Permit CITY OF TIGARD ELECTRICAL RESTRICTED ENERGY PERMIT
' , COMMUNITY DEVELOPMENT Permit #: ELR2011 -00159
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/30/2011
Parcel: 1 S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD
Project: Four Lincoln Subdivision: LINCOLN BUILDING Lot: 0
Project Description: Low voltage for fire alarm.
Contractor: ADVANTAGE PROTECTION INC Owner: LINCOLN CENTER LLC
8510 -C EAST MILL PLAIN BLVD BY SHORENSTEIN PROPERTIES LLC
VANCOUVER, WA 98664 555 CALIFORNIA ST 49TH FL
SAN FRANCISCO, CA 94104
PHONE: 360- 695 -5072 PHONE:
FAX: 360- 696 -2901
FEES
Description Date Amount
Specifics: Restricted Energy Permit 06/29/2011 $75.00
12% State Surcharge - Electrical 06/29/2011 $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: N Fire Alarm: Y
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 thr R 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 5 . .1987 or 1.800.332.2344.
Issued By: Me (`"''' `- Permittee Signature: e fi1��5 ew 7 !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 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.
From: Andrea Rice 06/29/2011 11:20 f211 P.010/013
Electrical Permit Application V ia' i oR olni;ICI: USIA ON L\
(Q City of Tigard r � \ Received M�% 0�
I v 131 SW Hall Blvd., Tigard, OR `!+ 0 , to Date/B : i _ Permit No:: f � �(/ ��
C Phone: 503.718.2439 Fax: 503.5", '60 \``\\v V n ,RQ s ::- : Other Permit: f �_ / 7
T' t r., 4 li l's Inspection Line: 503.639.4175 Jv �\ �l� \:. ' ru • 63 See Page 2 for
Internet: www.tigard - or.gov
■ 6 _ • \1 \- S Supplemental information
}s ,"L I A0Silt 4 Mt. 1 Y"- r � r , .a' ' x,'A , q;, r. 7:,...,... . s' . 4* .�N {,�e aR al "`
ID 1 Please check all that apply (submit a sets of plans w /items checked below):
New construction e Addition/alteratio «• ant
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
r w p,: a F : ' ,� z , .
.W., . a a .� , a ; ° . a � * ss Le �, 4 exceeds round, 10,000
or exceeds 14,000 ❑ Commercial agricultural
❑ 1 - amps at 150 volts or ❑ Floating buildings.
• ` � '��` , �� �" less to ground, and 2- family dwelling ® Commercial/industrial ❑ Access9ry building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
rid 4 p er ,: --� [] Emergency system. larger separately derived system.
� � � �� e ,�,��� �,� � � ^z � ;� ,,,, .-4f., ❑ Addition of new motor load of ❑ «.4 °E••, •<I.2••, ••I.3•
or o
Job no.: Job site address: 10250 SW Greenburg Road Si . or more. occupancy.
❑ S or more residential units. ❑ Recreational vehicle parks.
City / State/Z1P: Tigard, OR, 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: 4Lincoln'.` ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description &);I:1 ? q
Qty. Yee. Total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. It. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
-* tks� ran „ - ar , ray"" s e s �� `�1.K :j W (with above aq. di) 75.00 2
Limited energy, multi- family
Fire radio installation to existing equipment residential (with above sq. ft) 75'00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 ' 2
XM
F ; t 7, �a ` IVI P '` r 47 ,' � g � `., ° 7 i s; ' 201 amps to 400 amps 133.56 2
Name: Lincoln Center LLC 401 amps to 600 stops 200.34 2
.. 601 amps to 1,000 amps 301.04 2
Address: 555 California St 40 FL Over 1,000 amps or volts 552.26 2
City/State/ZIP: San Francisco, CA, 94104 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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
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 extension, er panel
Owner signature: Date: A. Fee for branch circuits with
.�.� )±? .w> a a t= 'e d 111` i ;� 8 'x - 1 ' ,-. t �3 ` c above service or feeder fee, 7.42 2
each branch circuit
Business name: Advantage Protection, Inc, B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Jason Keller branch circuit
Each add'l branch circuit 7.42 2
Address: 8510 - East Mill Plain Blvd Miscellaneous (service or feeder not included)
City /State/ZIP: Vancouver, WA, 98664 d
Each mg service and/or or r modular 67.84 2
dwelling, serviceand /or feeder
Phone: (360) 695 - 5072 I Fax: : (360) 696 - 2901 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail jasonkeller@advproinc coin
1 m <Ap Sign or outline lighting 67.84 2
4?- TMI Sisal cirouit(s) or limited- energy
Business name: Advantage Protection, Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 8510 - East Mill Plain Blvd Additional inspection (1 hr min) 66.25/ hr
City/State/Z1P: Vancouver, WA, 98664 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone; (360) 695 - 5072 I Fax: (360) 696 - 2901 Inspections for which no fee is
specificall listed ('A hr min) 90.00/ hr
CCB Lic.: 114312 I Electrical Lic.: 37 -672CL E ` Suprv. Lic.: 3217LEA ,, ;; L,c n "c • ti ': ;,; ?a , ii � ^`F
.. Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: 1' `"" 7 ( , s S . r j
/7 ,(1
Date: 6. 102q / J State surcharge (12% of permit fee):
TOTAL PERMIT FEE:
Authorized signature: �!
This permit application expires if a permit Is not obtained within 180
s /„. inspections days after It has been accepted as complete.
Print name: ¢l$E9f V� L A, 8 `� , /� Date: 6 y per • Number of allowed er P ermit
I:\ Bui ldinglPamits\ffi.C•PamitApp.doc 07/01 /10 440.4615T(11/05 /COM/WEB
I
From: Andrea Rice 06/29/2011 11:21 #211 P.011/013
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
TWOJ :° ., ®' - ,
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 Systems'
❑ Vacuum Systems*
❑ Other:
Gask. �'�7F �:. fi F, ':C,. Py 'y F R t 3, �°xv M F
.u"56 ... / 7^ �; �^ ��::arG�����.`'�'t^�'��uR`^. �.�v"`-'.�'3"�i'as.:
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
Total number of commercial systems: 1
*No licenses are required. Licenses are required
for all other installations
1aivaamg Parma, \ELC-rermitApp dog 07/01/10