Permit •
CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELR2012 -00111
T j G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/06/2012
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 110
Project: Terra Staffing Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Data telecommunications
Contractor: CAPITOL DATA & COMMUNICATIONS Owner: LINCOLN CENTER LLC
11401 NE MARX ST 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 06/06/2012 $75.00
12% State Surcharge - Electrical 06/06/2012 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems:
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 2- 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: Permittee Signature: t t . J, 4 ! /J6T1 /�
O" "
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.
06/04/2012 15:27 5032551966 RC 11 ' 1 APITOL ELECTRIC PGE 02 is-, . _. ( (J' L,�s
VOR OFi'i(:F: IISE ONLY
Electrical Permit Application JUN 0 4 2012 Received T , 1,�,�j4a. oo (I I I e
City of Tigard lat n Review Femtit r
�' � TY OF TIGAc�C7' Plan
. ..- " 13125 SW Hall Blvd., Tigard, OR 9 onte/By: Other Permit;
Phone: 503.639.417t Fax: 503.5•:' DIVISION • t
T I �� R i? Inspection Line: 503.639,4175 Date RcadyBy: Jon a pep i n,
Internet: www.tigard- or.gov
• Notified/Method; Supplemeolnl Information
TYPE OF WORK . . .. P.t pxREV1EW
L] New construction V Addition /alteration/replacement Please Check all that apply;
—
❑ Demolition y Other: Cl Service over 225 amps, comml ❑ Hazardous location
_CATEGORY OP CONSTRUCTION•. '. . • . .. . • Cl Service over 320 amps - rating ❑ Building over 10.000 sq.ft.
LJ 1- and 2 family dwelling L] Commercial /industrial LJ Accessory building of 1 and 2 - family dwellings 4 or more new residential
D Multi - family ❑ Master Builder ❑ Other ❑ System over 800 volts nominal units in one structure
' JOB SITE 1NPORMATION'AND•LOCATJON . . • . ❑ Building over three stories ❑ Feeders, 400 amps or more
Job no.: C12234 I Job aitc address: 10300 SW Greenberg Rd ❑ Occupant load over 99 persons El Manufactured structures or
111 ❑ Egress /lighting plan RV park
City /St:rtc/LIP; Portland, Or. 97225 ❑Health -care facility 0 Other
Submit 2 sets of plans with any of the above.
Suite/bldg./apt. no.: 110 PM,jcct name: Terra Staffing Th above are not applicable to temporary construction service. —
'' FSL'SO1EDUtt • • • . • .
Cross Street/Directions tnjnh site: Description I pty. j von. I Total 1
New residential - single or multi - family dwelling milt
Subdivision: Lot n0,; InNodes attached garapa
I (tan sq, tl, or less S 108.64 4
Tux map/parcel no.: Ea. Addi 500 sq, ft Or portion S 33.92 I
—
DESCRIPTION. OF WORK ' .• - Limited cncrB'residential 5 75.00 2
�,9— #- TEe- EC o"i"r CLA// P.4 i7014S — Limited energy, non- residential . 5 75.00 2
Each manufactured home or modular
U • PROPERTYOWNBR '1 • Li TENANT • . . • . dwelling, Service and/or feeder $ 67.84 , 2
Name: Service or feeders installation, alteration, and /or relocation
200 amps or less 5 l On.7n 2
Address: 201 amps to 400 amps s 133.56 2
401 amps to 600 amps 5 200.34 2
City/State/ZIP; 601 amps to 1000 amps $ 301.04 2
Over 1000 amps or volts s 552,26 2
Phone: Fax: Reconnect only 5 67,84 2
503.295.5555 Temporary services or feeders installation, alteration, and/or
Owner installation: This installation is heing made on property that I own which is not relocation
intended for suit, Icasc, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less I I S 59,36 I I I
Owner signature: Date: 201 amps to 400 amps $ 125.08 2
401 amps to 599 amps $ I6A.54 2
JJ APPLICANT I U CONTACT PERSON Branch eireuits • new, alteration, or extension. r 2nel
Business Name! A. Fee for branch circuits with
service or feeder fee, each
Contact name: branch circuit 5 7,42 2
B. Fee for branch circuits
Address: without service nr feeder fee,
each branch circuit S 56.18 2
City/State/ZIP: Each additional branch circuit: S ?,42
Miscellaneoris (service or feeder not included
Pump or it i 2
tion circle I S 67.84 1
Phone; Fur:
Sign or outline lighting $ 67,84 2
E -mail; Signal circuits(s) Or limited-
CONTRACTOR energy panel, alteration, or
Business Name: Capitol Data & Communications, Inc, extension. Describe: Tele/Dean 1 75 75.00 2
Page 2
Contact name: Mitch Knobbs Ench additional Inspection over allowable in any of the above
Per inspection 5 5625
Address: 11401 NE Marx Street Investigation per hour (1 hr min) S 66
industrial plant per hour S 75.10
City /State/ZIP: Portland, Oregon 97220 • ' '' ELECTRtCAt PERMITT FEES' '. . .
( Subtotal 75.00
Phone: 503 �11V Fax 0 57-7121 % \l`S . \ Plan rcvicw (25% of permit fee)
State surcharge ( 12% of permit fcc) 9.00 /
CCB Lic.: 142457 Electrical LI • Sttprv. Lie,; 2 S7LEA TOTAL PERMIT FEE 84.00 /
Suprv, Electrician signature, required: Thh paotk applleodno wire' Ira perms In ant natnloed +lthla Ito
• drys otter It boa beta aeerrund wr eamMae
Print Name: Terry Bras Date: 06/04/12 • Foe methedningy act by IA- CounVVV Building Industry Service Beard
Authorized signature: J l �� � "Number of inspections per permit allowed.
Print Name: Terry rasch
503 -718 -2439
06/04/2012 15:27 5032551966 CAPITOL ELECTRIC PAGE 03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
:IMMO r ,T I '1 °!" "'C: ~31i1i^ n! ;p o 1111 n o;l �! I , ii
i ; f Ijl ; J Jr 16. ^ I! I I,.I. �. L. q r.•r-:,. rlla I, "�
I .. �6 „i. �, f � �r i !:!fil L; .. J,I .l . I I
Fee for all residential systesm combined $ 75.00
Check Type of work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
El Other;
ISY ;VIYi1111.CR1i�K611'K�F�I! .:Yid`- mp!,cl .• , n ::— ._- ''...... ...... ......�...
i : L• "' „ ; ,: ,•.:11l.iL ilklana �� .. � � ' "I
Fee for each commercial sytem $ 75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
Cl Boiler Controls
El Clock Systems
El Data Telecommunication installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ , Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Cl Other
Total number of commercial systems:
No licenses are required. Licenses are required
for all other installations
06/04/2012 15 :27 5032551966 CAPITOL ELECTRIC PAGE 01
FAX COVER SHEET
•
Capitol
Data & Communications, Inc. Date: 6/4/2012
11401 NE Marx St.
Portland, Oregon 97220 -1041 Time: 1 :00 PM
(503) 255 -9488 FAX 503 -255 -1966
www.capitoleiecrricco corn
Please deliver the following pages to:
Name: City of Tigard
Firm:
From: Terry Brasch
Comments:
Electrical Permit Application 10300 SW Greenburg Road Suite 110. Terra Staffing.
TOTAL NUMBER OF PAGES, INCLUDING COVER SHEET 4
IF YOU DO NOT RECEIVE ALL PAGES, PLEASE CALL (503) 255 -9488