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Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT 11111 $ COMMUNITY DEVELOPMENT Permit #: ELR2012 -00093 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/31/2012 Parcel: 1 S 135AB03400 Jurisdiction: Tigard Site address: 10260 SW GREENBURG RD 710 Project: Axiom Subdivision: METZGER, TOWN OF Lot: 9 Project Description: Low voltage for fire alarm 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 05/31/2012 $75.00 12% State Surcharge - Electrical 05/31/2012 $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 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: n law requires you to follow the rules adopted by the Oregon Utility Notifi Center. Those rules are set forth in OAR 952- 001 -0010 ugh OAR 9 001 -00 Y may obtain a copy of the rules or direct questions to OUNC by calling - . 87 or 1.800.332.2 44. • Issued By. Permittee Signature: I � � 7l 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 Applicatp r I t FOR OFFICE USE ONLY R eceived D �s�" "'O Permit no.: f R, t� 1). �/ City of Tigard Date/By: J C 1 C` 2.- 13125 SW Hall Blvd., Tigard, OR 97MY 1 1 2012 Plan Review G/ � II C ' ' Phonc: 503.639.417 I Fax: 503.598.1960 Date /By: Other Permit: r r Ac1)..,,, T I G A R D Inspection Line: 503.639 CITY �(�idll Date Ready /By: Juris U See Page 2 for Internet: www.tigard C� ° ' ® ® l . ' . Notified/Method: co Supplementoi Information TYPE OF WORK PLAN REVIEW U New construction U Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Demolition ❑ Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards U I- and 2- family dwelling U Commercial /industrial U 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.: 120516 -45 Job site address: 10260 SW Greenburg Road ❑Fire Pump ❑ Installation of 75 KVA or ❑ Emergency system larger separately derived system. City / State/ZIP: Tigard, OR 97233 ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 - ", 100HP or more. ❑ occupancy Suite/bldg. /apt. no.: Suite 710 Project name: Axiom Expansion T.I. ID 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 I •• 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 $ 33.92 t U PROPERTY OWNER I U 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.) S 67.84 _ 2 Service or feeders installation, alteration, and /or relocation City /State /ZIP: 200 amps or less S 100.70 2 201 amps to 400 amps S 133.56 2 Phone: Fax: 401 amps to 600 amps $ 200.34 2 601 amps to 1000 amps S 301.04 2 Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts S 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 LI APPLICANT I U CONTACT PERSON 201 amps to 400 amps S 125.08 2 Business Name: 401 amps to 599 amps 5 168.54 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 City / State/ZIP: without service or feeder fee, 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 S 67.84 2 Business Name: CAPITOL ELECTRIC CO., INC. Reconnect only S 67.84 2 Pump or irrigation circle $ 67.84 2 Contact name: DAN WILSON 503.262.0411 DIRECT Sign or outline lighting $ 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 -9484 )t i I c��� 503- 257 -7121 Per inspection 5 66.25 - v /' �J Investigation per hour (I hr min) 5 66.25 /CCB Lie.: 48748 4 F(ectrieel -Lie: 26 -496C ISuprv. Lie.: 3132 -S Industrial plant per hour S 78.18 Suprv. Electrician signature, required /07. ° ELECTRICAL PERMIT FEES* Subtotal $ 75.00 Print Name: DARRELLMCNEEL ate: 05/09/12 Plan review (25%ofpermit fee) _ Authorized signature: State surcharge ( 12% of permit fee) $ 0 TOTAL PERMIT FEE $ 84.00 Print Name: DARRELL NEEL This permit application expires If a permit Is not obtained witht 180 days after It has been accepted as complete. • Number of inspections per permit allowed.