Permit 1 f rf CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
11 1 COMMUNITY DEVELOPMENT Permit #: ELR2011 -00097
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718,2439 Date Issued: 05/03/2011
Parcel: 1 S 135AB01003
Jurisdiction: TIGARD
Site address: 10300 SW GREENBURG RD 450
Project: CU Homes Subdivision: ASHBROOK FARM Lot: PTS 1, 2
Project Description: (1) data telecommunications
Contractor: CHRISTENSON ELECTRIC INC Owner: LINCOLN CENTER LLC
111 SW COLUMBIA ST BY SHORENSTEIN PROPERTIES LLC
STE 480 555 CALIFORNIA ST 49TH FL
PORTLAND, OR 97201 SAN FRANCISCO, CA 94104
PHONE: 503 -419 -3300 PHONE:
FAX: 503 - 419 -3695
FEES
Description Date Amount
Specifics: Restricted Energy Permit 05/03/2011 $75.00
12% State Surcharge - Electrical 05/03/2011 $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 copy of the rules or direct questions to OUNC by calling 503.2 .1 1987 or 1.800.332.2344. J
Issued By: - 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 603.639.4175 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.
MAY -02 -2011 MON 01:43 PM CHRISTENSON ELECTRIC, INC FAX NO, 95034193695 P, 01
Electrical Permit Application RECEIVE F t1R on. C USE ONLY
City of Tigard e/BY -- -' //
MAY Permit No � ao / /_ 0D0?
N.- hA • 13125 SW Hall Blvd., Tigard, OR 97223 3 2 O 11 Plan Review Other Permit:
Phone: 503.639,4171 Fax; 503,598.1960 II Date/By:
•i I (; A It D Inspection Line: 503.639.4175 Date Ready/By; ]urir B1 See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method; Supplemental inform
. , E a WO xi
BUILDING DIVISION.
El New ConslruCtiOn ' ' dition/alteration/replaccm nt Please shark ell that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building ever three stones,
❑ Demolition ,U Other: where the available fault current ❑ Marinas and boatyards.
CAT O OF :CONSTIUJC 1'IQN.. exceeds 10,000 amps at 150 voila or ❑ Floating buildings.
less to g ro, ,,d, or exceeds 14.000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling ommercial Industrial (] Accessory building amps for all other installations. buildings.
D Multi-family �
tacit. y I °' builder ❑ Other: ❑ Fire pomp. ❑ Installation of75 KVA or
L_t Master ..2 ' ' 0 Emergency system. larger separately derived system.
TOli SITE INI, O1tMA AND LOCATION! • ['Addition of new motor load of ❑ ' - A ", "E", "1 -2 ", "1 -3»
^ �� - loollP or morn. occupancy.
Job no.: 6 62 Job site address: �y O /
l �� ,� • �C�� �V� _ 1AiY�1 I ' O Six or more residential units. ❑ Recreational vehicle parks.
C i 'v r ❑ 1laaltlt -taro facilities ❑ Supply voltage for more than
City /S1 ate / /_l P:
+ ► 7� r ❑Hnznrdous locations. 600 volts nominal.
Suite /bldg. /npt.no,: Project name: LA •0 C, ❑ Scrviceorfeeder600rmpsor morc. •
/'+. W • , TEE ;SCHEDULE .
Cross street/directions to job site: I � � �r1 ��� C - r 3fl f, necc et . J On'. I Fa: I ' rntnl I
lV 1 F1 New residential single- or multi - family dwelling unit.
_- I ', - �j Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less _ 168.54 4
. - --- Ea, acid'1500 sq. It. or portion 33.92 1
Tax map /parcel no.: _ ' Limited energy, residential
-- �-- ----.-
• Dii SCRIPTION OP WORK with above sq. ft.)
7s.00 2
M1 . 001 t -'-� -- Limited energy, multi - family 75,00
ra C1 �c'� ..L� -. L V), s' 'b residenti l (with above sq. 11.1 _ 6 r� Services or feeders installation, altetion, and /or relocation 2
0 �! ;�� \ - ' ' -# 200 amps or less 100.70 2
1 �❑ PROPERTY .0 ' ER TENANT ' 201 amps to 400 amps 133,56 2
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 552.26 2
Cil IStaie /'l..iP: - Temporary services or fccdcra installation, alteration, and /or
Y relocation
_
Phone: ( ) Fax; ( ) 200 amps or less - 59.36 1
201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps _ 168 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. -
Branch circuity- new alt or extension, per panel
Owner signature: Date: _ A. Fee for branch circuits with
0 APPLICANT .. 1 1 CONTACT; PER ' . , above service or feeder tee ' 7.42 2
each branch circuit.
Business name: \AL ••• e1 B. Fee for branch circuity witnour
' �.f'; 31 � 4�/ �� service or feeder Fee, First 56,18 2
Contact name: branch circuit
Lttch add'I branch circuit 7,42
Address: NJlscellaneons, or feeder not inctodcd) --
Aach manufactured or modular 67.84 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only _ 67.84
� - Pump or irrigation circle 67,84 ` 2
E -mall: ._.. Sign or outline lighting 67.84 2
_ - • CONTRACTOR 1 .. " Signal circuit(s) or limited - energy
1 > c � t W -� panel, alteration, or extension, Page 2 2
Business nano:
- � k L∎ / l - " .. ,.,_ Each additional inspection over allowable in any of the abov
Address '''c\,_. --.4 .'N ( , , e .k t, C - 0 Additional n pection (1 hr loin) „ 66.25/ hr M.
Ci /Stale /ZTP: - -1 ', q
• investigation (I hr min) 66,25/ ltr
} 1 ✓. ,,.,,_ •t ` " -1 � l l � Industrialplant(1 hr min) 76.is /hr
Phone: 6 - ‘. (, _ ^ ) �c: ` , 2 r Inspections for which no fee is
_ _1 _M 90 / hr
sp listed (h hr m in)
-CB Lie,: E s. n Electrical Li i r'4 n Suprv. Lie .n (` F t l'C'C)tICAL PERMIT 1 l F5
_ t om )
_ •
/ / /� _ Subtotal ,1
Suprv. Electrician signa ur , required: • /6
Pt' I . ! „ ., / Plan review (25% ol'permit fee)'.
Print name: _7)---e/(k., ..,:::V idle ~ '
.. State surcharge (12 °1a of permit ice):
TOTAL Pi-RMIT FEE: -,
Authorized signature: ...
This permit npplicallmt expires if a permit is riot obtained within l80
Clays after it has been accepted as complete.
Print name: Dfftc: • Number of inspectimrs allowed or pandit.
I ,rluildinglPcrmirntl 'l. C- Permil App dec 07!011!0 4.1n- n61i'I'(11J45 /COM/WL•a
S nee
MAY -02 -2011 MON 01 :44 PM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P, 02
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL.WORKONLY:
Fee for residential systems combined........ $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
E Garage Door Opener.*
n Fleating, Ventilation and Air Conditioning System*
n Vacuum S
❑ Other:
COMMERCIAL 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
74\ Data Telecommunication installation
❑ Fire Alarm installation
• ❑ 1 -lVAC
n Instrumentation .
❑ Intercom and 'Paging Systems
[] Landscape Irrigation Control*
n Medical
Ti 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
p o Nrpiitnpp. <lut CVO u14