Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
•
! COMMUNITY DEVELOPMENT Permit #: ELR2013 -00123
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/05/2013
T I C� A R D 9 Parcel: 1S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 135
Project: AmCheck Subdivision: METZGER, TOWN OF Lot: 9
Project Description: Data telecommunications system.
Contractor: AMERICA'S PHONE GUYS Owner: LINCOLN CENTER LLC
PO BOX 873279 BY SHORENSTEIN PROPERTIES LLC
VANCOUVER, WA 98687 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 360 - 904 -6782 PHONE:
FAX: 360 - 254 -1967
FEES
Description Date Amount
Specifics:, Restricted Energy Permit 06 /05/2013 $75.00
Type of Use: COM 12% State Surcharge - Electrical 06 /05/2013 $9.00
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 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 e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B = �:
yam— _ _ 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.
06/04/2013 11:52 3602541967 PHONE GUYS LLC PAGE 01/02
Electrical Permit ApplicatiolilRECE D F(FR (1I It h 1 fit. ( )Nil
14 City of Tigard 1 \LJ�iLI '-' R "md Pam" No.: .
13125 SW Hall Blvd., Tigard OR 97223 I ' N.I ^ n 313 Plan Review Date. y: 0L/ ` 3 ' j 4 /t 966-0o/2.3
3 Phone: 503.718.2439 Fax: 503.598.1960 a U 4 Date/3y Other Permit:
' T I C • \ r D Inspection n 303.639.4173 r g.f�! �D ln tfN/ Dare Rcady/By: lisi H Scc rage 1 for
4173 11U
Internet www ngard -or gov CITY O Nontled/Methtfd: -1-- / Supplemental information
Nil Ili ` 0 N
, � . ,. .. _ �')(!�",. �7 I .. aDIVISION
o ,:n .a .:.,� a: nap.. �..:,�W ::.:.:r• , 114zw se ts of plans wit , � ,
❑ New construction Addition /alterati lacement Please check all that apply (submit 2 cros checked below):
❑ Scrviee or feeder 400 amps car more ❑ Building over three stories.
12 Demolition ❑Other.
where the available fault current ❑ Marinas and boatyards.
r'
Q 1- a nd 2 -f y g R C'1'IOTI t ' I I exceeds 10,000 amps at 150 volts or ❑ gs
Floating buildin.
r omit dwellin }.Commercial / industria` � 14` :i•,.,.,•.,•• less to ground. or exceeds 14,000 ['Commercial-use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multlfemll 1x117 ❑ Fire pump. 01net+IL„MonoFISO
y ❑ as ❑ Other:
,10$ 5 1[ 71 CI I mergency "'"1". larger separately derived system
Master udder
C ['Addition of new motor load of ❑ "A ", "E "1 - 2" "1
Job no, A n e* I Job site address: �e'N 100HP or more. occupancy.
'�'`� `"' ❑ $;x or more residential writs. L.) Recreational vehicle parks.
City/State/ZIP 1 4414 1 1 og ��,PCT Su-4 +,- (3S ❑ Health-care facilitiex, ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: i Project name: a4 k_ CI Service or ruder 000 amps or more.
'� _ FEE 5e Pu!-E_
'
Cross street/directions to job site: 9 Vac.. f G -Ol L(,,, . ndrr;m;,n 1 o'r. I Fee. I TOW I
J
\ New reyidentinl angle or multi- family dwelling snit.
In attached garage
Subdivision: I Lot no.: 1.000 sq, ft, or less 168.54 I 4
Tax map /parcel no -:
Ca. add'I 500 sq. ft. or portion 33.92 I
r,::::,,''';;"-.,:''':; t , ", ' C.Rfl'noT O WORK , , . . I Limited (w abo v ft) hat 75.00
rh .. (with 2 .
0 I 1 ' ' ` A.
.i e s i nn ial (with multi-family . 75.00 2
� i i i f ,_ , / ` residential (.with above a l,_n,) _
Renewable Energy Ei See Page 2
Services or feeders installation. alteration, and/or relocation
, lay PR'OPtprrtt Owl IC • 1 ,
1 kits 1 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 ! 2
CIIV /Slfl1e /71P: Temporary services or feeders Installation, alteration, and/or
Phone: ( ) I Fax: ( ) , relocation
200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 omp: to ioo ampe 126.08 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: Branch circuits- new, alteration, or extension, ,er panel
!r14 7 LJ 9T, i p r A. rco for re circwta +r ?
