Permit II CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
I: COMMUNITY DEVELOPMENT Permit #: ELR2010 00243
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2010
Parcel: 1S135AB01002
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 601
Subdivision: LINCOLN THREE Lot: 0
Project: Matrix Absence Management
Project Description: Low voltage for data
Owner: FEES
LINCOLN CENTER LLC Description Date Amount
BY SHORENSTEIN PROPERTIES LLC, 555 Restricted Energy Permit 11/04/2010 $75.00
CALIFORNIA ST 49TH FL 12% State Surcharge - Electrical 11/04/2010 $9.00
PHONE:
Contractor:
AF TECHNOLOGIES
1418 HEMLOCK ST. NW
SALEM, OR 97304
PHONE: 503 - 362 -2364
FAX: 503 - 362 -2382
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 $84.00
Intercom/Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N Required Items and Reports (Conditions)
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N
Other Desc:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: law re uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 thr gh OAR 952 -00 100. Y u may obttain�a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: et.��2�.a1 / Permittee Signatur a. — .�' / ' t�--
r OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an Inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
NOV. 3.2010 3:39PM 7 03- 608 -7198 NO. 0783 P. 1
Electrical Permit Application A �
City o Tigard EL" Y 31Sw Hall Blvd•, Ti . d .: ' P
r & •
>: Phone: 503.7182439 'ax: 5O3.598- % 1 . Aetc/By: Other Permit:
Inspection Line: 503, • ' •' Acv 1k Ready/By: 1 : EI See Page 2 for
CIC;:IRD
Internet www.Hgard- or.gov ,G * � `0otilted/Mc r,
thod: � Supplemental
-.,� , .it' , P 4iF, 'r, ; " ;�..:iq `'F "r 4: n.cm,1% l l rla'::.1 ' I1,.' " 4')17 ''' 'ti' 11 4 ;; I :, :,te a min.' ,ii:ru yit it
, . � r ,I rl:; -, ,1 jiult I ;r. - , !'e ;t :'.Mf$fi1:61 ;'I }F fit:. 4 p . J .! ,.1 1 .y1 !rd , ; i r,. . ;1 . 11' „ rN, I l, )Itl� ,{ '( i. ` } l I ,. i1.6 I� '4 '7 . 1.1 I 'M1 1• !
� p l..7r 1, llla! Ii!'� ++, =.. t t 1,r�J► ., ; , ! ,,, ; , 1 . ,, .{ j , , P; ., ; , q t ) : (,. , , .,t,a 1111 +t, ,.,{ „1441 /JYill '. tt ' li dq ll l l (l �: 1 !> 1tR E 7� G4+F �1 , 1!�. .1 i J
l ,, I d uf i � t� 1 i I', ,,i�) .� t , , y l ) ! ! i = i� i 1 , ,� . i l l . ; f n „, ,!:.. ).ti A!:lr...,.,1,�.,,1,bill. ,t! {iY� ,,, ', a; { @ • 1 , .h,.t tl il...t :n un:31J: trilk,l+,t !, , t, J ! t ,, ,
lldl; f�ltllll .tilill �nft�lf >� �;�9,Lf14 t 1 ll:lt�, G4 i tr:i ns, ;u9 url C,:t:et.rt a .. •--'n . w`, Please check al that apply (emit 7 sets of plans w /hems checked below):
❑ New c i! • ddition/alteration/r ; r_: o • - t
El Demolition ❑Other: �` Service or ❑ ,,; feeder ❑
400 amps or more Building over three atones.
where the available fault current ❑ Marinas and boatyards.
a•, r, t !t t :aa ; rs ! 'crt u i ; I? J {r ,. '• s . i p ; • { � ' ; j exceeds S0 volts or ❑ Floating g buildings.
I . t ,1 , i , , ; ' ;;u ,, ;n ,•,' i , t + , � Nf. , tt.i ;SiG�! :
=?'t .r r a o :a�l I �• N��3�:' 7 4 � ;' � t : ) l+ ' 'f'r }!J 1 +11 ; rf�i {� } � ��f, 10,000 amps at 1
!i i � ..I 1i! 11..11 iii', 1� ' jl µt . 1 ',1 ' ,! 1!ti. r .s ti.'i I(1 .I ! 71! ii I f I 1+ i'.' .; r t 1 24• �, ,
tat {�t {t'1!1!r, ;,.,G: �`i +# iltil�!I:lir�.i'. �� � , �) : � �• ?:s7rlli. ;aiR.trtill:n ".,5 i•ulc,4l � ��d fti;i: + „l:t:ii1'i.ti 1 {..�;i, ,tl.w i less to ground, or exceeds 14,000 ❑ Commercial-use agrioulWral
.:S;l:UCt.i;::i i 1Y.ta:4tdnit Y
❑ 1- and 2 - family dwelling Q Commercial/industrial ❑ Accessory building amps for all othar installations. buildings,
0 Multi family ❑ Master builder Q Other: ❑Fue pump. ❑ Installation of 75 KVA or
6 i 11 a , { d (t7 i Ipi l ; +J t 1, ❑ l J Pme of syst new e tor load of larger separately derived system.
