Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111 = COMMUNITY DEVELOPMENT Permit #: ELR2012 -00186
• 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/14/2012
T i I; A R fl g Parcel: 1S135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 200
Project: GTS Subdivision: 1991 -055 PARTITION PLAT Lot: 1
Project Description: Low voltage for TI
Contractor: TECHNOCOM INC Owner: LINCOLN CENTER LLC
7929 SW BURNS WAY SUITE F BY SHORENSTEIN PROPERTIES LLC
WILSONVILLE, OR 97070 5335 MEADOWS ROAD, SUITE 300
LAKE OSWEGO, OR 97035
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PHONE: 503 - 682 -4195 PHONE: 503 -619 -3200
FAX: 503 -682 -2781
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/14/2012 $150.00
12% State Surcharge - Electrical 08/14/2012 $18.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
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: Y Total $168.00
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 1.800.332.2344.
A Issued By: /\ % Permittee Signature: O V A? O i TL A..T
OWNER INSTALLATION ONLY v u
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 603.639.4176 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 Applica,i i`'�' = ' e FOR OFFlCr 1.51 ONL \•
City of Tigard 4; • R...i,cd
Datc/By:p f-/'-/-111._ Penni' LR A00. —oo v/,
13125 SW Hall Blvd.. Tigard, OR 97223
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Phone: 503.718,2439 Fax 503.598. 13 2 012 Plan Review Other Permit:
T t G A R.p Inspection Line: 503.639.4175 Date [f
YBY rte;
>a See Page Z for
Internet: www. Tigard- or,gov cv ; , _ .. Notified/Method: Supplemental Information
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its :.:: ,.. ....
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❑ New construction Addition/alteration /r lacement Please check all that apply (submit 2 sets of plant wfitems checked below):
❑ Demolition [] Other D Service cif. feeder 400 amps or more ❑ Building over three stories.
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m.
CATEGORY :OF :Cb1!IS'�'R11C`1'lcOIV amps ❑ Floating buildings.
. ,� � � .� exceeds `0 000 1 SO volts or
D I - and a - fermi) dwell In less to or exceeds 14,000 0 Commercial -use agricultural
Y g 1 /industrial ❑ Accessory building amps all other installations. buildings.
Multi - family El u F
Master builder Other: icm of 75 KVA or
...... 0 Erna system, larger separately derived . .::.Y•:-....: .:.. :.. ..:.........:...•. .
.. ,.0,11 �:1l :tc lY(A',E'IC) :iA aO system.
Si`I'E
,........ . .... ...,.- .,_,. . ..............._......., ., . ............. ,...; � : °< . . ,..... , ... ... Add m �o new motor load of - -
Job no.: ?4058 Job site address: 1 pZ 7 O W 6 , ' >, too "' °°° "p sti o n
0 Six or mirre residential units, D Recreatinal vehicle parks.
City/State/ZIP: , a 01 Gj I : 0Health.4re facilities. ❑ Supply voltage for more thin
�� ❑ Haffido�s locations 600 volts nominal.
Suite/bldg. /apt. n j/� 4 Project namc: 5 ' ev r i ❑ service rip feeder 600 amps or more.
Cross street/directions to job site: ":: 1::: ;i :: . :M ` E>0,S IP.M.. ;E ` c •: ..
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D'iNoa I 1 ,, I Fee I TOMI . I
New residential single- or multi family dwelling unit.
includes alttached garage.
Subdivision: Lot no.: 1 ,0 0 0 sq. ftl or less 168,54 4
Tax map/parcel no.:
Ea. add'I 500 sq. ft, or portion 33.92 1
Limited residential
75.00 2
DESGRTI'11('1N OR :WORK. (with a sq. ft )
Limited cndr
ev' y, multldamily 75,00 2
Vu > C A _ r J • 3c of feeders fostallation and/or relocation
200 amps o1 lace 100.70 2
- 0 PIROPERtrt OWNER 201 amps td 400 amps
..'IIENAIVT -. ;: :�:::; :,.. -. •,: 13156
Name: 401 amps td 600 amps 200.34 2
601 amps td 1,000 amps 301.04 2
Address: Over I,000ytnpsorvolts 552.26 2
City/State/LT; Temporal* services or feeders installation, alteration, and /or
relocation)
Phone: ( ) I Fax: ( ) • 200 amps of less 5936 1
Owner installation: This installation is being mode on property that I own which is not 201 amps td 400 amps 125.08 2
intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps tt 599 amps 168,54 2
Branch circuits- new, alteration , or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
-- f
. •::: CO 7,42 2
Business name: � D v //y) -. — 13 for *rich without
(� feeder fee firr 56.18 2
Contact name: _ j Ar branch circuit
Ea
/ ch add branch circuit 7.42 2
,
Address: ? # ! ; , /� i ♦. .
1/�1�1'i,�
.//,;, r. . 1.. /,t �/ L Mlaee.IlanPhllq (service or feeder not included) ) _
City /State/ZIP: g i_ , V ! • Q T
dwelling manufhchucd or modular 67.84 2
t L 1 G� g, sehrite and/or feeder
Phone:' 03 19 r 2 CI. ICI Fax:: ; ;4, • ; Reconnect only 67,84 2
� Pump or im�on circle 67.84 2
E -mail: . / . /! f !1 _ • ■' /_ ill I ,
.. „ ......... Si or outlb li lin
:.. Cigna) C1irtiil(4) a ilmited•etlM • .. 67.84 2
limited-energy
Business name: f O panel, alteration, or extension. Page 1 •rAG 2
I ,` Each additional inspection over allowable is any of the above
Address: q 2,q 5 11$ Lk 1 �/' . Additional inspection (1 hr min) 66,25/ hr
City/State /Z , te 01 14+ inv�ttigatiot{ (I hr min) 66,25/ hr 1
J (( industrial plant (1 hr min) 78,18/ hr
Phone: 02 ( g Z (4' 45 Fax: ( F ( 2-2721 instrrtinns � w no fee is 90.00 / hr
specifically fated (%f hr min)
CCB tc Electrical . • i --- . , rv. Lta. �! • ^ I :
:....:.:: ELEG17r1G4 . !PERI<11ET.I'e 5:.::;
.
7 Suprv. Electrician signature, required ri O , •
Plan review (25% of permit fa);
Print name: l'�Di 4 _ .. - Date: S surcharge (12% of permit fee): le I DO
N. J TOTAL PERMIT FEE: I 0 DO
y Authorized signature: This resit a
pe pplintion expires if a permit Is not obtained within 180
IPAM.LL...O days after it has been accepted as complete.
Print name. J Date: Number 01 inspcuiontalli..al par vomit,
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1: 18ulldinglPerminnELC•PermitApp.doc 07/01/10 440 46157(11%oS/C0Wa'EB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES;
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
[] Other:
:CO e • OYAIW ONLY:::
Fcc for each commercial $75.00
system
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(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Rnilrr Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscapc Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems: r
*No licenses are required. Licenses are required
for all other installations
taBuildin Portoit ELC- PemitApp.doa 07/01/10