Permit . ' CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
q
Ft s COMMUNITY DEVELOPMENT Permit #: ELR2010 -00052
I Date Issued: 03/30/2010
41 G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 305
Subdivision: LINCOLN THREE Lot: 0
Project: Comsys
Project Description: Low voltage for data
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 03/30/2010 $67.84
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 03/30/2010 $8.14
PHONE:
Contractor:
TELECOM LABS INCORPORATED
7591 SW MOHAWK ST
TUALATIN, OR 97062
PHONE: 503- 218 -2414
FAX:
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 1
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: Y Fire Alarm: N
HVAC: N Instrumentation: N Total $75.98
Intercom/Paging: N Landscape /Irrigation: N
Required Items and Reports (Conditions)
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
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 - .. • • - - , ith 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. • ENTION: Oregon -w - q ' es ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 %01 -0010 through OAR 9� 1 -010. • may obtain a copy o the rules or direct questions to OUNC by calling 5' . .. • or 1.800.332.2344.
Imo"— -- I sued By: / / Permittee Signature: C - .
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 an inspection that business day.
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.
a_ y or i � d
„,:s"`i ~r,. Electrical Permit Application OFFICE USE ONLY
A' ... . .
a:. City of Beaverton Community Development Date Received: 3 ; i i 0116TP Permit No.: eiv ' Real — 57-
4 PO Box 4755 B ea v e rt on, OR 97076 Date Issued: By:
,. Phone: (503) 526 -2403; Fax: (503) 526 -2550
Internet address: www.beavertonoregon.gov Payment Type:
PLAN REVIEW
TYPE OF WORK Please check all that apply: — Service or feeder over 600 amps
] New construction C Addition/alteration /replacement _ Service or feeder 400amps _ Building over three stories
L Other:
— or more _ Marinas and boat
CATEGORY OF CONSTRUCTION _ F ire pump _ Floating buildings
E mergency system _ Commercial -use agricultural
— 1 1- and 2- family dwelling n Commercial /industrial n Accessor building A ddition of new motor buildings
— 1 Multi- family r Master builder r 1 Other: load of I00HP or more — Installation of 150 KVA or larger
JOB SITE INFORMATION AND LTION __ Six or more residential units separately derived system
LOC i u _ Health -care facilities _ "A, " "E, "`1- 2, " "1 -3 "occupancy
Job no.: Job address: 11 � e4 305 — Hazardous locations J Recreational vehicle parks
FEE SCHEDULE
City/State /ZIP: I eA,jp-.r ✓� \- Description I Q. Fee I Total
t ` ` � Z � P '
Suite /bldg. /apt. no.: 3Q S Project name: (14,i,_1 ! Residential single- or multi- family dwelling unit
Includes attached garage
Cross street/directions to job site: 1,000 sq. ft. or less 144.20 4
Ea. add'1 500 sq. ft. or portion 25.75
Limited energy, residential
Subdivision: Lot no.: (with above sq. ft) 40 2
Tax map /parcel no.: Limited energy, multi - family 67.95 2
residential (with above sq. ft.)
DESCRIPTION OF WORK Services or feeders installation, alteration, and /or relocation
(-----1r,'•' (/_ 11 `- T 200 amps or less 85.80 2
' � I _. "Q �e�tL +' 201 amps to 400 amps 102.15 2
401 amps to 600 amps 169.90 2
E PROPERTY OWNER _J TENANT 601 amps to 1,000 amps 222.20 2
/ U _ ( (� Over 1,000 amps or volts 511.35 2
Name: ( ,. m S/ S �.1_ — �. l O 1 e (, Oq y� Temporary services or feeders installation, alteration, and /or
Address: 1 Q � L, („..)\,„ C' \-., S. 2000 0 r 3o ( c) '
relocation
�t amps ps or less 67.95 2
City /State /ZIP: y v -�. U Z ( 7 22.3 201 amps to 400 amps 94.40 2
401 amps to 600 amps 136.40 2
Phone: (903) 29'3 _ Zy 99 Fax: ( )
Branch circuits — new, alteration, or extension, per panel
Owner installation: This installation is being made on property that 1 own, which is not A. Fee for branch circuits with
intended for sale, lease, rent, or exchange. above service or feeder fee, 3.15
each branch circuit 2
Owner signature: Date: B. Fee for branch circuits
J APPLICANT I _J CONTACT PERSON without service or feeder 60.10
fee, first branch circuit 2
Business name: A 1 Ly >„,, 604- Each add'I branch circuit
3.15
Contact name: CT t ��� Miscellaneous (service or feeder not included)
Each manufactured or modular
� 1 \ dwelling, service, and/or feeder 67.95 2
Address: c / S0 (A01,A,v lL
Reconnect only 67.95 1
City/State /ZIP: 7-64 \A tr., q CTL J ` 7O(O Z Pump or irrigation circle 67.95 2
Sign or outline lighting Z 67.95 47. 9€4 2
Phone: (�? )a jg- _ 2� ( F ax: ( )
Y Signal circuit(s) or limited -
E -mail: 3r Pg/ e, c.t \ \ ,) a „--V - coy, energy panel, alteration, or 67.95
CONTRACTOR extension. Describe: 2
Business name: , ,.../ ; / / „ p -- t �M �`� 5 Each additional inspection over allowable in any of the above
!t►r '''' �Q�� t f� Per inspection 60.10
Address: --) S ( W 3 ) i S+ Investigation fee
City/State /ZIP: 1 ;) A t A �� 1Z S (-
Other:
/ ELECTRICAL PERMIT FEES
Phone: (s-6? ) 21 - Z r y Fax: ( ) , 88 � Subtotal /„ 7 , DG �
E -mail: ,,, 1 ,, � CCB lic. no.: i _t c r TT l b `e
-76 /
10 Electrica lic. no.: 3'7_ �� `' C 16414 Plan review (25% of permit fee) ty or metro lic.: State surcharge (12% of permit fee) 1./11 Supervising electricia t-
signature, required: c y ZI $ L,; 3 TOTAL PERMIT FEE 75 gg P- R Print name: Date: This permit application expires if a permit is not obtained
fZ y j .. 2 S - l0 within 180 days after it has been accepted as complete
* Number of inspections allowed per permit.
Authorized signature:
Print name: Date: 440 -4615T (8/05 /COM/WEB) Revised 12/08