;•:t• ' r 1 1 118!1.791^' R',:11 Ctrl , T't ;!'i4itR,,.. t "'.'L7 (� ;lam,'• t ,',', 1�''t1 {P4 •
' ! i1 i r, 11 , . l r ti. ^ 'l' 4 , 1 1 e( 7� Ptii :4 1 r I ,� t
(�, �1 t ����IJI� {� p' { l' }! �'l�l l�ii) jv� �) I ^'t . 5 ��1 ;t, i � e.�I i i ;� �d :�' Ir,1. i r ti t w, � i� � t,,tr�' (' f i' +fl' I(! {) r il � ? ihou o 13 . •A ". "l; , 1-Z', "1-3
llIG),!5 1 : to c }:�tf ,!:l viJ,a;tx nla!ii; i) uldii(, } :�?�1:1 ta�ln tan rl.c,uclaitts:n 9!)ta t_, t.t ! n ;J S f. lr.ra: Jtlth't',�.1'I I {i,. i
-R-o IOOHP or more. occupancy.
Job no.: 10 1y 2 Job site address: 10220 SW Gree 11 b ur • ❑ Six or morn residential units. ❑ Recreational vehicle parka.
City/State/ZIP: 1�ortl and OR 1722.
❑ Health -cart facilities, ❑ Supply voltage for more than
�� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: l ' _ ❑ Service or facer 600 amps or more.
} 1TYt 4 r� _ .� 1;114 'P11'•• 'PI' ,1,. "9�111teti ;i 1 t 0'J 11 Ji
I + 1itlri:�J tall+ll�E��a ` rial h;,; >� l >/�.: p iyll..
Cross street/directions to job site: leri •> 0� -
New residential single- or multi -family dwelling unit.
. Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less - 1 168.54 4
Ea. add'l 500 sq. R. or portion 33.92 1
Tax map /parcel n0•: Limited energy, resid 75.00 2
- n,•nnr !rc,•�s r:u•°a•1 u•:c •.. •,nft•C rt'a ;4y1 11'1 t7 ;tr ;4 "�lii1° •I �,...[h eb0 aSQ. tt,)
dry�{'{
)t ;
( .. + i ' ,Ei i'i�
{ ;.�j t��"�ji�ly' ;f ;'1'F'�tli {{ { ;ftl�trt 'vi.lrtt�! .ot t �i`! F:,If �� i I {�;i } il t1 t )i v _ .
��IM1' Ii�Ul6! llli,: isi); ��t: 1, lli4iit},{,; fi, �l]' �I���s±xr,:° leu4,+ lnit�flip�nJ; riutl? I; I:. m:',, 1. �jt`, ElL�iflt�l.,; is. 1. �11� :1'tiJ.�.�,l,l:�i�lili.l,, ;l� , iitt:, Limited energy, multi - family
- t r Cable— residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
I,uly: u:nc ' tt rr�. 7r1" r r 9 rut ( 1'ry
�,��, IJ ; ryi : {•::"{•r,r ili;:'itrl; �t irMildf�": tnirp(t P I % ii ! i3.` +` if )jy „i {f %;;L� i r i -,1' 1 (' }f y(� ` i ;1 ) i� 201 amps to 400 amps 133.56 2
sf�S6lI { ')','!0' },1ii4,,1 ^ ^ t ^2, 11 i 1 + 1 ' J t a /1't i � ,) ,,i !` �,� E ! :ill 1 r ;l ;�ile ). ° v., , �tht ,1.11,,11, 4)l!f'L i c' 1 �11,�1� —
1 1 ! . s,,.r„ 1 ,...ct,t nlri . ells, . .i ltft{L.n.tl,,., �0i1f ,., sh, 1 t + 1• I• 401 amps to 600 amps 200.34 2
Name: ►n/letri A. � - 601 amps to 1,000 amps 301.04 2
Address: 10120 v‘) G[ een ». (. 1:701 over 1,000 amps or volts 552.27 ( 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP _ �' relocation _
Phone: ( ) Fax: ( ) 200 amps or lass l 59.36 1
201 amps to 400 amps 125.08 1 2
Owner installation: This installation is being made on property that I 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 - nets, alteration, or extension, r panel
Owner signature: Date: A. Pee for branch circuits with
'rr -. all ! its —'�'. ' rail + i:lJ1' % %Y:+ 7 :. t' rt' 1`4 ' ;!•paar"t .9, ;:J�-�•r• ram;ro, :gr;1J; 1i''q ,1 A7+'t t nbOVe service or feeder fee, 7.42 2
fl ?l, ,;t .,t; l ! �I'•'' ;t j. 1. � 1 ',,'r, , (;, fI .'i .l, ,, .t.it1
