Permit v CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s COMMUNITY DEVELOPMENT Permit #: ELR2012 -00205
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 1 S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 201
Project: Radiant Senior Living Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) low voltage for burglar alarm
Contractor: ADT LLC Owner: LINCOLN CENTER LLC
2815 SW 153RD DR BY SHORENSTEIN PROPERTIES LLC
BEAVERTON, OR 97006 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 -469 -7219 PHONE:
FAX: 503 -469 -7128
FEES
Description Date Amount
Specifics: 12% State Surcharge - Electrical 09/04/2012 $9.00
Type of Use: COM Restricted Energy Permit 09/04/2012 $75.00
Class of Work: ALT
Total Number of Systems: 1
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: Y
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 A may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4! Permittee Signature: Dill 4POLleig 10k1.
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.
09/04/2012 09:56 FAX 5034697110 SECURITY VI001
Electrical Permit Applieati0, Ec FOR OFFICL USE ONLY
014 • City o BIvd OR 97223SE O 4 2012 ReceiB ved
9 / Permit No.�l e ( 2. 0 ,,,,.... t'
Plan Review Other Permit:
Phone: 503.718.2439 Fax: 503.598.1960 0 DataB :
Ti G:\ I: D Inspection Llnc; 503.639.4175 CITY i �® Date Ready/By See Page 2 for
Internet: www.tigard it ► 1 VISION Notified/Method: ISM Supplemental Information
. 0 J? 4 , L•::/k,4.11.i ♦��. . "1,' _f zu� R1 . 9.fr • - .31,
❑ New construction ® Addition/alteration/replacement Please cheek all that apply (submit E sets of plans whims checked below),
❑ Service or feeder 400 amps or more O Building over three stones.
❑ Demolition ❑ } Other: where the available fault current ❑ Marinas and boatyards.
fi_" ureic I -. .-. '' i5� `c`f v"',.w'e ry- e.,,wog ral exceeds 10.000 amps at 150 voles or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
❑ 1 - and 2- family dwelling CI Commercial /industrial ❑ Accessory building amps for all other installations. buildings,
❑ Multi family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Installation of 75 KVA or
. ,a r. Jr , , ❑Fmcrgency system. 4vger separately derived system
i `'li ... p i a f . I i,. e �'r ` e %Y.`�:tcr , cr`e .D t• .,,,..1:: �+�� ,.yl.:.,�A C'.ol>�i�tS�: :�._ •�1 �'- '•���� -c��.r ��= �- ,>.�'; ❑ Addition of new motor load of ❑-A', ,. u X
Job no.: 083 -26742 Job site address: 10220 SW Greenburg Rd 1 00ttP or more. may.
❑ Six or more residential units. 0 ReereAlon:d vehicle parks
City/Statc/Z1P: Portland, OR 97223 ❑ Health-care facilities, ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt no.: a.0 1 I Project name: Radiant Senior Living ❑ service or „l &ech .600 amps or more.
.:` 5 L• .. .... i ..',- . :feel 1311 r. J',:.''',"'s. .." Sr ,�r iYi: -t .�t M
' .
Cross street/dtirections to job site: Dmertpdoa Qtr. Fee. Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. f!. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
.4i } +0/r :a�t?emifi !Eego acSQ Ito a 4 5 , f' :0/9' m (witb above Sti. 11) 75.00 2
Limited energy, multi- family 75.00 2
Low voltage burg alarm residential (with above sq. It.) ,
Services or feeders installation, alteration, and/or relocation
200 amps or less • 100.70 2
>r:, a w'k' •N c `'°ai` ? v • =1, r;: rz a"' 400 amps � t�r�^;1� , • t :. ' �: I,,.,.�t�t'" . `�1 201 amps PS 133.56 2
Name: Radiant Senior Living 401 amps to 600 arms 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 10220 SW Greenburg Rd Over 1,000 amps or volts 552.26 2
City/State/ZIP: Portland, OR 97223
Temporary mp
relocation
services or feeders Installation, alteration, and/or
Phone: (503)595 -2810 I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps ro 400 a taps 125,08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 nrt>ps to 599 amps 16854 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuim with
°:3tiio-8 hJ t qt Y ti�,a : .,..- r!'. ® , L ys +' "t'Afi!4t'!!f'3`fi, , ` above service or feeder fee. 7.42 2
3tii V +``�'Af!4+c'"73L' each branch circuit
Business name: B. Fee for branch circuits rvithonr
service or feeder fee. first 56.18 2
Contact name: _ branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling. service and/or feeder
Phone: ( ) I Fax: : ( ) — Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
s ign or outline lighting 67.84 2
.,,.? ::•. .•... a :'. ��Y0.'d . ',. ' '?` •: `IL ?_ I; i.,bb, . 1, .,' IA Signal circuit(s) of limited - energy
Business astute: ADT LLC panel. attc ation, or extension. 1 Page 2 75,00 2
Each additional inspection over allowable in any of the above
Address: 2815 SW 153 DR Additional inspection (I hr min) 6625/ hr
City/Stine/ZIP: Beaverton, OR 97006
Investigation dutiplant (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78,18 / hr
Phone: (503) 469 -7241 I Fax: (503) 469 -7128 Inspections for which no fee is 90,00/ hr
specifically listed (ii hr min) � ,er � ,c
CCB Lic.: 1 %560 I Electrical Lic.: CLE317 I Su Lie 4252LEA ,,A %, ;'; c1 �Yaila 4
Suprv. Electrician signature, required :� $ubtohil: 7500
Pla review (254/0 of permit fee):
Print name: Eric Willard Date: 09/04/12 State surcharge 02"% of permit fee), 9.00
TOTAL PERMIT FEE; 84.00
Authorized signature: This permit application expires Ku permit is not obtained within I80
Print name: Date: days after it but been accepted as complete.
i • N um b er of inspections allowed per permit
t 1BUhaingWermiru\ELC•PermicApp.doc 07/01/10 440 - 4615T(1 1/OS/COM/WEB
09/04/2012 09:56 FAX 5034697110 ADT SECURITY 1 002
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMTT FEES:
Fee for all resi 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.
r 11.1 j,�r11Lt'i \��'� _' $70 _ .�:,•`,'�''�
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
❑ Audio and Sterco Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
Q Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ 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
1:18audins\PmmitiNELC -Pe niiAmdnc 07/01/10