Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
. COMMUNITY DEVELOPMENT Permit #: ELR2012 -00121
T I GA RD 13125 SW Hall Blvd.. Tigard OR 97223 503.718.2439 Date Issued: 06/12/2012
Parcel: 1 S 135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 710
Project: Axiom EPM Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Data Telecommunications
Contractor: TECHNOCOM INC Owner: LINCOLN CENTER LLC
7929 SW BURNS WAY SUITE F BY SHORENSTEIN PROPERTIES LLC
WILSONVILLE, OR 97070 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 682 -4195 PHONE: 503 - 619 -3200
FAX: 503 - 682 -2781
FEES
Description Date Amount
Specifics: , Restricted Energy Permit 06/12/2012 $75.00
12% State Surcharge - Electrical 06/12/2012 $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 OA 9 2 -001 -0 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
l
Issued By: bJt Permittee Signature: /� A !f 1 /OLL
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.
PC P o
Electrical Permit A licatio pp FOR OFFICE l �ti }: °N IA'
City of Tigard R" °i °m' re i P 1' Permit Nn �(�, 1201 , 24 d1
13125 SW Hall Blvd., Tigard, OR 97223 JUN N 0 8 2012 Datdi3v: _
( Plan Review /1 ff az1a,u O (l(J '77
Phone: • 503.718.2439 Fax: 503,598, I DMe/8v: Other Pcrmil:
T 1 C A R n inspection Line: 503.639.4175 Y OF Date Rcatfy/ay;
TIGA�D I /u d. - Sec Page 2 for
Internet; www.tigard.or.gov BU ' , , t Notificd/Mcthod: I U S/ I Supplemental Intnrmnhnn
TYPE: or WORK I
i PLAN REVIEW
❑ New construction % Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /heats chucked hetaw•):
El DCmOlitlOn ❑Other:
[(Service o feeder 400 amps or more ❑ Building over three sin?' leg
whore th4 available fault current ❑ Marinas and boatyard%
'' CATEGORY OF CONSTRUCTi'ON exceeds (0,000 amps at 150 volts or ❑ Floating buildings.
i
Ins to gr(sttnd, or exceeds 14,000 ❑ Commercial -ttse agr
❑ 1- and 2- family dwelling Commercial /industrial '❑ Accessory building r amps for lell other installations. buildings.
❑ Multi- family El Master builder .❑ Other: ❑ Fire numb. ❑ Installation of 75 KVA nr
•.:.:.'JOB SITE INFORMATION AND LOCATION OEmcrgenkysystem. largo separately tien .d system
❑ Addition f new motor load or ❑ "A ", "E ", "I.2 ", - 1.3".
Job no.: ) W 1 I J ob site aaaress; p f / . ml i , � , IF, toO or m e,,i occnpnnc.
❑Six or Am resid units. ❑ Rccrcetinnal vthitic parks
City/State/ZIP. :� I Icalth c�rc facilities. ID Supply voltage: air more than
MY volts nominal.
r r�� ❑ Har�rdo�s locations.
Suite/bldg, /apt no.: p ' oject name: ■ 341 O M 41l•l •m ❑Service n• feeder 600 amps or more.
Cross street/directions to job site: I FEE' SCHEDULE
... Dererl teen • j Qty. I pro. I Total l •
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 10on sq. R.Ior less IfiA 4
Ea. add 51)0 sq, rt. or portion 33.92 I
Tax map /parcel no.: Limited cn�'rgy, residential • . DESCRIPTION OF WORK with abdvc. • . ft.) 75.00 2
• Limited endigy. mult1- family 75 I
_ M JIG [ • L _ f residcnti$I (with above ft.)
I. 2
ii° � ' ' ' Services ot` feeders installation, alteration, and /or relocation
200 amps ot! less 100.70 2
: •- .. - 0 ?ROP RTY OWNER• . • ❑ TENANT • 201 amps td 400 amps 133.56 2
Name:
401 amps td 600 amps _ , 2(13
04 2
601 amps its. 1,000 amps 301 04 -
Address: Over 1.000 limps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
_ relocation
-
Phone: ( ) 7 Fax ( ) 2UU amps of, less 59 aft . I
Owner installation) This installation is being made on property that 1 own which is not
201 amps toi400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. 401 amps its599 amps 168.5
Branch cirbuics - new, alteration, or extension, . crltanef
Owner signature: Date: A Fee for bran i circuits w1/h
APPLICANT above set!vice Or feeder lee. j
1 �®'CO NTACi PERSON each hredch circuit 7 4L .. .r
Business name: / y M a � B. Fee e reader nr Circuits ar _LW itho
Ili i M sorvicice ni fr der l ec c, not 56.1 18
Contact name: ' I — , II branch circuit *
Each add'i liranch circuit = 7.42 2
Address: /��' T
.tl r/ �'/ /, Misrrltant Isno service or feeder not included •
•
City /S F..ach manufbctured or mo ■ h7 84 2
ffite/ZlP: ; ' ; ■ a � �
...4 L .1 A , ] / �J� r dwclfin •„ se and/or feeder
Phone: (, .4 F x:: s O O S Reconnect 1.11 67.84 2'
E 01, dr
fraY.a/ralrO Z , I / ' Pump or irritation circle 67.84 = 2
' s i gn or outline li 67.84
CO' ' OR = .
•: ' - -- Signal rirrnil(c) nr Iimitad.energy mii Business name: if d i L a �i/� , n e, 'ncl, attcraiion. or extension. 52 ER 2 t
'I/ Each additional inspecti over a'towable in any of the above
Addressi9 1 rio.' _ • ', Additional inspection (I hr min) I_ 66.25 / hr —
r 'J`lJ . /4A /► oO �� Invosta(I hr min) 111 f5.25/ hr v MI
InduStnal pin pldnl (I hr min) _ 78.18/ hr
` Fax: tI i Inepentinn% for which no fen is Ell
I `� s• .citiwlly listed (A hr min) u0 hr
M th o, f` "•rv. .: r 4 , l l ELECTRICAL. PERMIT FEES
Suprv, t lectrfcian signature, rc aired: I \ \A Cuhtntal `X
Plan review (25% of permit feel'
J D atc: C / Q 9tatc surcharge (I Z "/ of permil Iccl: A
Authorized signature: I I OI nL FERMI!' 1 1:H: _ �
This permit!appllcatlon expire%Ira permit in not obrainet IMO
I f e . days after it has been accepted as complete.
Print name: _ I A [ � /Jf. � , , Dale:' ,, � A • Number or, inepectiena allowed per permi,.
1: tBuildina \Permite1ELC- PormitApp,doc 07/01 /10 t ;1ST(l .OM/WAA
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
'RESIDEN'I'IAi;: W.O1ZK ONLY;
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COry ERC L WO1 ONLY:
Fee for each commercial $75.1.10
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Cont.tols
❑ Clock Systems
p . 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
11BuildinoPermitAstx -ro milmo.doo 07/01/10