Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2013-00227
Date Issued: 09/10/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 9/10/2 B01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 360
Project: DiLorenzo&Company Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Data telecommunications for TI.
Contractor: PAVELCOMM INC Owner: LINCOLN CENTER LLC
1640 NW 14TH AVE BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97209 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-223-5008 PHONE:
FAX: 503-223-0104
FEES
Description Date Amount
Specifics: Restricted Energy Permit 09/10/2013 $75.00
12%State Surcharge-Electrical 09/10/2013 $9.00
Type of Use:
Class of Work:
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 1 Fire Alarm: 0
HVAC: 0 Instrumentation: 0
Intercom/Paging: 0 Landscape/Irrigation: 0
Landscape Lighting: 0 Medical: 0
Nurse Calls: 0 Protective Signal: 0
Security Alarm: 0 Other: 0 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 OA C52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: Permittee Signature: Oil/ "}9e'/°G./e19-Td &C!
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.
09/09/2013 10:33 50322316/1.n PAVELCOMM PAGE 02
l VE I'OR of i i E I.:si:ONL\
Electrical Permit Appl>ICat1 _
City of Tigard 5 E P 9 2013 U1 rya 9/0/x — Permit No.; F1.Re20/3 700,2 2.7
61 13125 SW Hall Blvd„Tigard,OR 9 Plan Review Other'Permit: go/j--(JDs•/f
Phone: 503,718,2439 Fax: 503,59 OF TIGARD pate/By: hirer 121 See Page 2 1br
1'I C:A It . Inspection Line: 503,639,4175 BUILDING DIVISION Nati Ready/13y;1had: 121 Seementol lnformntinn
Internet: www,tigard-or.gov
" ." - > q c i'�iems :F4K,,-7. . a .';0 i ai
,eC rai, '„"':- 7l A'?+' r,a`7,.l a• . d -?Y o,e "1i,W \. AnuP .,c441 w .I,i 5 .,:, I
ati,.
❑New construction ®Addition/alteration/replacornent Please cheek all that apply(subrnitl sere or plans w/items checked below):
❑Service or feeder 400 amps or more in Building over three stones.
❑Demolition ❑Other: whore the available fnolt current ❑Marinas and boatyards.
s, Tn !PF,'I'': T' 1 Fi,t n• exceeds 10,000 amps at 150 volts or ❑Floating buildmgs,
g... less to 1{mund,or exceeds 14,000 CI commercial-use nFricnbvral
O 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for al other insmilnHnnu. buildings.
❑ Multi-family 0 Master builder ❑Othe ❑Fire pump. ❑Installation of 150 KVA or
Other.
.e,}, ❑Eminency larger separately derived erive
d s
stem.
� tsit ilal,, � fi : I ; V RIV �� �hi3 D Ad<litl on of new motor load of ❑"A"";" "t-Z""1.5".
100HP or mare. occupancy.
Job no.: Job site address:10300 SW Creenburg Road
O Six or more residential units. ❑Recrent:onnl vehicle porky,
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. C Supply voltage for morn than
tY 8 _ ❑fauurdotis locations. G00 volts nominal.
Suite/bldg./apt.no.:360 I Project name:b i Loi2E,Jno }n Se'vvigce��or tbeder 60n amps or more p } t
-�• p '�;�i'Pt?its';:'v'Fitain rigig,R?gt.'^ ,'t k'Te �1'�LW1,'r%"'ti'�'',u.li'��'��It;r''i„"��71f(fr?g
Cross street/directions to job site: Desert•ten • • Fee. Tntnl •
New residential single-or multl•fnmily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.Ii.or portion 33.92 1
To map/parcel no.: Limited energy,residential{' {7l ' ORtinF +? . Pilt l °1u ' F, " wit( 17abO 2-4
75.00 2
Limited energy,multi-family 75.00 2
Low voltage cabling `residential(with above sq.It.)
— _RetiEYvOble Q Sts Page 2 . , .
Services or feeders installation,alteration,and/or relocation
p� iPa , ,ta 1 w µi L`%.7p y..�.1 1 ltr;- ii a:y a..:lis'.7V':i
200 amps or lay 100.70 2_
201 amps to 400 amps 133,5E 2
Name: — 401 amps to 600 amps 200.34 2
Address: 601 amps m 1,000 amps 301,04 2
Over 1,000 amps or volts 552.26 2
City/State/ZiP: Temporary services or feeders installation.alteration,and/or
Phone:( ) 1 Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that l own which is not 201 amps m 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: Branch circuits-new,alteration,or extension,pier panel
_7- 3�; ti 3' A.Fee for branch circuits with l
i .� 4,',, ,I .:r- r . :,-1., i °.. w ;', f i4or ;; ,,.....r•,,:..rr•t-a � above service Of feeder fcc,•
Dusincss name:
each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name: service Or feeder fcc,first •56.1$ 2
branch circuit
Address: _Each add'I branch circuit 7.42 2
City/State/ZIP:/State/7_1P: Miscellaneous(service or feeder not Included)
tY Each manufactured Or modular
67.84 2
Phone'( ) I Fax:: )( dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67,84 2
.441 5 `, F`titl l '' '''_."•4iii,*W vas r49 s,'; M- Sign or outline lighting 67.84 2
Business name:Pavelcomm,ins. Signal circuits)orlimited•energy i See
75.00
panel,alteration,or extension. Page 2 2,
Address: 1640 NW 14t4 Ave Each additional inspection aver allowable In any of the above
Additional inspection(1 hr min) 6625/hr
City/State/ZIP:Portland,OR 97209 Investigation(1 hr ruin) 66.25/hr
Phone:(503)223-5008 1 hex:(503)223-0104 Industrial plant(1 hr min) 78,1 tl/hr
Tnapcctions for which no fcc is
90.00/hr
CCB Lie.: 63963 Electrical Lie.: 26559CEP Suprv.Lie.: 699-LEA specifically listed '4 hr min) �n ��y,� +
IQi'''r `�r'+t�f -i, a to lit✓ rimirt1Cl''' J i's� ��!;rl'r°�f rr�lity 1,
Suprv.Electrician signature,required: Subtotal: 75.00
Print name: James R Pavel I Date: 9/9/13 Plan review(25%of permit fee):
State surcharge(12%of permit fcc): 9.00
Authorized Si:. =re:J, l/._...n...A. TOTAL PERMIT FEE:: 84,00
■ tt This permit application expires if a permit is not obtained within 180
Print norm: Date: days niter it has been accepted ns complete.
' Number of inspections allowed per permit,
lanuiid mg\Pormits\ELC_eematApp__LR BREdee Revosrn/2a19 110.46I5T(1 t(nsicom VED