Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit#: ELR2015 00184
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/11/2015
Parcel: 1 S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 950
Project: Ameriprise Subdivision: METZGER,TOWN OF Lot: 9
Project Description: Data telecommunications.
Contractor: ALLPHIN COMMUNICATIONS INC Owner: LINCOLN CENTER LLC
23220 SW BOSKY DELL LANE BY SHORENSTEIN PROPERTIES LLC
WEST LINN, OR 97068 235 MONTGOMERY ST, 16TH FLOOR
SAN FRANCISCO, CA 94104
PHONE: 503-638-9000 PHONE:
FAX: 503-638-9100
FEES
Description Date Amount
Specifics: Restricted Energy Permit 08/11/2015 $75.00
12%State Surcharge-Electrical 08/11/2015 $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: 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 Notificati enter. Thos- rules are set forth in OAR
952-001-0010 through OAR 95 101-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5 .1987 r 1 • •32.2344.
AI di
Issued By: '4 �Ilrtti� La 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.
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Electrical Permit Applicati pp I O It O I II( 1 ( .I ()NI 1 q �}
City of Tigard C 112015 Daze/Bea O ���/� Permit#: �,Qo2Q/S��IQ Ia
13125 SW Hall Blvd.,Tigard,OR 972�U G Plan Review y1
Related Perm ,ao/s-Da, r'
Phone: 503.718.2439 Fax: 503.598.1960 1/ [(')Y�('' Date/B : �/'
Inspection Line: 503.639.4175 �� 0�. 1(J ( V Ready Date/By: runs: ® See Page 2 for
I �'`�h I) Internet: www.ti ardor. ov ��� Notified/Method: Supplemental Information
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TYPE O PLAN REVIEW
❑New construction Addition/alteration/replacement Please check all that apply(submit/sets of plans w/items checked):
❑Service or feeder 400 amps or more ❑Building over three stones.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
❑ I-and 2-family dwelling j2J Commercial/industrial ❑Accessory building less to ground,or exceeds 14,000 ❑Commercial-use agricultural
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
4 ❑Addition of new motor load of system.
Job#: Noci Job site address: 0? 0 3(4) a-Kee01c I00HP or more. ❑"A","E",°l-z",°t-3",
�� ❑Six or more residential units. occupancy.
��3 ❑Health raze facilities. ❑Recreational vehicle parks.
irle/ZIP:
g./apt.#: —/ `J 67 I Project name: Y7m.4/'Jcipp 6,e ❑Hazardous locations. ❑600 voltage
alr more than
❑Service or feeder 600 amps or more.
street/directions to job site: t./pi e_oLiv`IN/U,0:3n FEE SCHEDULE
Description I Qty. I Each I Total I •
New residential single-or multi-family dwelling unit.
Subdivision: I Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential
1 C ) �/ (with above sq.ft.) 75.00 2
jVC7IG� 4 }V�t C.Quf4-1,51-t-,v1 Limited energy,multi-family
/ residential(with above sq.ft.) . 75.00 2
Renewable Energy ❑ See Page 2
❑ PROPERTY OWNER I ❑ TENANT Services or feeders installation,alteration,and/or relocation
Name: 200 amps or less 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email: relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT I ❑ CONTACT PERSON _Branch circuits-new,alteration,or extension,per panel _
A.Fee for branch circuits with
Business name: above service or feeder fee,
7.42 2
each branch circuit _ _
Contact name: B.Fee for branch circuits without
Address: service or feeder fee,first 56.18 2
branch circuit
City/State/ZIP: Each add'I branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:( ) I Fax: :( ) Each manufactured or modular
AI dwelling,service and/or feeder 67.84 2
Email: t- / J,''" Reconnect only l 67.84 2
A CONTRACTOR Pump or irrigation circle 67.84 2
Business name: �iJ �m�avy�G-1111 /WL Sign or outline lighting , 67.84 2
L„,,...) Signal circuit(s)or limited-energy See Page 2 r� 2
Address: ' ;711 0 )'� /,„S- y �x lit panel,alteration,or extension. 75 40
City/State/ZIP: '�"' Each additional inspection over allowable in any of the above
wQ 5 F 1_//✓/� y�}r0 Additional inspection(1 hr min) 66.25/hr
Phone:(5b5) 693 to . DoQ Fax:573 ) 616_ q/w Investigation(I hr min) 66.25/hr
Email: I ` �1 ^ l Industrial plant(1 hr min) 78.18/hr
(it EG �h i,.) (lofty. Conn, // � Inspections for which no fee is 90.00/hr
CCB Lie.:Jo EI trical 'c.: 3-4'Olp4 rv.Lic.: t.,77LE'� specifically listed(V3 hr mm)
D { / /r/ /7 a ELECTRICAL PERMIT FEES
Suprv.Electrician signatur ,r uired: 1 • /6J_t_ Subtotal: V.<Print name: f` 4 Date:Vi 5" ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit fee): 9,pi
Authorized si ature: TOTAL PERMIT FEE: fey 0-0
This permit application expires if a permit is not obtained within 180
�/�
Print name: I.J 1 N mrL Date: q ,1 r(- days after it has been accepted as complete.
{/ v • Number of inspections allowed per permit.
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1
Electrical Permit Application—City of Tigard
Page 2—Supplemental Information
Limited Energy Permit Fees: Renewable Energy Permit Fees:
RESIDENTIAL WORK ONLY: FEE SCHEDULE
Description I Qty. I Each I Total
Fee for all residential systems combined: $75.00 Renewable electrical energy systems:
Check Type of Work Involved: 5 kvaorlcss 100.70 2
5.01 to 15 kva 133.56 2
❑ Audio and Stereo Systems* 15.01 to 25 kva 200.34 2
Wind generation systems in excess of 25 kva:
❑ Burglar Alarm 25.01 to 50 kva 301.04 2
50.01 to 100 kva 552.26 2
❑ Garage Door Opener* >100 kva(fee in accordance 552.26 2
with OAR 918-309-0040)
❑ Heating,Ventilation and Air Conditioning Solar generation systems in excess of 25 kva:
System* Each additional kva over 25 7.42 3
❑ Vacuum Systems* >100 kva—no additional charge 0.0 3
Each additional inspection over allowable in any of the above:
❑ Other: Each additional inspection is 6625/hr 1
charged at an hourly(1 hr min) •
-
Inspections for which no fee is 90.00/hr
specifically listed(Vs hr min) _
ELECTRICAL PERMIT FEES
COMMERCIAL WORK ONLY: Subtotal(Enter on Page 1):
Fee for each commercial system: $75.00 • Number of inspections allowed per permit.
(SEE OAR 918-309-0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n Boiler Controls
El Clock Systems
Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other: /
Total number of commercial systems: /
*No licenses are required. Licenses are required for all
other installations
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