Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
s rr Permit#: ELR2013-00242
COMMUNITY DEVELOPMENT
• w 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2013
IIGA .. Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Project: Axium Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Data telecommunications for expansion
Contractor: CAPITOL DATA&COMMUNICATIONS INC Owner: LINCOLN CENTER LLC
11401 NE MARX ST BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 10/07/2013 $75.00
12%State Surcharge-Electrical 10/07/2013 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 0
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 ■0•' •50090. 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: �j ~ � Permittee Signature:
t A.f i°2-/C9-77o n/
•
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 603.639.4175 by 7:00 a.m.for the next available inspection date.
This penult 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.
10/02/2013 09:45 5032551966 CAPITOL ELECTRIC PAGE 01
ECE '11FD NL/N6 electrical Fermit Applicati R n°E X0/3^002 _
OCT 2 2013 Dot/8T /4/05
City of Tigard Plan Rcvicw Other Permit:
le 13125 SW Hall Blvd,.Tigard,OR 9 Datc/Dy:
I"TIGARD Date Ready/By: kris' el•nae>:r^,-
Phone: 503.639,4171 Fax: 503.59 O �/�
TlGAR17 inspection Line: 503,639.4175 BUILDING DIVISION Nolifed/Mcthod Sanrr^r1+17011ltnr^^^^"^^
Internet: www.tigard-or.gov
7 Ncw construction {J Addition/alteration/replacement Please check all that apply:
Demttlitinn
(� ❑ Other: ❑ Service over 225 amps,come! ❑Hazardous location
_, s.'n: ,,',^',S.1..,3 ES_;ti, 42 OS , ❑ Service over 320 amps-rating ❑Building over 10.000 sq.ft.
❑ 1-and 2-family dwelling
of 1•and 2-family dwellings 4 or more new residential
U Commercialhndustrial ]Accessory building ry g
❑Multi-family ❑ Master Builder ❑Other ❑ System over 600 volts nominal units in one structure
[] Building over three stories ❑Feeders.400 amps or more
10200 SW Greenburg Rd. ❑ Occupant load over 99 persons ❑Manufactured structures or
1pb Ito,: C13648 I Job site address — ❑ Egress/lighting plan RV park
❑ Health-care facility ❑Other:
(;ity/Statc/7-IP: Portland,Oregon 97223 Submit sets of plans with any of the above,
l Axiom Expansion
The above are not a+•livable to tempera construction service.
Suite/bldg./apt.nn.: 5#6O0 IPro�ect name: P _ _:,....:._ .. _._ --k. :�e qa'..E __u`s ..+�:' a•3t-c t' :1.
Cross StredJDircctinns to iob silo: Lincoln Tower
Do/460am. Ori Fee. Tntnt
New re idential-single or multi-family dwelling unit.
includes altnched garage.
Subdivision: • Lot no.: - -
1000 sq.ft.or less S 168.84 4
Tux map/parcel no.: Ea.Add'l 500 sq.ft or portion S 3..92 I
C{ Limited energy residential f 7s.nn 2
7th floor Expansion Installation of voice and data cables,cat5e,cat6,and fiber. Limited energy.non-residential S 73.00 2
Etch manufactured home or modular
ri, dwelling,Service and/or feeder IS (+7.84 , 2
r^ .�-�;;j�ROPrBEtfY1?O- Service or feeders Installation,alteration.and/or relocation
Name; 200 amps or lass s ion.in 2
201 amps to 400 amps s 137.54 2
Address: _ 401 amps to 6(10 amps S 205.34 2
601 amps to 1000 amps — S 301.04 2
CilylSmtrJZIP' Over 1000 amps or volts s 522.26 2
Reconnect only S 67.84 _ 2
Phone' Fax;
503-295-5555 Temporary services or feeders installation,alteration,and/or
Owner installation: This installation is being made on property that I own which is not relocation S 5
intended for sale,lea '1 tb se,rent or exchange,according to ORS 447.449,670,and 701 200 amps or less S 15' 3s 2
Owner signature: - Datc: 201 amps to 400 amps
401 amps to 599 amps S 16854 2
rte 6 •.'• ': • -'..1.1,== ;:-C 4.;',:j I.. ;;'2:., .';.•:!'ilfly i`,{21 tr r: 1k........:,.._. Branch circuits-new.alteration,or cttension.per jmncl - -
A Fcc for branch circuits with
Business Name: service or feeder fee,each
branch circuit $ 7.42 2
Contact name: B. Fcc for branch circuits
without service or feeder fee,
Address: each branch circuit S 56.18 2
Each additional branch circuit: S 7.42 2
City/State/7iP; Miscellaneous(service or feeder not included)
Pump or irrigation circle _ 5 67.64 2
Phone: Fax: Sign or outline lighting $ 61.84 2
E-mail; al circa
,x..-,. r..; ..., ? °i L T n•_t. T , energy panel,alteration,or
extension, DCSeI'ibC: TciclDatt 1 75 75.00
Business Name; Capitol Data&Communications,Inc. Page 2
Each additional inspection over allowable in any of the above
Contact name: Terry Brasch Pcr inspection S 66.25
Investigation per hour(1 hr min) S (425
Address; 11401 NE Marx Street Industrial lent er hour S 78.16
r.4
City/Ststci7-iP: Portland,Oregon 97220 Subtotal 75.00
Plan review(25%of permit fees
Phone: bt)3.255 9488 Fix: 503-257.7121 State surcharge( 1.2% of pcmtit fee) 9.00
CCB Lie.: 142457 !Electrical t.ic,:26-1o54CLE I Suprv.Lie,:2757LEA — TOTAL PERMIT FEE 84.00
�) 7Ttt permit ipptieatian expires it a tannic a not obtained.rith:n ISO
Suprv,Electrician signature,required: ,�! � Qv4 days crier it bas been accepted as enmpIMe
Print Name: Terry Brasch Date: 10/02/13 • Fee methodology set by TO-County Building Industry Service Board
_ "'Number of inspections par permit allowed.
Authorized signature: �—
Print Name: Terry Broach
503-7113.2439
10/02/2013 09:45 5032551966 CAPITOL ELECTRIC PAGE 02
Electrical Permit Application -City of Tigard
Page 2-Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systesm combined $ 75.00
Check Type of work Involved:
❑ Audio and Stereo Systems'
❑ Burglar Alarm
❑ Garage Door Opener'
❑ Heating,Ventilation and Air Conditioning
System"
L] Vacuum Systems'
❑ Other:
Fee for each commercial sytem $ 75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
GI 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: 1
'No licenses are required. Licenses are required
for all other installations