Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
COMMUNITY DEVELOPMENT Permit #: ELR2010 -00187
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/15/2010
Parcel: 1 S 135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 125
Subdivision: LINCOLN THREE Lot: 0
Project: Hood River Distillers
Project Description: Data telecommunications system.
FEES
Owner:
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 09/15/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 09/15/2010 $9.00
PHONE:
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503 - 419 -3300
FAX: 503 - 419 -3695
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
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 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 se‘ forth in OAR
952- 001 -0010 through OAR • 52- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
� La
Issued B Permittee Signature: _ G
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.
SEP -14 -2010 TUE 08:55 AM CHRISTENSON ELECTRIC INC FAX NO, 95034193695 P. 01
Electrical Permit AU»lication RECEIVE / FOR OF i(71; USE ONL\
. _ { /� - • ,
City of Tigard 1 4 [' 0 f 0 Date/8 : t0 - _ •� ''�i
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Olber Permit: ` ' t I q ('
Phone: 503.639.4171 Fax: 503.598.19 Received
Date R :
Inspection Line: 503.639.4175 ITY OF TIGARD Date eadyaty: Sec Paine 2 for
•'' `" '`" Internet www,tigard- or.gov BUILDING DIVISIO ILNotified/l ,thud: NM Supplemental Information • ;,.. ; .. '. ... •
..::... . . .:... - r�9 �t ' ems checked below):
[] New construction ddition/alteration/rr:placement Please check all that apply (submit 2 sets
Service or feeder 400 nmpa or more 17 Building over three stories.
❑ Demolition ❑ Other: _ where the available Gault current ❑ Marinas and boatyards. •. • .:•-•
tatcatts 10,000 amp at ISO volts or 1?Iom buildings.
dings•
:;• =.:; .,:::.. . • i i t : i ( y;.O IyCONSFYt...... IaI`':. . .. .. less to ground, or exceeds 14,000 G1 Commercinl•u s agricultural [] 1- and 2 - family dwelling m mercial/industrial ❑ Accessory building amps for all other installations, buildings. •
Other: ❑ f ire pump, ❑ Installation of 75 KVA or
❑Multi family ID Master builder ❑ 0 i1ey system, forger separately derived system.
J OR SITE' 1,NF,ORMATIOJN AND LOCATION ❑ Addition of caw motor load of ❑ "A ". "6 ", "1 -2" '•1.3 ",
• .,•,,,;;,;;:',,';•,'.; '. ;. : 1001.1' or more, occupancy.
Job no.: t.0 V. 1- Job site address: 0 . . 5Vk f - B ' ' k �. . ❑ Six or more residential unite. 0 Recreational vehicle parks.
- t.� 1 .& ❑ Health -care facilities. ❑ Supply voltage for mom than
City /State /'LIP. ' ❑Havadoeslocations. 600 volts nominal.
s; �X S�, : ❑ Service or larder 600 rungs or more, to.: Project name: "19 E>; SLIi
Spite /bid . /lipt ( ) ono, DULE:• :•'.,t,..,.. •
Cross street/directions to job site:
Decal i° n'... r . roe Total
•
•
New residential single- or multi- family dwelling unit.
�o Includes attached garage.
Lot no.: 1.000 s9• tt. or Tess 168.54 4
Subdivision: Ea. add'I 500 sq. ft. nrportiin 33.92 1
Tax map /parcel no.: Limited energy. residential 75.00 2
_:... .
.,... ; .. ,r.: (with show std )
' '; ... �.- pE9•�RIL WOIt><C: _ :.
Limit energy, multi - family 75,00 ' -
t l _ � r v ic es o r l ee ri e about ft.
\( �Gl 1 _Services or fee installation, alterntlon, and/or relocation
200 amps or less 100.70 2
. O N
Q •p ENAT s 201 amps to 4 00 amps 133,56 2
1:1. PROl�1uRTY:.OWNE 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 55226 2
_
Temporary services or Feeders installation, alteration, and /o
City /State /'LIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125,08
Owner installation: This installation is being made on property that l own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - sew, alteration, or extension, per panel
Owner signature: Date: - A. Fox for broth circuits with
above service or feeder fee, 7,42 2
ABPI:ICALVIFi' .::. •.. •,CONTACT PtfRSON eac b ranc h circ
- B. Fee for branch circuits wlrhwu
�JJ >;� l i. service or feeder fu. first 56.18 2
� ' branch circuit ..
Contact name: ` 7 � .. Each add'I branch circuit 7,42 2
Address: Miscellaneous (service or feeder not Included)
Each manufactured or modular 67,84 '-
City/State/ZIP: _ dwelling, service and/or feeder _
Phone: '',,,-._
„k 5 .--LA I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E- mail: _ Sign or outline lighting 67.84 2
GOb1TIi i# Signal circuit(a) or limited 2
panel_ alteration, or extension. '
1 Page 2
k t " ♦ , Each additional r xten do over allowable in any of the above
�� A
• Additional inspection (111r m 662 h r _
Address: �.
Investigation (1 hr min) 6b?s/ nr
IMMII C WAWA 10 — Tndustriul plant (1 hr min) 78.18/ hr
♦ Inspections for which no fax is 90 00/ hr
Phone: (m" A r ��, Fa +�h �� /� spccifical y listed (K hr min) _
CCE Lic. 4 ja �_ ElectricalLic � �1" - Suprv. Lie.: S~S . EI,Gr 'fItIC PERMIT. FblESH•. Y ... t .
Suprv. Electrician signature, required: — Plan review (25% of permit fee):
Ili !yr.., D � Subtotal:
• RW21 Shute surcharge (12 °/" of permit fee):
Print name: •► ` �!� lib • _t • . � TOTAL PERMIT FEE; 4 r,
Authorized Signature: Thi.% permit application cstdre+ if a permit is not obaiue • I ' th ''
days after it has area accepted as complete.
Print name:
Date: _.,„,,■•••--"' • miser of inspec ' • . : allowed per permit.
l:Ww F
'Id :n werrun.ull.C- r'rrmuispp.dor 07,'OI /ID 94th•• : (I: /OM7?"(
SEP -14 -2010 TUE 08:56 AM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P. 02
Electrical Permit Application City of Tigard .....
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENT,IAL.WORKONLY:.:. '.
Fee
— "f"4:7 an resid 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:
COMMERCIAL WORK ONLY:
Fee for e_wI commercial $75.00
system
(SEE OAR. 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
....K.
Data Telecommunication Installation
Fire Alarm Installation
❑ I N.AC
❑ Instrumentation .
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other 1
Total number of commercial systems:
*No licenses are required. Licenses are required ,
for all other installations
,1Huildit Pe 1iis\CLC- PnrmitApp.doc 07101110