Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 COMMUNITY DEVELOPMENT Permit #: ELR2013 -00100
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 05/06/2013
Parcel: 1 S 135AB01003
Jurisdiction: TIGARD
Site address: 10300 SW GREENBURG RD 265
Project: Reliance Standard Life Ins. Subdivision: METZGER, TOWN OF Lot: 9
Project Description: (1) low voltage for Data/Telecommunications
Contractor: CHRISTENSON ELECTRIC INC Owner: LINCOLN CENTER LLC
111 SW COLUMBIA ST, STE 480 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97201 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE 503 - 419 -3300 PHONE
FAX: 503 - 419 -3695
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/06/2013 $75 00
12% State Surcharge - Electrical 05/06/2013 $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)
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 plan's. 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
r1
bta a of the rules or direct questions to OUNC by calling 503.232 1987 or 1 800.332 2
Issued By: "JAVA/ /L1 Permittee Signature: /u 1 PUC11"' [O I`
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.
MAY -06 -2013 MON 09:19 AM CHRISTENSON ELECTRIC, INC FAX NO, 95034193695 P. 02
Electrical Permit A bleat'
FOR OFFICE USE ONLY
City of Tigard
� � Received / Sr Permit No, ell —o 3 - O0 /DD
14 25 Dina/By: —
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.7182439 Fax: 503.598 O 6 2013 Plan Review Other Permit
. 2 Date/13y:
r I G n It l7 Inspection Line: 503.639.4175 Dote Ready/By: furls: ra See Pogo 2 for
Internet: www.tigard- or.gov
CITY DpTIGARI) Notified/Method: & Supplemental Information
. = ,. E. pt NG'DNISIQN PLAN um*
1] New construction ® Addition /alteration /replacement Please check all that apply (submit 2 seta of plaits w/itcrc checked below).
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other where the available fault current ❑ Marinas and boatyards.
CATEGOR Y 017 CONSTRUCTION exceeds 10,000 am at 150 volts or ❑Floating buildings.
Tess to ground, or exceeds 14,0n0 ❑ Commercial - use agricultural
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings,
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger seperntcly derived system.
' JOB .SITE IJNFORMATION AND LOCATION - - ' ' -
- ❑ Addition of new motor loud of ❑ '•A" "E ", "I - ", "1 -3",
Job no.: 63116 Job site address: 10300 SW GREENBURG RD 1001.1P or mare. occupancy
❑ Six or more residential units. ❑ Recrennonel vehicle parks.
City /State /ZIP: TIGARD, OR 97224 ❑ licnllh•carc facilities. ❑ Supply wimp fur more than
❑ Hazardous Incutions. 600 volts nominal.
Suite/bldg. /apt- no.; 3' 1411 Project n.'tme: RELIANCE STANDARD LiFE IN ❑ Service or feeder 6(111 amps or more.
r , . - FEE'SCREDULt ,•
Cross street/directions to jo: site: fCRIS TANGEN 503 - 702 -9346 pererlption 1 Qty- 1 pre. 1 fetid 1 •
--- New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. It. or leas 168.54 J 1 4
— Ea. udd'1500 sq. R or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 2
- DESCRIPTION OF WORK' - (with above sJc . ft.) 75.00
Limited energy, multi - family 75.00 2
LOW VOLTAGE CABLING 3 FLOOR residential (wills about aq. ft.)
Renewable Energy ❑ Sec page 2
Services or feeders installation, alteration, and/or relocation
' ❑ PROPERTY OWNER - - ❑ TENANT 200 amps or less 100.70 i 2
201 amps to 400 amps 13356 2
Name: _401 amps to 600 amps 20034 2
Address: 601 amps (0 1,000 ainps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone; ( ) I Fax: ( ) 200 ;imps or lees 5936 1
Owner installation: This installation is being made on property that ) own which is not 201 ainps 10 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 599 amps 168.54 2
Owner signature: — Date: Brnnch circuits - new, alterati or extensinn,Ber panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee. 7.42
Business narne: CHRiSTENSON ELECTRIC each branch circuit
B. Foe for brunch circuits without
Contact name: service or feeder fee, first 56.18 2
branch circuit
Address: Each add'I branch circuit I 7.42 2
Miscellaneous (service or feeder not included)
City /Stain /ZIP: Each manufactured or modular
67,84 2
Phone: ( ) Fax: ( ) dwelling, service and /or feeder _
_ Reconnect only 67,04 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting - 67 84 2
Business name: CFiRIS'1'E;NSON ELECTRIC Signal circuit(s) Or limited energy
panel, alterulinrt, or extension. I Past 2 75 2
Address: 111 SW COLUMBIA, SUITE 480 Each additional inspection over allowable in any of the abov
—, Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP:97201 investigation (1 hr min) 66.25/ hr
Phone: (503) 419 -3354 Fax: (503) 419 - 3695 industrial plant (1 he min) _ 78.18/ hr
Inspections for which no fee is 00.00/ hr
CCB Lic.: 458 Electrical Lie.: 26 -34C Suprv. Lie.: 5215S - s pecifically listed min)
ELECTRICAL PERMIT FEES
Suprv, Electrician signature, rem, +: _ Subtotal: 75.00
Print name: ROBERT BRUEN 17ati: 5/6/13 Plan review (25% of permit fee):
_ State surcharge (12% of permit fee): 9.00
Authorized signature: � �` -- r TOTAL PERMIT FEE: 84.00
- This permit appllcittino expires It a permit is not obtained within 180
Print name: Date: days offer It has been accepted as complete.
' Number of inspection :. allowed per permit.
1 \6ndding \ I'crmitu \ELC, Pa mi'App_040913.doa 440- 41,131(1I /O5 /COM /WLn
MAY - 06 -2013 MON 09:19 AM CHRISTENSON ELECTRIC,INC FAX NO. 95034193695 P. 03
for all other installations
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*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
® Data Telecommunication Installation
[] Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ 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
imuild Ind crnlliMLC_PrnnllApp_MO9
AUTOMATIC COVER SHEET
DATE MAY 06 -2013 MON 09:19 AM
TO:
FAX #: 95035981960
FROM CHRISTENSON ELECTRIC,INC
FAX #: 95034193695
04 PAGES WERE SENT
(INCLUDING THIS COVER PAGE)