Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
t y U
• COMMUNITY DEVELOPMENT Permit#: ELR2015-00074
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/17/2015
Parcel: 1 S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 417
Project: Cypress Semiconductor Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Low voltage for access control,adding door to suite access.
Contractor: HSI SECURITY SYSTEMS INC Owner: LINCOLN CENTER LLC
3424 NE 35TH AVE BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97212 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO,CA 94104
PHONE: 503-287-4604 PHONE:
FAX: 503-287-1345
FEES
Description Date Amount
Specifics: Restricted Energy Permit 03/17/2015 $75.00
12%State Surcharge-Electrical 03/17/2015 $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 $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTE •• Oregon law requires you to follow the rules adopted by the Oregon Utility Notificatio -nter. Those rules are set forth in OAR
952-001-r• 0 through• 95 -161-01190. You may obtain a copy of the rules or direct questions to OUNC b caetlirI. I .- 2.1987 or 1.800.332.2344.
Iss •dBy: to ' r /A-4I r PermitteeSignatLr : ;PP < (.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC'
Date: / r
LICENSE NO. ,5773
S
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicat' �� FOR OFFICE USE ONLY
City of Tigard Received
g DateBy: /7 /6— �J PermitNo.: Eiji. e..)15- Iy
;, • 13125 SW Hall Blvd.,Tigard,OR 97223 1 Qt
1 Plan Review Other Pemtit: d PaU/S G !!
Phone: 503.718.2439 Fax: 503.59$,( , Re Date/By:Received
I I t,n.It I1 Inspection Line: 503.639.4175 x`11 `, Date Ready/By: lulls: ® See Page 2 for
Internet: www.tigard-or.gov V CiC1� Notified/Method: Supplemental Information
catL:�
TYPE OF ,•s °'' PLAN REVIEW•
❑New construction ® Addition/al , nnreplacement Please check all that apple(,uhrun 2,els of plans w item,checked bel,,
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Deti olitlot) ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ I-and 2-family dwelling ®Commercial/industrial ❑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 ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E "I-2","I-3",
Job no.:23245 Job site address: 10220 SW Green burg Road I00HPormore. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.:417 Project name:Cypress ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I 1 0131 I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00
add door to suite access control s Limited energy,multi-family
Y residential(with above sq.ft.) 75.0()
stem
Renewable Energy ❑ 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:cypress Semiconductor Corp. 401 amps to 600 amps 200.34 2
Address: 10220 SW Greenburg Road 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP:Tigard,OR 97223 Temporary services or feeders installation,alteration,and/or
Phone:( ) 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 with
above service or feeder fee,
7.42
Business name:HSI Security Systems,Inc. each branch circuit
B.Fee for branch circuits without
Contact name:Barney O'Donnell service or feeder fee,first 56.18 2
branch circuit
Address:3424 NE 35th Ave. Each add'l branch circuit 7.42 2
City/State/ZIP:Portland,OR 97212 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:(503)287-4604 Fax: :( ) Reconnect only 67.84 2
E-mail: barneyna hsi-security.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name:Same Signal circuit(s)or limited-energy a See
panel,alteration,or extension. I Page 2 2
Address: Each additional inspection over allowable in any of the above
City/State/ZIP: ,
Additional inspection(1 hr min) 66.25/hr
Phone:( ) / Fes:( )
X Investigation(1 hr min) 66.25/hr
CCB Lie.: 42140 y,l 4 ¶'7 Electrical Lic.: 26-755C Suprv.Lic.: 3778S (0/I I I° Industrial plant(1 hr min) 78.18/hr
11 A Inspections for which no fee is 90.00/hr
Suprv.Electrician signature,required: specifically listed(':hr min)
ELECTRICAL PERMIT FEES
Print name: Greg Borosun Date: 3-13-15
Subtotal:
Authorized signature: `f/it!/ Plan review(25%of permit fee):
State surcharge(12%of permit fee): �I ref
Print name: Barney O'Donne Date: 3-13-15 TOTAL PERMIT FEE: ill.
""
C\Building\Permits\ELC_PennitApp_ELR_ERE.doc Rev 05/21/2013 44046151(11/05/COM/WEB
This permit application expires if a permit is not obtained within 180 days after it has been accepted as
complete.
• Number of inspections allowed per permit.
•
l:Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10220 SW GREENBURG RD 417, TIGARD, OR,
97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00074
Jeff Grove
Violation Summary:
Inspector Contractor