Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELR2012- 00139
T [ G A R J) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/10/2012
Parcel: 1 S135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 300
Project: Jason & Leiberan Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) Data & Telecommunications for TI
Contractor: ANDERCOM Owner: LINCOLN CENTER LLC
8560 SW 151ST PL BY SHORENSTEIN PROPERTIES LLC
BEAVERTON, OR 97005 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 886 -9045 PHONE:
FAX: 503 - 766 -6508
FEES
Description Date Amount
Specifics: Restricted Energy Permit 07/10/2012 $75.00
12% State Surcharge - Electrical 07/10/2012 $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 J/ , O f AR 952-001-0090.
J 01 00090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1. e f 1 r0/4 8 �) J
Issued By: )��{'lJI{J of Permittee Signature: D/� tA Pr 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.
07/10/2012 02:10 p TO:+1 (503) 5981960 FROM:5037666508 Page: 1
.VEI Reced Permit
Electrical Permit ApplicatioRE CE FOR OFFICE 1.1 .- ::: ONLY •
- City of Tigard
1312'5 SW Hall Blvd.. Tigard. OR 97223
711
Phone: 5018
3.7. Fax: 503.598.1%4UL 1 0 2012
• , ive
l)rariliv-
Plail Review
Dateliis
lIl . t...-- ,.4...R .. act 3... ... 0 0 3 •
Other --7
Perigaindia. - 00( a
Inspection Line: 503.639.4175 Dai• Readylliy: 1 lati,, co, 1 RI See Pa 2 for
I I C. A R D
Internet: www.ligard-or CllY OF TIGARD
.eov Nollfied:Method I 1 t• Supplemental Inforrnation
" ' ............ .. _... .... .
]:•••.•'''i.'.::: ----- ''''':::',. •,-'''-',..- ........ '''' - - - tVit: i • i tN I ' P ' NG DI visiOv.. ' • : - . ..
..PLAN" gE.Y10*:.„ ... ...-.• ,.:
Please check all that apply Istibmit 1 sets of plans whrerns checked below
0 New construction 14 Addition/alteration/replacement
I 0 Service ot feeder 400 amps or more 0 Building ever three stones.
I 0 Demolition 0 Other: 1 where the available fault ClIrrelli 0 Marinas and boatyards.
..7 :S:: : f:.:... " . P. 7...- .....;.: : ': .r . . .... - . - .... . .
le5 in ground,
121 I- and 2-family dwelling F:LCommerciallincluNtrial 0 Accessory building exceeds ino0u amps al I :iii soils or 0 Floating buildings
i: or exceed s 1 4.000 0 Commercial-use agieultural
amps for all other installations. buildings.
l
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 7 5 KVA or
0 limeigency sysieni later separately detived sysiein.
: sitit. , :' , 811 1 EINtOkietkelQ,N - AlS.1). '14*.ATION. 0 Addinon of new motor load ill 0 - A", - 17. - 1-2 - ,
Joh no.: Job site address:
1001.11' or more occupancy.
fin a C)
0 Recreational vehicle parks
5 IA) 6,26.16.4i, 0 Six or more residennal flints
r (DK:aim-care tbesinics 0 Suppl oltag lit y ve mor than
e
i City/State/ZIP: 774 t ( 01 / 'I 7 17-3
F ___ ____ 0 I hizardous locations. 600 soils nominal.
' Stlile.ibldg./apt. no .4r300 1 Project name: jeA el L,,, . 0 Serylce•oi l'eeder WI a!
,, • -
ross strectidireetions to joh site: I Li n c . 0 ‘ 411 c e A yr Description O
( IIIUf O.
..•
l 9w. 1 Fee. 1 Tow 1 2
F" New residential single or multi dwelling unit.
includes attached garage.
Subdivision:
1,400 sq. 11 or less I 168.54
i Lot no: . FL i
Fa. addl 501) sii, 11. or portion I 33.02
Tax map/parcel no.: limited energy, residential
7500
... .... . . ...' i.:DtSg-Rit.r.r. 0 WORK. . (with above sq. ii.1
Limited encrQy. multi-faini I
[ N CitA-4-0■_ residential (with above !at It 1
Servi and/or ces or feeders installation, alteration. and/o relocation 2
I 21)0 amps or less
_— I (10.70 '
-
. .. .. ... ...
