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Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT '`1 _ g COMMUNITY DEVELOPMENT Permit #: ELR201300023 T F CARD , 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/28/2013 Parcel: 1 S135AB01003 Jurisdiction: Tigard Site address: 10300 SW GREENBURG RD 500 Project: Myatt & Bell Subdivision: METZGER, TOWN OF Lot: 9 Project Description: (1) low voltage for Voice /Data for TI Contractor: TELEDIGIT INC Owner: LINCOLN CENTER LLC PO BOX 22287 BY SHORENSTEIN PROPERTIES LLC PORTLAND, OR 97269 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: 503 - 722 -8084 PHONE: FAX: 503 - 722 -9914 FEES Description Date Amount Specifics: Restricted Energy Permit 01/28/2013 $75.00 12% State Surcharge - Electrical 01/28/2013 $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) .r • 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 • 52 101 -009 / You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. 3 .2344. • Issued By: ■4iL■ / ■. A 1.[_. / L Permittee Signature: 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. . Electrical Permit Application FOR OFFICE USE ONLY ( City of Tigard Received Date/By: t1 / (3 s-1— Permit No.: g. 1 3 - ° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review !!! III Other Permit: Win . ' Q� r U 17 Phone: 503.718.2439 Fax: 503.598.1960 Date/By: DO� TI G A R D Inspection Line: 503.639.4175 Date Ready/By: t• El See Page 2 for Internet: www.tigard - or.gov Notified/Method: �1 tt� Supplemental Information TYPE OF WORK PLAN REVIEW ❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial -use agricultural ❑ 1- and 2- family dwelling gr Commercial/industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ", 100HP or more. occupancy. Job no.: Job site address: 1 S t.,/ (.7rP�A.J ,.Lv ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State /ZIP: l � \ Q p 2 2 t' ❑ Health-care facilities. ❑ Supply voltage for more than R C..7 1 \ � ❑ Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: S© Art ) Project name: `` /A 44 S // ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi- family 75.00 2 V B ` Cej Aic91-4 residential (with above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 Name: 601 amps to 1,000 amps 301.04 2 Address: Over 1,000 amps or volts 552.26 2 City/State/ZIP: Temporary services or feeders installation, alteration, and /or h relocation Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2 each branch circuit Business name: B. Fee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit Each add'l branch circuit 7.42 2 Address: Miscellaneous (service or feeder not included) City/State/ZIP: Each manufactured or modular 67.84 2 ty dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E -mail: Signor outline lighting 67.84 2 CONTRACTOR Signal circuit(s) or limited- energy 7 ( 1 panel, alteration, or extension. I Page 2 2 Business name: I G L�� L� I I f A/ C , / Each additional inspection over allowable in any of the above Address: l- /, Z J r { C ei Cp 1 Z Additional inspection (1 hr min) 66.25/ hr City/State /ZIP: 0 e Q �a ' G �� [7 0 L / ( J S -- Investigation (I hr min) 66.25/ hr v c� [ (t Industrial plant (1 hr min) 78.18 / hr Phone: (703) 7 ZZ - a f'/ Fax: (SOS) 72,2 72,2 L/ Inspections for which no fee is 90.00/ hr / ece specifically listed (V2 hr min) CCB Lic.: ! 16 / O o y Electrical Lie.: 3 ' e- / �� Suprv. Lie.: z// CZ L £ 3 ELECTRICAL PERMIT FEES Subtotal: 7 S. °e' Suprv. Electrician signature, requi em: - z o Plan review (25% of permit fee): Print name: : I i4,1/ �1 u 1 Date: i! zd'/ i Z State surcharge (12% of permit fee): `I t GO .� / TOTAL PERMIT FEE: is 4 c Co Authorized signature: A.4 L This permit application expires if a permit is not obtained within 180 Date: Z ) days after it has been accepted as complete. Print name: Z r - -I.4,� j I V I' Z • Number of inspections allowed per permit. 1:\ Building \Permits\ELC- PermitApp.doc 07/01 /10 440 -4615T(I l /05 /COM/WEB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: _ Fee for all residential systems combined .. $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ' ❑ Garage Door Opener* El Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: , 1 COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems Data Telecommunication Installation ❑ Fire Alarm Installation El HVAC ❑ Instrumentation ❑ Intercom and Paging Systems . ❑ Landscape Irrigation Control* El Medical El Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling • ❑ \Other Total number of commercial systems: i *No licenses are required. Licenses are required for all other installations I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 Location: Record Type: Inspection Type: Comments: Inspection Date: Record ID: Result: City of Tigard 13125 SW Hal Blvd. Tigard, OR 97223 Tel: 503.718.2439 10300 SW GREENBURG RD 500, TIGARD, OR, 97223 Commercial - Electricial Limited Energy 199 Electrical final 02/25/2013 00:00 ELR2013-00023 PASS - No C of O Violation Summary: Inspector Contractor