• shove service or feeder fee,
' 7.4Z 2
..
1'I:i
:
Q ::i.•. ;': ,, ' ^CO)VT; " ' :� ' each branch ctrcuCircuit inn ° . ,r„ l ee for branch circuits without
. F
, A 2
Business name: , .� .7 - L1,e 24A �ti service or feeder fee, first 56.18
branch circuit
Contact name: Each add'1 brunch circuit 7.42 2
Miscellaneous servic or feeder n ut Inelu_ d
Address: Each manufactured or modular
67.84
City /State /ZIP: dwell) F. service and/or feeder t
!Reconnect only 67,54 2
Phone: ( ) Fax: ' ) Pump or irrigation circle 67.84 2
E-mail: - -
- 67 2
• d
.encr
„„ N.TRA .. % extension. une
�...r:. Signa alteration, � 2 2
.:r:5 ,,,':..� �',� .r,�,: ••,:,, r run
, , ... ..: ... ... ,., •: Panel, t ion, or axle
Business name: �(�/ A , i d � .. i� a . Each additional inspection over allowable in any o to above
11 • . 1 W�e, Additional inspection (1 hr min) - 66.25/ hr
Address: • , ,, it Al 4 - 66.251 hr _
A - 3 b nvcati g ation (2 hr min)
City /State/ZTP: Or . 1„„,,a U . . • Industrial plant (1 hr min) 78.15/ hr
-
�- ,.► inspections for which no fee is 90.00 / hr
Phone: (, ,'>- — 3, ` J ii it a �1 specifically tiatedia hr min)
AM : Su �� 15�,6:C1 �R'[�:I►1a 'P �iAMIT �REES,. � . . .:.:...::: ..::::.': ; ;, ,
Lic.:5�
CCB Lic.. 4 � ° '? 4 � rr / ,A, _ Subtol — 7 n.
Suprv. Elcctrici ignature, required: �� . 1...:_A; Plan review (25% of fee): -
D ate: S tate surcharge (13% of permit fee): Mil
Print name: i . 1 ` �
� _ . 0I PV TOTALPfiRMITFBE: �,
Authorized signature; This permit application expires if a permit Is net obtained w thin ISO
days Aar It had been accepted as complete.
Datc; • Number of inspoctiona allowed per permit.
Print. name:
I:U3uIIdinElPcrmi¢ \ELI. - YCnni IAPP Out/ ut /IO d4a- 46 ism t/o5IC0MtWen aRu d1 L/
APR -17 -2012 TUE 12:20 PM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P. 02/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
: WORK ONI N :: :. ;:. .
Fee for all residential systems combined $75.00
Check Type of Work Involved:
0 Audio and Stereo Systems*
Burglar Alarm
Garage Door Opener"
[] Heating, Ventilation and Air Conditioning System*
O Vacuum Systems"
O Other
'C O 4ME c1AL:WO K ON? X:::! ........ , .
Fee for each commertial $75.00 .
system.
(SEE OAR 918. 309 -0000)
Check Type of Work Involved:
O Audio and Stereo Systems
O Boiler Controls
•
11 Clock Systems
Data Telecommunication Installation
Q Fire Alarm Installation
❑ HVAC
• Instrumentation
O Intercom and Paging Systems
O Landscape Irrigation Control*
• Medical
▪ Nurse Calls
O Outdoor Landscape Lighting*
0 Protective Signaling
• Other
Total number of commercial systems:
*No licenses arc requited. Licenses are requited
for all other installations
i madin O Wemione_Pemilopp.d% 07IUIi10
13. 03/03
AUTOMATIC COVER SHEET
DATE: APR -17 -2012 TUE 12:20 PM
T0:
FAX #: 95035981960
FROM: CHRISTENSON ELECTRIC, INC
FAX #; 95034193695
03 PAGES WERE SENT
(INCLUDING THIS COVER PAGE)