Permit IN : q .CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 00135
T j G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/17/2010
Parcel: 1 S 135AB01003
Jurisdiction: Tigard
Site address: 10300 SW GREENBURG RD 120
Subdivision: LINCOLN ONE Lot: 0
Project: Genex
Project Description: Fire alarm.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 07/27/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 07/27/2010 $9.00
PHONE:
Contractor:
SAFE TECHNOLOGY GROUP INC
6400 NE HWY 99 SUITE 375
VANCOUVER, WA 98665
PHONE: 360- 699 -2130
FAX: 360- 719 -1527
Type of Use:
Class of Work:
Total Number of Systems:
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
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 a e 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. ENTION: Oregon . law - l uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0 -0010 through OAR 952—'01-01.0. 0u may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Iss d By: � i. . I! /L :, 4 J 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 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.
Electrical Permit Application FOR OFF ICL USFO
City of Tigard �� AU `'' Permit No : "
Received
Date/B � „
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.196 Date/B < : Other Permit: / le,, i0 _s 11
T t GAR Inspection Line: 503.639.417 11 q7 �4�0 Date Ready/By:
See Page 2 for
Internet: www.tigard- or.gov ��l B Notified/Method: `' , Supplemental Information
T YPE OF WORK O1 VIS ON PLAN .REVIEW
❑ New construction ® Addition/alteratioD(yr��pp� U1 Please check all that apply (submit 2 sets of plans w /items checked below):
tJ'l ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ 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
❑ 1- and 2- family dwelling ® Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
, . ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 10300 SW GREENBURG RD 10OHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: PORTLAND OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 120 Project name: GENEX ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: LINCOLN 1 Description 1 Qty. 1 Fee. 1 Total 1
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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
. • DESCRIPTION OF WORK K . (with above sq. ft.) 67.84 2
Limited energy, multi - family
FIRE ALARM residential (with above sq. ft.) 67.84 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT above service or feeder fee
PL N
❑ CONTACT PERSON • each branch circuit 7.42 2
Business name: Safe Technology Group Inc. B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Jason Sweet branch circuit
Each add'I branch circuit 7.42 2
Address: 6400 NE Hwy 99 Suite G375 Miscellaneous (service or feeder not included)
City/State/ZIP: Vancouver WA 98665 Each manufactured or modular
Ci
tY dwelling, service and/or feeder 67.84 2
Phone: (360) 699 - 2130 Fax: : (360) 719 - 1527 Reconnect only 67.84 2
■ Pump or irrigation circle 67.84 2
E - mail: sales @safetechnology.net Sign or outline lighting 67.84 5--- � 2
. CONTRACTOR - Signal circuit(s) or limited- energy 1
Business name: Safe Technology Group Inc. panel, alteration, or extension. 1 Page 2 .84 2
Each additional inspection over allowable in any of the above
Address: 6400 NE Hwy 99 Suite G375 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Vancouver WA 98665 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
P ne: (360) 699 - 2130 Fax: (360) 719 Inspections for which no fee is 90.00 / hr
specifically listed (%I hr min)
CB Lic.: 173731 lectrical Lic.: CLE79 prv. Lic.: 4272LEA ELECTRICAL PERMIT .FEES `
90,3/
Suprv. Electrician signature, required: J ek
Plan review (25% of permit
Subtotal: fee): 75-,a
Print name: Jason Sweet Date: 7 -26 -10 State surcharge (12% of permit fee): (1. t1O
TOTAL PERMIT FEE: yLI, 0Q
Authorized signature: 9//' This permit application expires if a permit is not obtained it 180
days after it has been accepted as complete.-7
Print name: Jason Sweet Date: 7 -26 -10 * Number of inspections allowed per permit. PApleo 1 ' /// r, Q }'" 1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11/05/COM/WEB ( _ 91 t 6.7'
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
•
LIMITED ENERGY PERMIT FEES:
.RESIDENTIAL WORK,ONLY;
Fee for all residential systems combined ... $67.84
Check Type of Work Involved:
❑ Audio and Stereo Systems*
• Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
kCOMMERCIAL W.ORB;ONLY :, . • .
Fee for each commercial . 4
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
• Audio and Stereo Systems
• Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
® Fire Alarm Installation
HVAC
O Instrumentation
• Intercom and Paging Systems
• LI Landscape Irrigation Control*
❑ Medical
• Nurse Calls
O Outdoor Landscape Lighting*
Protective Signaling
O Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09