Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
e • COMMUNITY DEVELOPMENT Permit #: ELR2010 -00167
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 1S135AB00900
Jurisdiction: Tigard
Site address: 10200 SW GREENBURG RD 600
Subdivision: LINCOLN CENTER/FIVE LINCOLN Lot: 0
Project: Axium
Project Description: Data and Telecommunications system.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 08/26/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 08/26/2010 $9.00
PHONE:
Contractor:
CAPITOL DATA & COMMUNICATIONS
11401 NE MARX ST
PORTLAND, OR 97220
PHONE: 503 - 255 -9488
FAX: 503- 257 -7121
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 $84.00
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 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 -0100. You may obtai .• .y of the rules or direct questions to OUNC by calling 503.246 r 1.800.332.2344.
Issued By: `/ / ir�—� -- 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.
FOR OFFICE USE ONLY
Electrical Permit Application O Received f p L � y �J Date /By: • >61 0 �1iI it no.: l — I ( •
City of Tigard \ Plan Review ■
IN • 13125 SW Hall Blvd., Tigard, OR 9722 v Date /By: Other Permit: • I / (0 _� R
_ • Phone: 503.639.4171 Fax: 503.598.19 1 G � Date Ready /By: gee Page 2 for
TIGARD Inspection Line: 503.639 \��) t A , vrtified/Method: Supplemental Information • Internet: www.tigard- or.gov ® t Ak I" 0
TYPE OF WORK O ..tc3V PLAN REVIEW
Li Ncw construction U Addition /alteration /replacement '` VVI \ Please check all that apply:
E] Demolition 11] Other: B ❑ Service over 225 amps, comm'I ❑ Hazardous location
CATEGORY OF CONSTRUCTION ❑ Service over 320 amps - rating ❑ Building over 10,000 sq.ft.
LI I- and 2- family dwelling Li Commercial /industrial U Accessory building of 1- and 2- family dwellings 4 or more new residential
❑ Multi - family ❑ Master Builder ❑ Other ❑ System over 600 volts nominal units in one structure
JOB SITE INFORMATION AND LOCATION ❑ Building over three stories ❑ Feeders, 400 amps or more
Job no.: C10199 Job site address: 10200 SW Greenburg Rd. ❑ Occupant load over 99 persons CI Manufactured structures or
❑ Egress /lighting plan RV park
City /State /ZIP: Portland, Or. 97223 ❑ Health -care facility ID Other:
Submit 2 sets of plans with any of the above.
Suite /bldg. /apt. no.: #600 Project name: Axium The above are not applicable to temporary construction service.
FEE SCHEDULE
Cross Street/Directions to job site: Description I Qty. I Fee. I Total I "
New residential - single or multi - family dwelling unit.
Subdivision: Lot no.: Includes attached garage.
1000 sq. R. or less $ 168.54 4
Tax map /parcel no.: Ea. Addl 500 sq. f1 or portion $ 33.92 1
DESCRIPTION OF WORK Limited energy residential $ 75.00 2
Installation of voice and data. Limited energy, non - residential $ 75.00 2
Each manufactured home or modular
Li PROPERTY OWNER 1 U TENANT dwelling, Service and/or feeder $ 67.84 2
Name: Service or feeders installation, alteration, and /or relocation
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 1000 amps S 301.04 2
Over 1000 amps or volts $ 552.26 2
Phone: Fax: Reconnect only $ 67.84 2
503- 295 -5555 Temporary services or feeders installation, alteration, and /or
Owner installation: This installation is being made on property that I own which is not relocation
intended for sale, lease, rent or exchange, according to ORS 447, 449, 670, and 701 200 amps or less $ 59.36 1
Owner signature: Date: 201 amps to 400 amps $ 125.08 2
401 amps to 599 amps $ 168.54 2
U APPLICANT 1 U CONTACT PERSON Branch circuits - new, alteration, or extension, per eanel
Business Name: A. Fee for branch circuits with
service or feeder fee, each
Contact name: branch circuit S 7.42 2
B. Fee for branch circuits
Address: without service or feeder fee,
each branch circuit S 56.18 2
City /State /ZIP: Each additional branch circuit: $ 7.42 2
Miscellaneous (service or feeder not included)
Phone: Fax: Pump or irrigation circle $ 67.84 2
Sign or outline lighting $ 67.84 2
E -mail: Signal circuits(s) or limited -
CONTRACTOR energy panel, alteration, or
Business Name: Capitol Data & Communications, Inc. extension. Describe: Tcle /Data 1 75 75.00 2
Page 2
Contact name: Terry Brasch / Scott Zadow 971- 533 -6821 Each additional inspection over allowable in any of the above
Per inspection $ 66.25
Address: 11401 NE Marx Street Investigation per hour (1 hr min) $ 66.25
Industrial plant per hour $ 78.18
City /State /ZIP: Portland, Oregon 97220 ELECTRICAL PERMIT FEES*
Subtotal 75.00
Phone: 503- 255 -9488 Fax: 503 - 257 -7121 Plan review (25% of permit fee)
State surcharge ( 12% of permit fee) 9.00
CCB Lic.: 14257 (Electrical Lic.: 26 CLE 1 Suprv. Lic.: 2757LEA TOTAL PERMIT FEE 84.00
$Uprv. Electrician signature. required: This permit application expires if a permit Is not obtained within 180
�_ days after It has been accepted as complete
Print Name: Terry Brasch Date: 08/24/10 • Fce methodology set by Tri- County Building Industry Service Board
Authorized signature: pQ A "Number of inspections per permit allowed.
Print Name: Terry Brasch