Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00176
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/07/2010
Parcel: 1S135AB01006
Jurisdiction: Tigard
Site address: 10500 SW GREENBURG RD 100
Subdivision: LINCOLN PLAZA Lot: 0
Project: Beal Bank
Project Description: Security and CCTV systems.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 09/07/2010 $150.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 09/07/2010 $18.00
PHONE:
Contractor:
GLOBAL SECURITY & COMMUNICATION
3212 MAIN ST
VANCOUVER, WA 98663
PHONE: 360 - 693 -1900
FAX: 360 - 906 -9692
Type of Use: COM
Class of Work: ALT
Total Number of Systems: 2
Audio & Stereo: N Boiler Controls: N
CCTV: N Clock Systems: N
Data & Telecommunications: N Fire Alarm: N
HVAC: N Instrumentation: N Total $168.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: Y Other: Y
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 0 952- 001 -0100. You •• - • • • - in ' • • • I e ru - - or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. —
Issued By. �` % ' Permittee Signature: tS?"---e. r
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.
09/07/2010 TUE 8:28 FAX 3609069692 Global Security 0001/003
Electrical Permit Application RECEIVE 1 FOR OFFICE USE ONLY
City of Tigard
.1 SEP 0 7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Er
3 ' Phone: 503.639.4171 Fax: 503.598.19CITy s-,
uF T 2p. 0 Ninth No.: -
, Received '
6 1 natoa : MIPIPI l ir
Date/By a
.... ‘.....,A
Other Penn&
TIGARD 41e00--(x)01-1
inspection Line 503.639.4175 IGARD Date Ready/13y: .1 tiris cc I age 2 for
Internet: www.tigard-or.gov BUILDING DIVISIO N° 7--b Supplemental Information
-,'...,:.:::..-.:'•';.:::"....-::':•.;::.‘'..-....:• ;)..; : T...;....,.:: Ti(F,E:DK.Ivolik:: :.i:. - ::.,..-: : „.-..::. , :.:i:,:::::.:::: : .: i ., I:. ....-:.:::;:,;'.:::....„•:-.,::,: .P1.044 :R
0 New construction rAddition/alteration/replacement Please check all that apply (submit 2 sets of plans w/itcms checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CATEGORY Of CONSTRUCT8ON exceeds 10,000 amps at 150 volts or D Floating buildings.
less to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling 12(Comtnercial/industrial 0 Accessay building ainps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation 0175 KVA or
...., , .,, , ‘,., , . . . , 0 Emergency system. larger separately derived system.
,:' ;;:',I ir4ForolATIoisb OcATIQN ,..: :: a Addition of new motor load of 0 "A", "F.", "1-2", "1 -3",
Job no.: Job site address: SL) GruA RO 1001-IP or more.
0 Six or more residential units. 0 occupancy.
Recreational vehicle parks.
City/State/ZIP: 7„.1. ,„,d, o l 4-12-7-3 pc 0 Health-care facilities.
4° 0 Hazardous locations. 0 Supply voltage for mom than
600 volts nominal.
Suite/bldg./apt. no.: too Project name: R e4 k 5 e ar, .. v , 0 Service or feeder 600 amps or more.
. "' .; ...'.:1: . '... ' .. ',. .." , FEE:SCHEDULE .: • 1 . ; • . - .: .. - ,
Cross street/directions to job site: 6 7/7/ 1 0 Description 1 Qty. 1 For. 1 Total 1 •
New residential single or multi-family dwelling unit.
6 , ) s Includes attached garage.
1,000 sq. R. or less 168.54 4
Subdivision: Lot no.:
Ea. add'I 500 sq. R. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
(with above sq. R. 75.00
DESCRIPTION 00•:8VORK. 2 . i .... ,.•.• - .•••
.. .. . ., . . . . .
Limited energy, multi-family
OtcAr N 1)As 6A\ residential (with above sq. R.) 75.00 2
Services or feeders installationolteration, and/or relocation
200 amps or less 100.70 2
. • . . , .
(.3 OWNER . .- •", '... ' '.:: : '. a TENANT. .: : ..:' .- ,: ..:.. 201 amps to 400 amps 133.56 2
401 amps 10 600 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 I
• 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
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 e xtension, per panel
Owner signature: Date: A. Fee for branch circuits with
• . . above service or feeder fee,
,' ±:-:••.'-....:': :;•••.. ErAPPLICANT f ... • :' ' '.'. '':. :0 CONTACT rglis*.:::...s....: 7.42 2
. - .. each branch circuit
Business name: 13. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not it eluded)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 ir4
Phone: ( ) Fax: : ( ) Reconnect only 67.84
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84
,, . . ,. .:: ., :. CONTRACTOR - . '. .. : ' '.'. .:. Signal circuit(s) or limited-energy I
panel, alteration, or extension. 9 P't Page 2 .....?‹° 2
Business nainc: 610b 1 Seeks ill)/ Each additional inspection over allowable in any of the abov
Address: 32.11. AA,. A &1- Additional inspection (1 hr min) 66.25/ hr
Investigation (1 lir min) 66.25/ hr
City/State/ZIP: \) °Awl/amt._ ii_ Ri-03 Industrial plant (1 lir min) 78.18/ hr
Phone: (360 ) ‘i3 - lip() I Fax: (310 ) 7 - F6c2_ Inspections for which no fee is
90.00/ In
specifically listed (1/2 hr min)
CCB Lic.: gc705 I Electri 1 Lic.: -7/Ictel Sus . Lic.: k2el.,04- . .-..•: .-.;:. ELECTRICAL:PERMIT.. • • : . l • ;
Suprv. Electrician signature, requir :
, 101//ih--- Subtotal:
Plan review (25% of pennit fee):
/
_ .
Print name: ,S /lax) /1
5:17 D .:97,7 Jo State surcharge (12% of pennit fee): IgA
TOTAL PERMIT FEE: /6 t .0
Authorized signature: 11,1 88 --'.---- This permit application expires if a permit is not obtained within I80
11111 pjv days after it has been accepted as complete.
Print natnc: eACC ' IS 44k. Date: f .1-40 0 Number of inspections allowed per permit.
01310610cl inits \ F.I.C-PennilApp.doc 07/01/10 440.46 i sn was/commie
4 , 01A_PAV 7- 60Ae 2.
09/07/2010 TUE 8:29 FAX 3609069692 Global Security 21002/003
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL'WORK ONLYi I.
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener`
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems"
❑ Other:
,COIVIIVIERCIAL;WORK ONLY
Fee for each commercial $75.00
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
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
"Protective Signaling
Other CC TU
Total number of commercial systems: Z—
*No licenses are required. Licenses are required
for all other installations
I:H3uildinecrmits' iLC•PcnnitApp.doc 07/01/10