.... .......:� 0 .. ,. �,; - Cr� , �, �, �,.,�� i.,�i:. lboveservice 0rfeederfec
Business name: OW [ 1 del_ S h o ru S each branch circuit 7.42 2
�_ B. Fcc for branch circuits without'
Contact name: L s WQ service or feeder fee, first 56.18 2
branch circuit
Address: ' S77.. (3) s Each add'' branch circuit l 7.42 2
City /State /ZIP: , f a U e (A) A ' S r , Each man f ufa ctu (service ured or mod u or
feeder not included;
V-µ + - (Nog) Each manct
X10) °)n L1 11 g 7 (3I 7) 7_4 i 9 / 7 dwelling. service and /or feeder 67.84 2
Phone: Fa x: : ( dwlli
O f -
Reconnect only 67.84 _ 2
E -mail: Pump or irrigation circle 67.84 ' 2
LL 'tOSrrRk 'ltrilf , , Sign or outline lighting 67.84 ' 2
t ,,
Business name: r r l ei 1 a �1� C.2 r signal clrculr(s) or tmlrea- energy See
r v, 7 panel, alteration, or extension. Page 2 1, 2
Address: PO box 1 3 2.19 Each additional inspection over a ■ io au of the above
ty u vc ottge �', • rj Tnv e s ionof in :p on (1 hr m in) 66 251 hr
Ci /State /yIP: V r t K �++( l
r Investigat (1 h r min) 66 ,25/ hr ,
Phone: (3 ) (�(,r Col g2.- � L Fax: `1 )Z5.1 1196 7 Industrial plant (1 hr min) 7R. I S/ hr '
lnspecuorr for Much no fcc Is 90.00 / hr I
CCB Lic.17 O Electrical Lic.CLE ?I. .Su Lic 07 L - specifically listed ('/ hr min) _ 1
,, , - �___...--- i/ ,.:: )QERMI'1 IT,•._.
Sur", Electricianl // gnahrr required; 10 il --.
Print name, 5 A e Date: to / y 1 zp � 3 Plan review (25% of permit fee): -f -
/// F State s urchar g e I S of permit fee): ,
Authorized Signature: t TOTAL PERMIT FEE: tl
/ � �1 f,, / / 3 This permit application expires if a permit is not obtained within ISO
Print name: to 15 Ad t Date 1L/ 1 `7 /� f ✓ days after it has been accepted as complete.
- Number of inspections allowed per peon
T.1Aullding\Pennin1E•LC rertnitApp_F.LR_17t2 Rev 05/21/2013 440.46I5T(II /05/COM/WEB
06/04/2013 11:52 3602541967 PHONE GUYS LLC PAGE 02/02
Electrical Permit Application — City of Tigard
Page 2 — Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
ll katl lr a� • '
Fee for all residential systems combined $75.00 em,:p io. ` 1 Qtr• i F. I Taal I •
Renewable electrical energy systems:
Check Typc of Work Involved: 5 Icva or less 100.70 2
5.01 to 15 kva 133.56 2
LI Audio and Stereo Systems*
15.01 to 25 kva 200.34 2
❑ Burglar Alarm Wind generation systems in excess of 25 kva:
25.01 to 50 kva 301 04 2
❑ Garage Door Opener* 50.01 to 100 kva 552.26 2
>100 Icva (fee in accordance with 552.26 2
❑ Heating, Ventilation and Air Conditioning OAR 918-309-0040)
System* Solar generation systems In excess of 25 kva:
Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva - no additional c 0.0 3
❑ Each additional inspection over allowable in any of the above:
Other: Each additional inspection Is
66,23/ In 1
charged at an hourly (1 hr min)
y fit, Inspections for which no fee is 90.00 / hr
specifically listed 04 hr min) -
.. "'. " ..,,...'•5::. ' F: 1< JP�Y: l7 tlii /S'li,:PISJEtiI�'A)LY:�N1:li3
Fee for each commercial system $75.00 _ Subtotal:
(SEE OAR 918- 309-0000) Plan review, if required (25% of permit fee):
State surcha a 12% of
Check Type of Work Involved: TOTAL PERMIT T _ S �•
mit
This per opplieetion espire.% Wet permit L•• net ebteincd..:thin Ian
❑ Audio and Stereo Systems days after it has been accepted as complete.
• Number of inspections allowed per puma.
❑ 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: l
*No licenses are required. Licenses are required
for all other installations
11awIdlnoran lmELC PermllApp- Eut_ERE. Rev 05/21/2013