Permit n CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
111111 COMMUNITY DEVELOPMENT Permit#: ELR2015-00163
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/23/2015
Parcel: 1S 135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 305
Project: Matrix Absence Management Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Fire alarm.
Contractor: CAPITOL ELECTRIC CO INC Owner: LINCOLN CENTER LLC
11401 NE MARX STREET BY SHORENSTEIN PROPERTIES LLC
PORTLAND, OR 97220 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-255-9488 PHONE:
FAX: 503-257-7121
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/23/2015 $75.00
12%State Surcharge-Electrical 06/23/2015 $9.00
Type of Use:
Class of Work:
Total Number of Systems: 0
Audio&Stereo: 0 Boiler Controls: 0
CCTV: 0 Clock Systems: 0
Data&Telecommunications: 0 Fire Alarm: 1
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 $84.00
Other Desc: Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �� -- __ —41r7_ Permittee Signature: a � ��•
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE: Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
' Receive /
City of Tigard KCF1Vl I 1 DateBy6/ / 5—sop—Remit no.. c ye . .,(i23
111 II 1312$SW Hall Blvd.,Tigard,OR 97223 Plan Revie �F
a Phone: 503.639.4171 Fax: 503.598.1960 8 Date/By: Other Permit:
T I G A R U Inspection Line: 503.639.4175 JUN 8 2015 Date Read /B Juris:
Internet: www.tigard-or.gov N 1 Ready/By: 1-0:-: 4> Su S�Page 2 for
Notified/Method: supplemental Information
■ New construction El Addition/alteration/replacement I % I ' i ' ass check all that apply(submit 2 sets of plans wdtems checked below):
❑ Demolition ❑ Other ❑ Service or feeder 400 amps or more
p D Building over three stories
CATEGORY OF CONSTRU where the available fault current ❑ Marinas and boatyards
I] I-and 2-family dwelling U Commercial/industrial Accessory building exceeds 10,000 amps at 150 volts or Floating buildings
❑ Multi-family ❑ Master Builder ❑Other less to ground,or exceeds 14,000 Commercial-use agricultural
JOB SITE INFORMATION AND LOCATION amps for all other installations. ❑ buildings
Job no. 151177 I Job site address: 10220 SW Greenburg Rd ❑ Fire Pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system.
City/State/ZIP: Tigard,OR 97223 El Addition of new motor load of ID"A',"E","1-2","1-3",
l 100HP or more. ❑ occupancy
Suite/bldg./apt.no.: 305 'Project name: Matrix Absence ❑ Six or more residential units ❑ Recreational vehicle parks.
❑ Health-care facilities ❑ Supply voltage for more than
Cross Street/Directions to job site: ❑ Hazardous locations
❑ 600 volts nominal.
❑ Service or feeder 600 am.s or more
,.. t c z FEEtr lEDDI.6,` x= ,'" °s -, a
Subdivision: Lot no.:
J'
Description Qty. Fee. Total
Tax ma./.arcel no.: New residential-single or multi-family dwelling unit.
u : C.' ,P Z2 *m t a 9t*=WOR1C--; .I: , Includes attached garage.
INSTALL FIRE ALARM CIRCUIT 1000 sq.ft or less $ 168.54 4
Ea.Add!500 sq.ft or portion $ 33.92 I
"'+a FEZ's ";;tY S .4 'Jr' = dk t,a", <;t. ,. .';' Limited energy residential
(with above sq.ft.) S 67.84 2
Name: SHORENSTEIN REALTY SERVICES Limited energy,multi-family
`` Address: residential(with above sq.ft.) S 67.84 2
1 Service or feeders installation,alteration,and/or relocation
City/State/ZIP: 200 amps or less S 100.70 2
201 amps to 400 amps $ 133.56 _ 2
401 amps to 600 amps $ 200.34 2
Phone: Fax: 601 amps to 1000 amps $ 301.04 2
Owner installation: This installation is being made on property that I own which is not Over 1000 amps or volts $ 552.26 2
intended for sale,lease,rent or exchange,according to ORS 447,449,670,and 701 Temporary services or feeders installation,alteration,and/or
Owner signature: Date: relocation
200 amps or less $ 59.36 1
!C .x'::41..1`"� ' ,Z°, " , r_ U ' CONTACT PERSON 201 amps to 400 amps $ 125.08 2
Business Name: 401 amps to 599 amps $ 168.54 2
Branch circuits-new,alteration,or extension,per panel
Contact name: A. Fee for branch circuits with
service or feeder fee,each
Address: branch circuit $ 7.42 2
B. Fee for branch circuits
City/State/ZIP: without service or feeder fee,
first branch circuit $ 56.18 2
Each additional branch circuit: $ 7.42 2
Phone: Fax: Miscellaneous(service or feeder not included)
E-mail: Each manufactured or modular
{s'Y, : ;+,. „.!. "•'':'1-T. .v-CONTRACTOR dwelling,service and or feeder $ 67.84 2
Business Name: CAPITOL ELECTRIC CO.,INC. Reconnect only $ 67.84 2
Pump or irrigation circle 5 67.84 2
Contact name: DAN WILSON 503.262.0411 DIRECT Sign or outline lighting 5 67.84 2
Signal circuit(s)or limited-
Address: 11401 NE MARX ST,
energy panel,alterations,or
extension. Describe: Fire Alarm I Page 2 $ 75.00 2
City/State/ZIP: PORTLAND,OR 97220-1041
Each additional inspection over allowable in any of the above
Phone: 503-255-9488 Fax: 503-257-7121 Per inspection S 66.25
Investigation per hour(1 hr min) $ 66.25
CCB Lie.: 48748 Electrical Lie.: 26-496C ISuprv.Lie.: 3132-S Industrial plant per hour S 78.18.7Th Suprv.Electrician signature,required: I ELECTRICAL PERMIT FEES*
/ [ Subtotal $ 75.00
Print Name: DARRELL MCNEEL D� 06/1/1R.
5 Plan review(25%of permit fee)
Authorized signature: State surcharge( 12% of permit fee) $ 9.00
./n1I /(LC /4- TOTAL PERMIT FEE $ 84.00
Print Name: DARRELL M NEEL This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
•Number of inspections per permit allowed.
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 305, TIGARD, OR,
97223
Commercial - Electrical Limited Energy
198 Low voltage final
PASS - No C of O
ELR2015-00163
Jeff Grove
Violation Summary:
Inspector Contractor