. '
[.. :::.. .....Qi' PROOWY Lamps ..OWNTR. : 0: TENANT 20mps to 400 amps 133 56
-
Name:
401 amps to 600 amps I 200.34 2
I _
i_. 601 amps lo I ,000 arnps 30I .f 2
Address: 1 Over I POO amps or volts L 552.26 s
_._' 1
r Temporar vertices or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: Fax: )
2(111 amps or Icss 1 I 59.3O I
( 1 7 (
201 amps to 400 amps 125.08 2
Owner installation: - I - his installation is being made on property that 1 own which is not •
1
intended for sale, lease, rent, or exchange. according to ORS 447. 449. 670 401 amps to 599 amps 68.54
, and 701. .
Branch circuits - new. alteration, or extension, per panel
Own __ _
Owner signature:_ ...... Date: A Per for branch circuita with
________ "' i
1:.:;. ...:6.::: J0 1;.:SOkfc:;8.r.s't :1 . 0 .:(:roNT4er::.mitsoN atiove service or feeder l'es4,
each hrtnch circuit .._ 7 42
i -
I Business name: Aiajligrdzi.. 13 Fee for branch circuits wit/tour
' service or feeder fee, first
56 13 2
Contact name: 1 — branch circuit
1.'-aell adifl branch z
circuit 1 7.42 ..,
Address: Miscellaneous (service or feeder no included)
City/Statel/ I l': Each manufactured or modular 1
dwelling, service and!or feeder 67 84 21
Phone: t 1 I Fax:' : ( ) Reco only 0.84 r _ 1
Pump or irrigation circle. 67.84 2
- .1
E-mail:
sign or outline lighting 6
. 7.84 I 2
- •• •
C.0.19AACTOR .' Signal circuitts) or limited-energy -
_panel. alteration, or extension. Pam. 2 75 1 r
.
Business name: p rld ercovv% ._ i Each additional inspection over allowable in any of the above
Address: 1/5 CO 5 1 5 I s r p L c _ Additional inspection (I hr min) 66 251 hr
Investigation (I hr mint 66.25! hr
City/State/Z1P: - 00" 1 Cr a.-- c i 7 00 7 _ _
Indus plant (I hr mini 78.18! hr
Phone: t 503) - 1 ( )Li ,...,-- I Fax: ( 563 ) 76g. --‘s- Inspections for which no fee is
90.00/ hr
- spa:die listed (V: lir min)
CCB 1 i E lectrical Lie.: Suprv. Lie,: i , - lie.: 7 Et ECTAICAkPERIvirTi.F0 -
E.. -
t eLegi 3 13 al, -
Sunni, Electrician signature, required: --"Z________. _____ Subtotal: 75-
Plan review (25% of permit feel:
__.
Print t
rint name: A) 1 c ii_ A...4 ri.") I Date: 71 1 b 11 - State surcharge (12'lli of permit fee):
-. . ......._____ _, _____ ..2t
TOTAL PERMIT FEE: lq
Authorized signature:
1 rhis permit application expires if a permit is not obtained within ISO
days atter it hns been accepted is complete.
Print name: L ml C e/LA4,4 1 1)ate: 7 I go IL i . Number of inspecrinni; allowed tie! permit
I , 11,:ti,3,,s4 , pc, nitti r-PermitApp doo n7411 du 4.411 1 Oil 110 !i4.1)NtrWEil
07/10/2012 02:10 p T0: +1 (503) 5981960 FROM:5037666508 Page: 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
_It gl)EIriVAL..WORK;QNIsY :
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar4Alarm
❑ Garage Door Opener*
❑ 1-leating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERI;CL L WORK:4Ntx:,-
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 00U0)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems .
la
Data Telecommunication Installation
Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
Ell Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: _
*No licenses are required. Licenses are required
for all other installations
I Uluddm IApp duff 07RI11I(I