f � li1!rig ES t l � �lt'itJi,) 'ill }.�,q4 l gni 1! 1 1 N ,,:c'J+;v. �'t� i(=1. • ll l ii�j
,�fil6' nit- 8c ;lr„ Ica, 1. llln. 1. l.. r' il�; hl] l�adl: ht4� 1a4{ il�ncn. i; f7( �. c(. nr.. � 11 1 fa(+ ; ;fi:�UYnI:JI�iLl+hl ea branchCi f
Business name: 13, Fcc for branch circuits without
service or feeder fee, first 56.1 2
Contact name: branch circuit
each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: dwelling. service and/or feeder _
Phone: ( ) Fax: : ( ) Reconnect only 67,84 2
Pump or irrigation circle 67,84 2
E -mail: • Signor outline lighting 67.84 2
I':., , t:�11J +: Yi I Tl' + `]'1).- ,•.t.:l,uf ;,�r 1l.t.r 'I ,rT �:1 tut
' r rt c;1'• ) 9f f t r It ;, 1 ! j 1 IIt + "Itr'! tlpir,',*r1 " j ,
�1 'II I ;)'i; �Ntt! 1 p P .i" l ' i 1�{ ,i �If i f �I't�'FeFe i'#.W�� . J tIifig,L t:1i1;�! ` .l, t� I�(j Eifti: } �4,�h 4 ltill�Jf i l � S crcut or lintitad -en
'�� { .,!..1 celiill�i l t r • ;. Ue...liil ! ,! 1 i, i tv., ii.n a5t.t:K,t1(:Y, , ; f,. ,, t f''.; , ' '.i • �' Signal (s ) era
Business name: panel, alteration, or extension. Page 2 2
OL _ NC • Each additional inspection over allowab its an oldie above
Address: - P0 (r ��^ � T✓'
I �5) Additional inspection (1 hr min) I 66.25/ hr
Investigation (1 hr min) 66,25/ hr
City/State/ZIP: r ~f Ot�l O q � , t 1 Industrial plant (1 hr min) 78.18/ hr
Phone: 3 ) `'ft� . Z Q() Fax: 6�3) ` 7 - 2a 22. inspections for which no fee is 90 00/ lir
11 specified listed %:hrmin)
lipl �6l Suprv. Lic.: E : �'` („ I„ y 1 , .,,:,.
CCB Lic.: Electrical Lie.: CLE IO p • �3� Z L i{I ?111$�fiR11'!k•1!�'dyf�`E . iil� .���:�l, ; ;j��`� ;.�';"i�lf:� }:i� = `'� + "�:'i:��MEMIIiiINV
Subtotal: °)
Suprv. Electrician signature required: PC)
TOTAL PERMIT FEE: _ plan review (25% of ponnit fee): - &'
Print name: Date: 11 State surcharge (12% of pclmit ft e): `r
.2. iD
`�' �q ix)
Auth0ii2ed Slgroaturc: r r� This permit application expires if a permit is not obtained within 180
«� days after it has been accepted as complete. C P'
Print name: �,{ �j h ig , Date: I/ " G pit) • Number of inspections allowed per permit.
I1B uitdiesn 'ermhBN31.C- PermitApp.doe 07/e1/70 440 4615T(11/05/COM/WEB
NOV. 3.2010 3:39PM 503 608 - 7198 NO. 0783 P. 2
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
' �i ! � '1 • �''`�i}1 i r t t ,li' ; ',j,?�:jV {;i�fl:i�.;ti t
i);'i, �!!rtiYjt+,
I:, ,t, F +� i t Yr I t i 1' 1 tl ! A ,,, '� � 1 t t 1. 4 t«
rx d,..�.�,. }h.�i � f . �.r. a r_.,;1� . �t t l... a.�d...,L.,. IJ..:.,,r.�1.� f� 16)f�
Fee for ji 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;
r t - .. t r . a;, •:' i { i!! Part 4 1i 1; , ' y 1 ' 1, •';
! �i�,tf1I��,IIt ffII i b U iii 1 IJ :E � {I[� �: i�t' SdUiS?{,!. f:' dLL: C: laiililA� {� {�L';I� }��ilfu(`r VI
.;Itn. ,rt r,Ifsu a:rt s h 1.. -!_ !r' t . -,en
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 Signing
❑ Other
Total numbcr of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1 \BuamnglPCmulu\kLC- PQmitApp.doc 07/01/10