Permit v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2012 -00162
T t G.A.At 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/31/2012
Parcel: 1 S135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 210
Project: Advanced Wealth Management Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) Signal circuit or limited energy panel for fire alarm
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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 07/31/2012 $75.00
12% State Surcharge - Electrical 07/31/2012 $9.00
Type of Use:
Class of Work:
Total Number of Systems:
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Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N 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 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.8000 -- `,
Issued By: Permittee Signature: t APR t <�`t f �DN.
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 603.639.4175 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.
07/27/2012 09:35 5032551966 CAPITOL ELECTRIC PAGE 01
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E1ectricsd Permit Application t� Received FOR OFFICE USf.OJN1.Y
RE i s ' , T Permit n a
City of Tigard Date/By. 1 3 1 (l/ 1 - --� . ���G
III "I 13125 SW Hail Blvd.. Tigard, OR 97223 JUL , 7 2012 Plan Review
Other Pc D .�,r,
11' Phone: 503.69.417 l Fox: 503.598.1960 342 . Date/liy: r' ,1� �f/ a 081 ' `'
Inspection Line: 503.639.4175 y ��i to �� r DatcRcad /B lords: acorn e'tbr
TIC,Ar:t? P CITY ! li e y y �i LI A -
Cntcrnet: tirww.tigard•t)r.�tw No tif ied /Method: I7 `tn prtrn rcntalInfomulion
- .. .. .... . . BUILDING DIVISION •
TYPE OF WORK PLAN RCVTEW
I .I New construction I' I Addition /alteration /replacement Ploaao chock all that apply (submit 2 sets Or plans w /Items chocked below):
_ Demolition n Other: n Service or feeder 400 amps or more ❑ Building over three stories
CATEGORY OF CONSTRUCTION where the available fault current ❑ Marinas and boatyards
. L I- and 2- family dwelling LI Commen:iallindustrial LjAccessor building exceeds 10,000 amps at 150 volts or Floating buildings
L] Muhi•lhml ly LJ Master Builder L Other leas to ground. or exceeds 14.000 Commercial -use apriwlluml
JOB SITE INFORMATION AND LOCATION amps for all other Installations. ❑ buildings
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.kph no.: 120889-45 Job situ address: 10220 SW Greenburg Road Piro Pump ❑ Installation of 75 KVA or
0 Emergency system larger separately derived system.
City/Suite/ZIP: Tigard, OR 97223 ❑ Additon of new motor load of 11"A", "E ", "1.2 ", "1.3 ",
100HP or more. Li occupancy
Suite/bldg. /apt. no.: Snits 210 Plrject name: Advanced Wealth T.I.
L.: Six or mom re•.sidenual units [Ti Recreational vehicle parka.
❑ I Icrlth -care facilities [Ti Supply voltage tar more Ihnn
Cross Street /Directions to job site: ❑ Hazardous locations L 600 volts nominal,
❑ Service or feeder 000 amps or more
Su E SCHEDULE
Subdivision; Lot n0 Ducriprloo I Qty, 1 pee, I Total � -
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Tax map /parcel no.: New residential - single or multifamily dwelling unit.
DESCRIPTION OF WORK lnelddcs attached garage.
INSTALL FIRE ALARM C:IRCUTf 1000 sq. t, or lass 3 168.54 4
En. Add9 500 so, ft or portion S ]3.92 _ I
[LI PROPERTY OWNER 1 L TENANT Limited energy tcsidential
Name: (with above sq, ft.) , 5 67.34 2
SHORENSTEIN REALTY SERVICES Limited energy, multi- family
Address; residential (with above sq. ft.) $ 67.84 2
Service or feeders tnstnllatlon, atteration, and /or relocation
f_.ily /Slatc/7.IP: 200 amps or less 8 100.70 2
201 amps to 400 amps - S 133,56 2
Phone: Fax; 401 amps to 600 amps 8 200,34 2
601 amps to 1000 amps $ 301.04 2
Owner installntinn: This installation is being made On property that I own which is not Over 1000 amps or volts S 552.26 2
intended for wile, lease, rent or exchange, according to ORS 447, 449, 670, and 701 Temporary services or feeders installation, Alteration, and/or
Owner signature; _ Datc: relocation
200 amps nr less 5 59.36 I
U APPLICANT j L CONTACT PERSON 201 amps to 400 amps S 125.08 2
ttusineas Name: 401 amps to 599 amps S 168.54 2
Branch circuits - new. alteration, or extension, per panel
A. Fcc for branch circuits with
Contact name:
service or feeder few:, each
branch circuit 5 7,42 2
Address:
B. Foe for branch circuits
without service or feeder fee.
City /aratrl /.1P: first branch circuit $ 56.18 , 2
Phone: Fax: Each additional branch circuit: S 7.42 2
Miscellaneous (service or fender not included)
E -mail: Each manufactured or modular
CONTRACTOR dwelling, service and or feeder $ 67,84 2
I.ausirlas4 Name: CAPITOL ELECTRIC CO., INC. Reconnect only S 67,54_ 2
Pump or irrigation circle $ 67.84 2
Contact name: DAN WILSON 503.262.0411 DIRECT Sign or outline lighting $ 57.54 2
Signal circuit(s) or limited -
Addrese: 11401 NE MARX ST. energy panel, alterations, or
extension. Describe: Fire Alarm I PnBc 2 5 75.00 2
City /State/ZIP; PORTLAND, OR 97220 -1041 . - -
Each addldonal Inspection over allowable in nny of the above
Phone: 503 - 255.9488 Fax: 503- 257 -7121 Per inspection S 66.25
Investigation per hour (1 hr min) S 66.25
CCB Lic,: 48748 jElcctrical ' • 26 -496C ISuprv, Lie,: 3132 -S Industrial plantper hour S 78.16 _ _
Suprv. Electrician signature, required: • ELECTRICAL PERMIT PEPS' _
A. / �: , , LAINL..1 I Subtotal $ 75.00
Print Name: DARRELL M EL Date; 07127/12 / Plan review (25 %ofpermit foe)
Authorized signature: 1A / /� TOTAL surcharge ( 12% ofpermit Fcc) $ 9.00
b q '�`S(,(/( TOTAL PERMIT FELL $ 84.00
Print Name: DARRELL MCNE.EL Thin permit apylleetlnn replw1 Ifa prrmlt Is net nhtalned within ntn
day.[ after It ho_s been ncoepted as cnmplcle.
• Number of inspection!, per etemtlt nllnwed.
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