Permit q CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I1 >R COMMUNITY DEVELOPMENT Permit#: ELR2015-00021
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/15/2015
Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 300
Project: Forest City Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: Low voltage for access control with electrical release.
Contractor: STANLEY CONVERGENT SECURITY SOLUTIONS IN' Owner: LINCOLN CENTER LLC
15495 SW SEQUOIA PKWY STE 100 BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97224 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO,CA 94104
PHONE: 503-968-3353 PHONE:
FAX: 503-968-3398
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/15/2015 $75.00
12%State Surcharge-Electrical 01/15/2015 $9.00
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 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: 1 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 of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
cT Issued By: 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 R1 CE VE ftlR(11.tlt I. Il,1 t141 l
II l.� Received
City of Tigard Permit No.:
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
R Phone: 503.718.2439 Fax: 503.598.1960 2015 Date/By: Other Permit:
I 1 i A It t Inspection Line: 503.639.4175 JAN 1 5 Date Ready/By: Saris: BI See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Ay Supplemental Information
TYPE OI'WQRfCa *4 ° 11 PLAN REVIEW
D❑New construction ®Addition/alterati� Please check all that apply(submit 2.sets of plans w/iteins checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition El Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less toground,-orexceeds-14;000-0Commereial-usengrieulmral --.._---
❑ 1-and 2-family dwelling ®Commercial/industrial El Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.:6263641 I Job site address:10250 SW Greenburg Rd.STE#300 Six 100HP mr more real occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Portland Oregon 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:300 I Project name:Forest City Trading Group ❑Service or feeder 600 amps or more.
'FEE SCIIEDLILE
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: I Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'(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
Install door closer with electrical release and release button residential(with above sq.II.)
Renewable Energy la See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 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
City/State/ZIP: 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 amps to 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,per panel
® APPLICANT I ❑`CONTACT PERSON A.Fee for branch circuits trirl,
above service or feeder fee,
7.42 2
Business name:Stanley Security Solutions each branch circuit
B.Fee for branch circuits without
Contact name:Gina Wrisley service or feeder fee,first 56.18 2
branch circuit
Address:3710 SE Naef Rd Each add'l branch circuit 7.42 2
City/State/7,1P:Milwaukee Oregon 97267 Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 12
Phone:(503)387-2903 I Fax::(877)285-3209 dwelling,service and/or feeder L
Reconnect only 67.84 2
E-mail:steve.snyder @sbdinc.com Pump or irrigation circle 67.84 2_
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Stanley Security Solutions Signal circuit(s)or limited-energy I See I
panel,alteration,or extension. Page 2 2
Address:3710 SE Naef Rd Each additional inspection over allowable in any of the above
City/State/ZIP:Milwaukee Oregon 97267 Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:(503)387-2900 Fax:(877)285-3209 Industrial plant(I hr min) 78.18/hr
Inspections for which no fee is 90.D0/Irr
CCB Lie.: 161567 Electrical Lie.: 371054c1 Suprv.Lie.: 47 3lea specifically listed('A hr mm)
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,require a Subtotal: 75.00 r
Print name: Ray Thiemeyer Date: /15/15 Plan review(25%of permit fee):
State surcharge(12%of permit fee): 09.00
Authorized signature: St. TOTAL PERMIT FEE: __LSSIO'' 0 7 —
This permit application expires it n permit is not obtained within 180
Print name: Steven Snyder Date: 01/01/15 days after it has been accepted as complete.
• Number of inspections allowed per penult.
1:1Building\Permits\ELC PennitApp_ELR_ERE.doe Rev 05/21/2013 4404615T(I I/05/CON/WEB