Permit •
� � CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
° "II COMMUNITY DEVELOPMENT Permit #: ELR2011 -00021
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2011
Parcel: 1S135AB03400
Jurisdiction: Tigard
Site address: 10260 SW GREENBURG RD 380
Project: North Pacific Group Subdivision: LINCOLN TOWER Lot: 0
Project Description: Data telecommunications system.
Contractor: STONER ELECTRIC Owner: LINCOLN CENTER LLC
1904 SE OCHOCO BY SHORENSTEIN PROPERTIES LLC
MILWAUKIE, OR 97222 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 503 - 462 -6500 PHONE:
FAX: 503 - 659 -4968
FEES
Description Date Amount
Specifics: Restricted Energy Permit 01/26/2011 $75.00
12% State Surcharge - Electrical 01/26/2011 $9.00
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
Intercom /Paging: N Landscape /Irrigation: N
Landscape Lighting: N Medical: N
Nurse Calls: N Protective Signal: N
Security Alarm: N Other: N Total $84.00
Other Desc: Required Items and Reports (Conditions)
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 -0090. You may obtain a cop of .lae- rules, oor direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B i /" «� G �"� Permittee Signature: C- /t /i�s�✓!�
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 the next available inspection date.
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.
J a n . 2 5 . 2 0 1 1 1: 5 9 P M S t o n e r E l e c t r i c G r o u p o . 6 4 1 1 P. 1
Electrical Permit Applica .
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- CETVE
City of Tigard Received ' /WM
DATA/171 : Es Permit No.: '-' . 1 _.. 0 , , /
, ,.... q 13125 SW Hall Blvd., Tigard, OR 9FR 9 c , ni 4 Plan R w _
evie
1 111 11
Phone. 503,639.4171 Fax 503.5M960 " " I. 1 111 Dateth : Other Perddt:
TIGARD Inspection Line! 503.639A175 Date Ready/By: 5 See Page 2 for
Internet: VAVW.ligard-Or.g0V CITY OF TIGARD NQiir.dimed.4: MI Supplemental Information
,' INi' ' .' 7 g. = :■ '; ': . '. . . . .::„.. .. . i"-:',1: --- . ,:.. '.': ,•'... ‘:: •: - :.:11:i.40.0.01ME1 :;•:-. .-
111 New construction
ki,kddition/alteration/replaccment Please Cheek all that apply (submit 2 ari Orphill5w/irerns checked below):
D Service or feeder 400 amps or more 0 Building over three Stories.
Ej Demolition ID Other: where the available fault current 1=1 Marinas end boatyards.
- '' ': '..:' ': exceeds 10 000 am a at 150 volts or 0 Plowing huitd,
loss to ground, or exceeds 14,000 0 Commercial opnallaMil
pi- and 2-family dwelling kCommereial/industrial 0 Accessory building amps for all other installations, buildings. .
Ei Multi-family 0 Master builder ID Other: ID Fire pump. I=1 instellogon of 75 KVA Ar
. „ 0 Emergency system. larger separately derived system
V ' .' ' •• :, ' i'" El Addition ofnew motocload of 0 'A", ”E", ''12" - 1 - 3 - ,
, . .. .. ,. ,, ..... „_
100H P or more. Actupancy.
Job no.: /7_y6, 4 Job Site address: I 02-460 5 G Res-lava& FbA i::. ['six or Mtge residential units. Ulketrealinnal velniale parks.
0 eath-care factes. 1:1 Supply vcd(Age for morn
CityCity/State/ZIP Fcrl 0 te 972 z-.3 n Hazardous localions. 600 yobs Amine]. than
Ini 1 ldglapt. no.: 3 8 Project name: ACE -7 620,4, El Service or feeder 600 amps or MORI.
7 ffgaZI : ft4V:: ;":::.7 'I r EE. ChEPP %..
Cross StreetidirectiOnS to job site; Description I gtr- I fee- I Total j *
New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. 11_ or less 168.54 4
Subdivision: Lot no.:
— Fe. odd'I 500 sq, R. or portion 33.92 I
Tax map/parcel nO.: Limited energy, residential
75.00 2
rAt-W,WiltegQig•:.:: .. OP Yvollic . : • ..' . .::':,:jiT':?fingM,. (with above sq. [1)
Limited energy, multi-family 75.0o 2
\ (C■
4 /0 P" cA-t-i A-re. residential (with above sq. ft.)
. Of reloca
Services or feeders Instaliallonolteralion, and/ I ri on
200 amps or less 100.70 2
' 201 tun to 400 sin
.RNigiatAFIPM;; . : , ' • .. . D TENAN :'00 :,...t. P Ps 133.56 2
401 amps to 600 amps 200.34 2
Nome;
601 amps io 1,000 amps 301.04 2
Address: Over 1,000 amps or volis 552.26 2
._.,..—.
Temporary services or feeders ihStAlla lion, alteration and/or
City/State/ZIP:
relocation
r
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125,08 2
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 - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
''---:::•:'•!'.' : ':',:i:: ''': -;: ti.=',.6*±A PERSON :: ..' .:;I:
.. . - 7.42 2 above service or feeder fee,
each branch circuit
1311SineSS name; B. Fee for branch circuits irithoia
service or feeder fee, first
6
Contact name: branch circuit 5 .18 2
- Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
—
Each manufactured or modular
City/State/ZIP: dwelling. service and/or feeder 67.84 2
Phone: ( ) Pax: : ( ) Reconnect only 67,84 2
— Pump or irrigation circle 67.84 2
E-mail:
,_ , •. _,,,, Sign or outline lighting _ 67.84 2
O. fg•-q 0 w • • •i Signal circuit(s) or limiled
3.6
Business name: STONER ELECTRIC, INC. panel, alterai ion, or extension. 2
Ench nddllionn1 Inapectl on over allowable In any or the above
Address; 1904 SE OCHOCO Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66,25/ hr
CilY/Stale/ZIP: MILWAUKIE, OR 97222 Industrial plant (1 he rnia) 78.18/ hr
Phone: ( 503) — Fax: ( 503) 659-4968 Inspeciions for 41Nne ft is
00.00/ he
specifically listed (Vi, hr min)
CCB Lie.: 44823 Electrical Lie.: 26-122C Suprv. Lie.: 3496S • EtEctidatalliatIlf. :.: •
Subtotal; s t° 6 - i 0'
Suprv. Electrician signature, reqUired: p'1 ilL........ Plan review (25% of permit fee):
Print name: MICHAEL FALCONER Date: it-7_54 State surcharge (12% of permit fee): 9, 0 0
TOTAL PERMIT FRC: 84 . Do
Authorized signature:
This permit application expires It o permit Is not obtained within 180
days after it has been accepted as coni
Print name: . • * NAmber A riAspeclicms allowed pee perudi.
L1Duilding1PermittlELC-PermiiApp.doC 07/01/10 440-16151(1 OA/MAYO
Jan. 25. 2011 1: 59PM Stoner Electric Group No. 6411 P. 2
•
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
=- 1 - DgNTIAL WWORK:ONL , .
Fee for a 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:
F COMMERCIAL WO1tK ONLY; 1
Fee for each commercial $75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved;
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
Data Telecommunication Installation
�❑
Pile Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems: I
'No licenses are required. Licenses are required
for all other installations
t:l ui [ding'Pennil.OELC•Penni1App.doe 07 /01/10